Q&A

the chanGInG

face of MEDICINE

bArbArA I. hELD, M.D.

Specialty: Obstetrics/gynecology Medical School: State University of New York Health Sciences Center at Brooklyn Residency: Columbia Presbyterian Board certified in obstetrics and gynecology

By Emma V. Chambers

FOUR FEMALE PHySICIANS gIVE THEIR VIEWS ON HEALTH CARE, AN AgINg POPULATION AND THE INTERNET

Teacher, mom, model. These were customary responses from young girls in the 50s and 60s when asked the age old question, ‘what do you want to be when you grow up.’ If they ventured into the medical arena, the answer was nurse.

That was then. As women’s career opportunities burgeoned as a result of the women’s movement of the 60s and 70s, so have their choices. Medicine, and physician in particular, is one of the leading career choices for today’s woman. Recently, I sat down with four female physicians on The Methodist Hospital’s medical staff to discuss a variety of topics. These respected clinicians and researchers are but a few of the women who comprise nearly 26 percent of the hospital’s medical staff: obstetrician/ gynecologist Barbara Held, M.D.; cardiologist Karla Kurrelmeyer, M.D.; neurologist Ericka Simpson, M.D.; and gastroenterologist Karen Woods, M.D.

Qyour success

is an example of how women have integrated the medical field. What experiences or lessons would you like to share with up-and- coming female physicians?

karla kurrelmeyer: Two of the most important things for upand-coming female physicians to know are one, that you really need to be organized, and two, you need to learn to delegate. It can be difficult — as far as your family and your profession — but both need to be in place to succeed at work and at home. It’s very important to realize that you can find invaluable help both in the office and at home. karen woods: There’s so

much guilt that goes into being a working mom, particularly when you get called out, even today. You get called out during a baseball game, you get called out during an important event, but you do your best. My kids will both say ‘mom made it for everything that was important. She couldn’t for some stuff, and we understood.’ It’s so important to share with your kids. Let them know that when you’re not there, it’s not because you don’t want to be. It’s because it’s work, and mommy has to go and help somebody who’s very, very sick right now, and really needs me more than you need me right at this very second.

Ericka Simpson: I remember as a medical student, transitioning from sitting in the classroom to rotating on clinical services. I was bright-eyed and bushy-tailed, but I soon felt isolated as a short, little female medical student surrounded by male surgeons, male PAs and nurse practitioners. I was ignored; it was devastating. When I did speak, I was shut down in a very aggressive manner, and I withdrew for about a week. I didn’t feel confident speaking out. I finally shook myself out of it and thought ‘OK, I better be just as outspoken.’ I think young women need to learn up front to not withdraw into the background. Without compromising your professionalism, get used to speaking for yourself on your cases, conferences and in general interaction with colleagues. kk: I appreciate what you said about medical school. That can definitely happen. I found that you’ve got to work harder, be more organized and efficient, and be a good communicator. If you

8,000

7,000

6,000

5,000

FEMALE MEDICAL SChOOL grADUATES

7,412

6,676 6,228

5,231

4,904

4,000

3,000

3,497

2,000

1,706

1,000

391

700 503

0

1962 65 70 75 80 85 90 95 00 05

leadInG The way

1849

Dr. Elizabeth Blackwell becomes the first woman in America to graduate from medical school. Dr. Susan La Flesche Picotte is the first female Native American to obtain a medical degree. 1889

1864

Dr. Rebecca Lee Crumpler becomes the first African-American to become a physician in the United States. Dr. Mary Edwards Walker is the first and only woman ever to receive the Medal of Honor.

1866 1876

Dr. Sarah Ann Hackett Stevenson becomes the first female member of the American Medical Association.

aren’t, you’ll be unhappy at work and at home, and therefore, likely ignored. It’s not blatant. It’s more about being up front. … Voice your opinions. kw: I’ve been on the medical staff here for 20 years. When I first started, there were very few female physicians. I don’t know the percentage now, but it’s much more even. It took two years to build a practice here, which is probably average, but I had to work hard at being visible and at being accessible. If you do your best, always try to do the right thing and give good care, eventually people will send you patients, and you’ll become successful whether you are male or female.

Barbara held: Medicine

is a field with many opportunities for women who want to balance work and home. Of course that depends on the specialty and place of employment. There are fields that are amenable to “practice sharing” — a pediatrician friend of mine practice shares. There’s also the opportunity for self-employment — private practice — in which you are in complete control of your schedule, so that you can design a work day/ week that best accommodates your home life.

KArEN WOODS, M.D.

Specialty: Gastroenterology Medical School: University of Missouri Kansas City Residency: Baylor College of Medicine Gastroenterology Fellowship: University of Texas Southwestern in Dallas Board certified in gastroenterology and internal medicine

Dr. Lillian H. South becomes the first woman to hold the position of vice president in the AMA.

1913 1925

Dr. Florence R. Sabin is the first woman elected to the National Academy of Sciences. Dr. Priscilla White began pioneering research on pregnant women with diabetes. 1930s

kk: Another message to up-andcoming female physicians is that medicine has to be something you have a passion for. If you don’t have a passion for it, and you don’t think you’re doing something for the betterment of society, you won’t want to invest the time or energy that’s required.

Qare there really

people who go through medical school and all the years of training who don’t have a passion for it?

kk: Oh yes, I think some people believe the only talent required to become an excellent physician is an aptitude for science. It also requires hard work, long hours and good people skills. kw: And then they get out in the real world and you know what, this is not an easy profession. You don’t go into this just because you think it’s a good profession, or it’ll make you some good money. You have to have the passion, or else you will burn out quickly. ES: If you have passion, if you really want to help people, and you think this is the best way you can do it, then do it. But if you’re only thinking about becoming a physician because you are good at science, your parents/family desire it for you or solely for monetary gain, it’s not the profession for you. I would encourage those individuals to consider another field.

Timeline images courtesy of: SUNY Upstate Medical University; Drexel University College of Medicine; homeofheros.com; National Library of Medicine; National Library of Medicine; PM Dunn; World-Telegram photo, Library of Congress, Prints & Photographs Division, NYWT&S Collection, [LC-USZ62-131540]; commons.wikimedia.org; nasaimages.org; AstraZeneca; defenseimagery.mil.

QSome of the

provisions of health care reform went into effect recently. How do you think health care reform will affect health care delivery? Will we have a healthier america?

Dr. Dorothy Hansine Anderson is the first person to identify cystic fibrosis and the first American physician to describe it.

1930s

Dr. Janet G. Travell is first female doctor to be the personal physician to a sitting U.S. president. 1990

1950s

Dr. Virginia Apgar founded the field of neonatology and developed the Apgar test to assess the health of newborns. 1961

leadInG The way

kk: It does look like it’s meant to lead to a healthier American population by covering more people who don’t receive health care coverage now, like people with pre-existing conditions. In my field (cardiology), that includes people who have congenital heart disease. I see it over and over again. They have undergone corrective cardiac surgery, but they cannot get health insurance. So in that respect, more people who were not insured before will be insured, but ultimately, there will be a cost to society — since health care reform will also provide more preventive services and more health care to other disadvantaged groups. The most interesting thing will be how our society absorbs that cost. ES: Groups of the population will now have access to health care, but the question is how these reforms will affect the quality of that health care. They’ll have access that they didn’t have before, but it doesn’t mean that what they receive will be quality. Will it be easily accessible, will it be complete? It’s a two-edged sword. I think in some situations it will help, but I’m not clear on if it will lead to a healthier America.

Bh: I think we need to wait and see how the reforms affect the system. Theoretically, more people will have access to care, so we should become a healthier society. With that said, I think that individuals still need to take responsibility for their own health and make healthier choices with respect to diet and exercise. As a gynecologist, I see more and more young women in their early 20s already overweight with an above normal BMI. This, to me, is the root of our health care dilemma. It starts in childhood — poor eating and exercise habits that are epidemic. I hope health care reform will help — giving more children/families access to care for early intervention to prevent obesity later in life. But there also needs to be reform in the home.

KArLA KUrrELMEyEr, M.D.

Specialty: Cardiology Assistant professor of medicine, Weill Cornell Medical College Medical School: University of Minnesota Internship, residency: Washington University Cardiology Fellowship: Baylor College of Medicine Board certified in internal medicine, cardiovascular disease and adult comprehensive echocardiography

Dr. Mae Jemison is the first AfricanAmerican woman to travel in space.

Dr. Antonia Novello is the first woman and first Hispanic to serve as Surgeon General. 1992 1998

Dr. Nancy Dickey is inaugurated as the first female president of the AMA. Dr. Jane E. Henney is the first woman to serve as commissioner of the U.S. Food and Drug Administration. 1998

2001

Dr. Eleanor Mariano is the first woman to serve as the director of the White House Medical Unit.

QWill the influx of

newly insured patients create an issue of supply and demand?

ES: This will be an issue for patients and physicians. Patients may have less time with their physicians. … ‘So I have 10 or 15 minutes with the doctor versus the 20 or 30 minutes I used to have.’

kk: Absolutely, because there’s a fixed number of providers, and you’re right. If you open those gates, there’s going to be more and more people seeking care. It’s an issue that’s going to exist.

kw: This is an example of what happened years ago when HMOs first came about. The reason HMOs disappeared was because the American public couldn’t tolerate asking permission to see a particular specialist and then risk having that access denied. They don’t want to ask permission to see a heart doctor; wait a week for a referral and another three weeks for the appointment. They couldn’t stand for that sort of outside control. Q The most common

causes of death, illness and impairment have been diseases of aging, where research funding is decreasing. What do you think can be done in research and/or practice to overcome these challenges?

kk: That’s a difficult question. I think it’s tied in with the new health care reform. I think in the end, society needs to make choices. The big question is who’s going to decide because we have expensive treatments that allow patients to continue to live on, but those additional years might not necessarily equate to a good quality of life. kw: I think we should focus on end- of-life issues. And we don’t do that very well. We… the public still has a perception that my elderly parent or grandparent, who is 97, incapacitated and has had another stroke should live on, and everything should be done. I don’t think we can globally make decisions just because of age, for certain, but I do think we need to begin doing a better job at educating the public that it’s OK to die. We’re all going to die, and we should die with dignity. We should die with support from the health care system in the right way. ES: My practice is made up of a large number of aged patients with a variety of neurodegenerative disorders. Specifically, I specialize in Lou Gehrig’s disease, and currently, a cure doesn’t exist. We deal with patients who have been on ventilators for years, and those who, along with family, have to face decisions regarding end of life. We’re starting to address these issues long before we get to that level. We can make a greater difference for our patients by engaging them earlier in their disease. Most physicians don’t feel comfortable addressing these issues or don’t know how to approach them.

Bench work has its place when you’re dealing with cultures and cells, but there’s been a big push for translational research, where you take that research and translate it straight to patients. Now there are studies looking at if you begin treatments early, how long can you delay progression and improve patient

ErICKA P. SIMPSON, M.D.

Specialty: Neurology Assistant professor of neurology, Weill Cornell Medical College Codirector, MDA/ALS Research and Clinical Center Director, The Methodist Hospital Neurology Residency Program Medical School: University of Texas Health Science Center, Houston Internship, residency and fellowship: Baylor College of Medicine Board certified in psychiatry and neurology

function and quality of life. That’s where we can make a difference. Maybe that’s worth concentrating on. Shrinking funding is a challenge, so scientists/ investigators are scrambling for funding from private resources and foundations such as the Michael J. Fox Foundation for Parkinson’s.

QWe’ve seen a

proliferation of direct-to-consumer advertising and medical websites pop up in the last few years. patients are self-diagnosing and going to their doctor’s office asking for a specific drug. are you experiencing this in your practice?

kw: I don’t mind it, especially if they’ve been to a reputable website. An educated patient, in my mind, is the best kind of patient to have because they want to be involved in their health care and decision making. You can usually get them to listen to what you have to say and explain to them why what they read about is correct or incorrect in their circumstance. I like to give them educational brochures and references.

kk: I agree. They already know what they should be doing so it becomes a patient/physician relationship, rather than just the doctor telling them what to do. I prefer educated patients. The educated patient is going to be more compliant, and more involved in their health care, and therefore, we’ll be more successful in treating their disease.

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ES: That’s exactly how I feel. I think most doctors want an educated, motivated patient because even if the resource is not reputable, it fosters a conversation between you and the patient. It ensures that you discuss it with your patient. This is always good for the patient’s care. Bh: There is a lot if information on the web, and not all of it is good. With that said, I think the abundance of information is good in that it helps people play a proactive role in their health care. It allows the patient to learn about alternative options for treatment, as well as helps them formulate questions to ask their physician. Advertising can also increase patient awareness of what’s available, but ultimately, it’s the physician’s responsibility to decide on the therapy. I would prefer that drug companies spend those dollars on research or lowering the costs of their products. Q Do you have any

feelings about receiving e-mail from patients?

kw: There’s too much liability associated with it at this point in time. It’s not really set up to handle the volume. We get volumes of calls a day. If all of those started coming to my e-mail, I’d be overwhelmed. I couldn’t handle it.

kk: I receive 200 e-mails a day. It could be devastating if there’s an important one I miss when I quickly scan through them because I don’t have time to go through each one thoroughly every day. I do get e-mails, but I discourage it. I ask patients to call my medical assistant or my nurse so they can triage urgent issues appropriately. Bh: I’m old fashioned. I actually like to talk to patients. I believe it’s critical in the evaluation of a problem. As much as I find e-mail convenient for many things in my practice, dealing with clinical issues is not one of them. I’m sure that will change as technology progresses, but I’m afraid that taking the personal contact out of the physician/patient relationship will weaken it. ES: Most of my patients call. I try to call them back within 12 to 24 hours if it isn’t an emergency. For a few of my long-term, stable patients, I correspond via e-mail to answer general, nonemergent questions. However, my patients are informed that e-mail communication in no way replaces telephone communication, especially in emergent circumstances. n