WHAT WOMEN DON’T KNOW CAN HURT THEM

Women’s health has traditionally been treated like a neglected stepchild in our system. It’s time for a new model.

AFTER MY HUSBAND HAD A HEART attack last year, his doctors advised him to eat a low-fat diet, do some aerobic exercise regularly, and take an aspirin every day. Because my family also has a long history of heart disease, I asked his cardiologist if all these stratagems would be equally beneficial for me.

“Most likely,” was the surprising response. Wasn’t he sure? No, he admitted, because all the tests of the efficacy of aspirin, aerobic exercise, and even a low-fat diet on heart disease prevention had been done on men. As a result, physicians do not really know how effective these measures are for women. This, in spite of the fact that heart disease has been the leading killer of women aged 40 to 65 for most of this century.

In the field of health care as a whole, I soon learned through interviews with doctors and health care specialists, women’s issues have traditionally been relegated to a secondary status. And so began a personal quest: To discover the barriers I face as a woman that prevent me from getting good health care {know thy enemy, plan thy attack). Along the way, I found that 1 was not alone on my journey and that the times, as they say, are at last a’changin’. The forces for change are many. Among them: More women occupy key positions in the health care industry; morewomen are making more health care decisions for themselves and their families than everbefore due to ever-bureaucratic managed care systems; and more women are living postmenopausal fives longer, a fact which has spurred a flurry of research on the topic. In fact, as we approach the next century, women’s health is becoming one of the hottest health issues in our country. And calls for a new paradigm for women’s health care are at last being heard.



A HISTORY OF NEGLECT

FOR CENTURIES, THE BODY OF MEDICAL knowledge on which all parts of the system draw, including women’s health, has been based on the male body, or more specifically, a paradigmatic 154-pound male, the basis for nearly all medical research and treatment. As Leslie Laurence, co-author of Outrageous Practices, The Alarming Truth About How Medicine Treats Women, points out, the effects of this on women’s health care have been demonstrably bad:

Consider these examples:

The Baltimore Longitudinal Study on Aging, one of the largest to examine the process of human aging, included no women in its studies for 20 years because the group’s facilities had only one bathroo

The 1988 study that showed that small doses of aspirin could help prevent heart attacks was based on information collected from 22,000 volunteers-all of them male.

A pilot project at Rockefeller University that tested how obesity affected breast cancer and uterine cancer was conducted solely on male subjects. Laurence underscores the absurdity: “Imagine how the medical community would react to a study of prostate cancer that included only women as research subjects

Laurence is quick to point out that none of this was done maliciously As she puts it, “No one goes into medicine with the intention of providing good health care for men and inferior care for women. But doctors study what they’re interested in, so middle-aged white male doctors study other middle-aged white men.”



WHAT YOU SHOULD BE WORRIED ABOUT

The National Women’s Health Resource Center in Washington, D.C. reports that the leading causes of death in women are:

heart disea

lung, breast, reproductive, or colo-rectal canccer

strok

For postmenopausal women, there’s another major concern: osteoporosis.

After menopause, women lose bone mass six times more rapidly than men, making osteoporosis a major contributor to death and illness. The statistics are bleak: Twenty percent of women will fracture a hip by age 90, and 30 percent of these women will die within three months of the injury, Osteoporosis affects as many as 15 to 20 million women, and the cost of health care for osteoporosis-related fractures is estimated at $7-$10 billion annually. The situation becomes more alarming given the following statistics: women older than 50 are now the fasting-growing segment of the U.S. population, and a full one-third of an average woman’s life will be spent postmenopausal.

All of these risks may be significantly reduced by proper preventive medical care, lifestyle changes, diet, and exercise. With early intervention, the risk factors for heart disease and osteoporosis can be reduced. With regular Pap smears and mammograms, cervical and breast cancer can be detected early enough for treatment to be very effective.

But getting good health care means overcoming some well entrenched barriers, which leads us to….



THE 5 BIGGEST OBSTACLES TO GETTING GOOD HEALTH CARE

1. The “genitalization” of women’s health care. For years, the male medical establishment thought of women s health care only in terms of women’s sexual and reproductive organs. This “genitalization” of women’s health care resulted in the faulty assumption that gynecologists can provide all the care necessary for women. But while Ob-Gyns are highly trained in their specialty, they are not trained to detect heart problems, lung cancer, or many other diseases from which a woman may suffer.

2. Time. When busy women must travel to different physicians in different locations on different days to get the care they need, that creates a significant barrier to good health care, especially for women who must take time off without pay from work or arrange child care. When exam results are delayed and many follow-up visits are required, the inconvenience prevents many women from completing their course of treatment.

3. Managed care systems. Almost everyphysi-cian, both general care physicians and specialists, interviewed for this story mentioned managed health care as a general barrier to good care and a particular thorn in the side of women, who are referred to specialists more often than are men.

This means that such managed-care phenomena as “de-selection” of a physician (when an insurance company, HMO, etc., drops a physician from its list of “approved” physicians) or “capitation” (a system under which a company pays only a limited number of dollars per year per patient) have a disproportionate impact on women. What if your company changes policies and your beloved family physician or your trusted Ob-Gyn isn’t on their list? Well, you’re either out of luck, or out a whole lot of money, because your only choices are to change physicians or to pay your own medical costs. De-selection can wreak havoc on patient-physician relationships-and pose a real problem for a woman with a long-term condition that needs monitoring.



4. The tendency of too many physicians to trivialize women’s health complaints. This can be especially dangerous in the case of heart disease, because women’s heart attack symptoms are not the same as those of men. Instead of the classic “pain radiating down the left arm,” women are more likely to suffer from vague abdominal discomfort, nausea and vomiting, fatigue, shortness of breath, pain in the neck or jaw, pain in the back or shoulders, and arm and/or chest pain. And, because many physicians tend to think of heart disease as a problem mainly for men, chest pain in a woman may be dismissed as indigestion or stress.

5. The tendencies of women to trivialize their own hearth complaints and give them a low priority. For many women, coping with the discomforts of menstrual cramps and child-bearing has taught them that pain is not necessarily a sign of something wrong. When compared to the pain of childbirth, most women experience heart attack pain as relatively minor, which can cause them to ignore symptoms for a long time. Such a delay can be deadly.



A NEW PARADIGM FOR WOMEN’S HEALTH CARE SURELY WE ALL COULD HAVE FIGURED OUT that the way a woman is reared, the food her mother ate during pregnancy, the food she herself eats, the time she spends caring for herself, even the way she thinks about herself- all affect her health. But until recently, the medical establishment did not acknowledge this, much less build it into research models, the way physicians and nurses are trained, or the business philosophies behind the way health care is delivered, Now, increasing numbers of health care providers are weighing the effects of culture as a vital first step in creating a new model for women’s wellness.

And what is that new model? Well, it’s still a work in progress, a fact that became very clear during my conversations with health professionals!!! the Dallas area who are working on designs for new women’s health programs. None were willing to talk on the record about their proposed programs yet, but all were willing to share basic concepts. This is the composite picture that emerged:

Imagine a program designed for women aged40to 60. It would be a one-day program situated in one place, using a holistic approach aimed at caring for the woman’s general physical health and well-being, instead of concentrating on her reproductive organs-although gynecological exams would be part of the program. Women would not go through the entire process alone, They would instead be part of a small group (perhaps co-workers or friends) that would progress through the day together, although each woman would have individual time with physicians. After each private session, women would come together as a group to ask any questions and share any concerns.

Each woman would receive comprehensive screening and education on breasthealth, cancer, heart disease prevention, menopause, osteoporosis, etc., as well as information on general disease prevention, including the design of personal nutrition and exercise programs. Tests aimed at identifying risk factors and early detection of disease would be performed; results would be available the same day whenever possible. Ancillary services would be coordinated to minimize waiting; and any referrals to specialists would be scheduled as soon as possible.

Patient education materials, test results, individualized nutrition and exercise programs, and dates for referral appointments would be gathered into a personal notebook for each woman to take with her. Also included in this notebook would be the names and phone numbers of the professionals with whom she had consulted.

When I described this composite program to a group of about 50pro-fessional women in Dallas, most of whom were in their mid-to-late 40s, every woman in the room not only said she would like such a program, she wanted to know how soon she could get an appointment.

Alas, an actual program like this does not yet exist in the Dallas area. The concept is brand new and the medical establishment has yet to determine how to make such a program work within the demands of managed care. However, physicians agreed such a program might break through some of the traditional barriers to good care. And several people interested in designing women’s health programs said the same impetus to control costs that created managed care also will drive the development of such a program. They are convinced the market is ripe for this idea.

Women interested in a program such as the one described above should contact their employer’s human resources department, their HMOs, physicians, clinics, etc., to ask them if such a program is in the works, and if not, why not? After all, it’s not just a matter of women s health. It’s a matter of the bottom line, A local women’s center has a slogan-“Save a Woman, Save a Family.” ’litis slogan could well read, “Keep a Woman Healthy, Keep a Family Healthy.” Healthy people help keep the cost of health ca re down.

And that’s healthy for us all.

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