Email this page  Print this page  del.icio.us  digg

To Her Health

Photo by Gary Payne

A one-size-fits-all mentality has no place in the doctor’s office. Just ask a number of San Diego physicians answering the call for quality healthcare that caters to the distinct needs of women.

THE TITLE of cardiologist Nieca Goldberg’s book, Women Are Not Small Men, alludes to heart research that focused on men and viewed women as “small men.” She writes, “It is now understood that our physiology is very different from that of men, especially when it comes to heart disease . . . Consequently, to be effective, heart disease prevention and treatment programs for women must be different from those for men.”

Indeed, an increasing number of San Diego physicians are adopting a more targeted approach to women’s healthcare, especially as it relates to preventing and treating cardiovascular disease—the number-one killer of American women. Of all the health concerns that confront women—breast and ovarian cancers, menopause, osteoporosis, obesity, the human papillomavirus epidemic—the most menacing (and often undiagnosed) is cardiovascular disease, encompassing both stroke and heart disease. It claims more lives than the top five forms of cancer combined.

Dr. Denise Barnard leads a local effort to reduce the staggering casualty count: nearly half a million lives annually. Director of the Women’s Cardiovascular Program at the University of California, San Diego Medical Center, she works with a team of female physicians to help women understand, prevent and treat the disease. (More later on the trend of women choosing female doctors.) When approaching a doctor to discuss risk factors or treatment, she encourages women to ask the doctor, “Do you believe heart disease is different in men and women?” The answer, she says, should be an unequivocal yes.

“Women can require different diagnostic tests and treatment,” she says. “And they tend to have different responses to medications than men.” Barnard also identifies a “gender bias,” saying women are less likely to be referred for diagnostic testing and less likely to undergo invasive testing or aggressive early treatment. The first step in sidestepping this bias, she says, is realizing it exists.

Barnard also encourages women to visit the program’s Web site (health.ucsd.edu/specialties/womensheart/) to complete a free risk-factor-assessment questionnaire that can be printed out and discussed with their doctors. “Early risk-factor identification [by women in their 30s-50s] and treatment is the key to heart disease and stroke prevention,” she says. The site also tells women how to reduce their risk through lifestyle changes and, for those already diagnosed, provides tools for managing the disease. “Women need to be their own advocates,” says Barnard.

Dr. Thomas Moore agrees women should take a proactive approach to their health. Chairman of the Department of Reproductive Medicine at UCSD, he splits his time teaching medical students and seeing patients. A specialist in high-risk pregnancy, Moore sees an average of 60 female patients each week.

He encourages women seeking a physician to take a written list of their health concerns to the initial appointment. “That sets the expectation that she has issues she wants to discuss,” he says. “Is the physician interested in going through those concerns one at a time? If the doctor seems too busy to listen or is dismissive, he or she may not be the person you want.” And he says it’s important to know when to walk away. “Don’t be reticent if the relationship isn’t fluid and you need to move on,” he says. “The physician isn’t going to be mad or take retribution if you want to look for another doctor. Like in any relationship, the wrong thing to do is stay if it’s not working.”

Moore has also noticed the growing trend of women choosing female healthcare providers. “They feel more comfortable and can discuss issues more freely; there can sometimes be a better understanding,” he says. Women in San Diego can expect to have an even greater number of options when seeking a female doctor, especially ob/gyns. Moore estimates 90 percent of the medical students in his department are female.

“That trend is pretty locked in,” he says. But he’s also quick to add, “I encourage women not to exclude male providers; there are many superb male healthcare providers for women in San Diego. It’s about going with a physician with whom you feel most comfortable.”

Dr. Yvonne Goff, who practices in obstetrics and gynecology at Sharp Grossmont Hospital, the largest healthcare facility in East County (and known for excellence in women’s healthcare), says the large number of females entering her field of medicine is market-driven.

“If a woman finds a male and a female doctor equally qualified, she’ll likely go with the woman, because it’s more natural talking to another woman about certain issues—incontinence, libido, sexually transmitted diseases—things they would not be as comfortable talking about with a doctor of the opposite gender.”

Dr. Monica Perlman, president and medical director of Perlman Clinic, advises women to seek out a physician who has similar interests or is in the same stage of life, whether married with children, young and single or an avid tennis player. Someone who deals with the same issues that you deal with on a daily basis will probably have better insight into your wellness needs, she says.

ANOTHER PRESCRIPTION for that perfect patient-doctor synergy? The office staff. “A lot of your conversations will take place with the office staff,” says Moore. “Make sure the staff welcomes contact, will communicate pertinent information to the physician or put you directly in touch with the physician— access is very important.” He also says the office staff should be “zealous” in protecting a patient’s privacy and confidentiality. “In what setting are they discussing the patient’s issues? All of us don’t want our health information shared with others.”

Lori Marquez, physician referral service supervisor at UCSD Medical Center, says part of her job is to get people past their preconceived notions about what makes a doctor good or bad. Some people are skittish about seeing a very young doctor, for instance.

“Because we’re a teaching institution, there are some doctors here who are 27 years old,” says Marquez. “But we could make a case for the 27-year-old doctor: If you’re young, you might be more eager and interested and more willing to do research outside of the office for a patient.”

Location is another deceiving factor. “We have doctors in Hillcrest, Scripps Ranch and La Jolla,” says Marquez. “People assume the doctors in La Jolla are going to be better doctors, but geography has nothing to do with it.”

Marquez tells patients to visit doctors’ Web sites to see what kinds of issues are addressed there. For example, alternative medicine is a hot topic right now, and doctors who are open to “complementary therapies”—such as acupuncture, chiropractic treatment and stress management—often say so in their site profiles.

“Another thing I tell people is to find out how long a doctor’s staff has worked there,” says Marquez. “If it’s 10 or 15 years, that means there is good rapport in that office.”

As important as bedside manner is, Perlman encourages anyone looking for a doctor to step outside of that comfort zone for a moment and understand that sometimes doctors have to say things patients don’t want to hear. If you need to lose weight, a responsible doctor will explain the risk factors that come with obesity and then tell you to lay off the Frappuccinos and join a gym. A responsible doctor will tell you to stop smoking, or to stop baking yourself in the sun if your skin has begun to resemble an alligator’s.

“You have to be able to listen to that without taking it personally,” Perlman says. “The doctor isn’t saying these things to hurt your feelings. The doctor is just taking an interest in your health.”

THE GOOD DOCTOR

Resources for finding the right doctor for you

WITHIN THIS ISSUE, you’ll find a listing of the county’s top doctors——as voted by their peers——listed by specialty. The list, compiled by the San Diego Medical Society, is a helpful resource in getting started with your search. Many people start with their insurance provider’s physician directory. Usually, these resources provide basic details such as contact information, gender and schooling——but highlighting a few names that catch your eye is just the first step in your search.

To make sure a doctor has board certification, visit the Web site for the American Board of Medical Specialties (abms.org) or the American Board of Family Medicine (theabfm.org). The state medical board will tell you if a doctor has been disciplined, and for a $10 fee, the Federation of State Medical Boards offers a search of all U.S. records and provides reports on licensing, training and any infractions. This information is extremely good to have. But as one San Diego woman puts it, “Just because a doctor hasn’t done anything bad doesn’t mean they’re a good doctor.”
—JULIA SPALDING

Do you like what you read? Subscribe to San Diego Magazine »