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THE WHOLE PICTURE

Women’s health is about more than gynecology

Reuters/Lucy Nicholson
Women’s health outcomes are getting worse, not better.
Stephanie McClellan
By Stephanie McClellan

MD, Chief medical officer, Tia Clinic

It is nearly 2020, and all around us, the medical world is advancing in new and life-saving ways.

Advances in technology may soon make 3D-printed lungs and livers a reality for the millions in need of replacement organs. We are closer to a cure for Alzheimer’s disease than ever before. Doctors have even learned how to manipulate our immune system to help fight cancer.

But in spite of all this progress, with respect to access, cost, and quality of care, women’s health outcomes are getting worse, not better.

The US healthcare system still views women as “small men” with different reproductive organs. This is absurd, of course, and it is as harmful for women ourselves as it is for the healthcare system as a whole.

In an effort to address this schism in how we as a healthcare system diagnose, treat and—my ultimate north star—prevent disease in women’s health, I joined Tia as chief medical officer—a women’s healthcare platform that builds products, tools, and services for the distinct needs of women and the providers that serve them.

Between 1995 and 2014 we saw a 10% increase in women aged 35 to 54 being hospitalized for heart attacks.

As an experienced OB/GYN, I have seen firsthand how the US healthcare system is failing to keep women healthy. This is in large part because it is comprised of specialists whose expertise lies not in comprehensive or preventative healthcare, but in the singular management or intervention of disease. While cardiologists, urogynecologists, oncologists, and reproductive endocrinologists are profoundly impactful physicians, trained for decades in their respective areas of expertise, they are not comprehensive women’s health providers trained to connect all of the dots that comprise female health in its nuance, complexity and interconnectedness. Nor, for that matter, are most OB/GYNs.

A nation full of specialists has led to a fragmented health system for patients—and for women in particular.

The current system confines women’s health to a body part or a medical specialization, when in reality, “health” as a whole should be the driving force behind women’s healthcare at large. With specialists who are often agnostic to sex, gender, or population-specific differences, we as a collective health system are failing to recognize just how different women’s healthcare is from one-size-fits-all healthcare, designed in large part by the men who have set the prior standard.

Women-focused health centers need to expand beyond gynecological practices, and need to expand to address patient suffering and the rising costs of treating them.

We require a whole-health practice to broaden the collective definition of women’s health and well-being.

Because women’s health is a whole lot more than reproductive wellness or gynecology. And it necessitates a whole lot more than an annual pap smear.

Women’s health is more than gynecology

The numbers don’t lie. Women are twice as likely to be diagnosed with anxiety disorders than men, and depression rates among women are also rising. The same is true for cardiovascular disease among women: Between 1995 and 2014, we’ve seen a 10% increase in women aged 35 to 54 being hospitalized for heart attacks, according to the American Heart Association. Per research published in Obstetrics & Gynecology, the US’s maternal mortality rate remains the highest in the developed world, with a rise from 18.8 to 23.8 deaths per 100,000 births from 2000 to 2014.

Our healthcare system can’t afford a pace of incremental change. American women need substantial reinvention to make women healthier.

It’s up to healthcare thought-leaders—clinicians, administrators, insurance companies, researchers—to lead the charge, with integrity. We have work cut out for us. At Tia and on our care team, our response is threefold:

Integrate treatment

We first need to commit to creating truly integrated, outpatient medical centers that combine primary care, gynecology, nutrition, mental health and evidenced-based wellness modalities, like acupuncture or meditation, into a singular practice model.

Most women visit a primary-care provider and/or an OB/GYN at minimum, and more often than not, an additional specialist, such as a mental-health provider, an endocrinologist, a nutritionist, or a cardiologist—or even all of the above.

Based on the statistics above, more than a multi-specialist practice, women need true collaborative, integrative care. Easier data-sharing between providers is a partial solution, but what women really need is a synthesized analysis and corresponding set of recommendations, derived from specialists actually working together where the synergistic sum is greater than the parts.

Take a pregnant woman with clinical anxiety, a high BMI and a personal history of preterm labor. We know that pregnancy-specific anxiety increases one’s risk of not just preterm labor, but complications throughout pregnancy as well. Intervening with treatments like acupuncture, mental health consultations, and nutrition can have a meaningful impact on the patient. For providers, these tactics can meaningfully reduce the cost of that pregnancy to the system at large.

Invest more in prevention

We as care providers need to move beyond treating disease and instead invest in preventing it. This requires investment in high-quality research—particularly, on the impact that nutrition, sleep and hormones have as potent modulators of the entire brain-body interface.

Polycystic ovary syndrome (PCOS), for example, affects one in 10 women of childbearing age, and in the past, many of these women could not conceive naturally. With advanced reproductive technologies and a better understanding of ovulation induction, that has begun to change. Yet women with PCOS are still labeled as “high-risk” pregnancies. They tend to have high blood pressure and a resistance to insulin, and are also at risk for gestational diabetes, hypertension and other obstetrical complications. Just as patients need better solutions for preventing PCOS in the first place, providers should be held accountable to intervene at the preventative state, too.

End-to-end care

This brings me to our last, but perhaps most compelling suggestion: Our healthcare system has excellent programs for disease-specific interventions and population-specific medical residencies, like geriatrics, but none focused on women’s health end-to-end.

Introducing a women’s health residency in medical school—notably, beyond an OB/GYN specialty—would ensure clinicians are trained to understand women not only anatomically, but functionally across life.

Any effective women’s care program needs to involve sexual and reproductive health, yes, but also immunology, nutrition, mental health, breast care, as well as a deeper understanding of the profound and complicated influences that hormones have on a woman at specific stages of her lifespan.

In fact, it’s because of this hormonal milieu that primary care for women is more complex than it is for men, and therefore merits a care model unto itself.

There is one more human response to our flawed healthcare model, and it is just that: Humans.

Humans are, by nature, social creatures. There is well-documented evidence that community has profound health benefits. This applies to women in particular, as documented in Shelley Taylor’s famed research study, “Tend and Befriend.

In the context of the rushed and time-pressured medical visits patients and care providers all too often experience, the opportunity for nuanced and meaningful dialogue is absent. Too often, the solution is too-simplistic recommendations for immensely complex problems.

What we need is a women’s healthcare model that supports deep relationships between a patient and her provider, and between women in the context of their health and livelihood.

If we can change the model to better meet the needs of patients and providers alike, we can provide women with that community where it matters most: Her entire life.

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