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News
- The Smart Woman's Guide to Health Care
- New guidelines spell out what checks are needed and when
- By Colette Bouchez
HealthDay Reporter
SUNDAY, Dec. 28 (HealthDayNews) -- If you view your obstetrician-gynecologist as your primary-care physician, make certain to let him or her know -- or you may not get all the medical attention you need and deserve.
Some medical experts are concerned that too many women are slipping through the health-care cracks by relying on a specialist as the gatekeeper of their primary and preventive care -- without letting that specialist know they are in charge.
"When, a number of years ago, managed care decided to allow women to see their ob/gyn without a referral from a primary-care doctor, it was supposed to make the act of obtaining reproductive and gynecological care easier," says Dr. Steve Goldstein, a professor of obstetrics and gynecology at New York University Medical Center.
But over time, Goldstein says, this arrangement "morphed" into an unofficial "subspecialty" -- and the ob/gyn became the primary-care doctor, at least in the minds of many women.
"The problem with this concept is that too often women don't tell their ob/gyns that they do consider them as their primary-care physicians. So the doctor continues to believe someone else is in charge," Goldstein says.
Complicating matters a bit further: While most women know what is supposed to take place in terms of exams and screenings at the gynecologist's office, many are less savvy when it comes to general health and preventive care. So they may not even know what primary screenings and evaluations they are missing.
"The woman thinks her gynecologist is providing primary care while her gynecologist thinks an internist is providing primary care. And in reality, no one is doing it," Goldstein adds.
To help close that knowledge gap, the American College of Obstetricians and Gynecologists (ACOG) has just published an updated set of primary and preventive care guidelines, the most comprehensive to date. Reporting in the November issue of Obstetrics and Gynecology, ACOG experts detail exactly what a woman should expect in the way of screenings and preventive care, regardless of who is caring for her.
"We feel it's important that both women and their doctors have a clear understanding of what constitutes primary care -- and the kind of screenings and evaluations every woman should have at various stages of her life, beginning in her teens through her senior years," says Dr. Bryan R. Hecht. He is chairman of the ACOG Committee on Gynecologic Practice, and he helped draft the new guidelines.
However, Hecht adds that what women may really need most is to have a heart-to-heart with their ob/gyn and establish whether he or she will be the one providing that essential primary care.
"It is very important that a woman let her ob/gyn know that she views him or her as the primary-care specialist, in order to ensure that she is getting all the care she needs," Hecht says.
More important, Goldstein says, is to give your doctor the choice about what role he or she feels most comfortable playing in your overall health care, since not all ob/gyns believe they are qualified to act as the mainstay of your health care.
"The truth is, not all ob/gyns feel equally confident about providing primary care, and many are not even really qualified to do so," Goldstein says. "So if your doctor says he or she would prefer that you see an internist for your non-gynecological needs, pay attention, and realize that this suggestion is being made in the best interest of your health."
Regardless of who is providing your primary care, both Goldstein and Hecht say it's still vital to see your gynecologist for a yearly visit -- even if you aren't due for a regular screening, such as a Pap smear.
To help ensure that you get what you need when it comes to gynecological and primary care, the following are highlights of the new recommendations from the ACOG experts:
Ages 19 to 39:
An initial health screening at 19, featuring a complete health history, including your health status; dietary/nutrition assessment; level of physical activity; use of complementary or alternative medicines; tobacco, alcohol or drug use; sexual practices; abuse or neglect; and urinary or fecal incontinence. This screening should then be updated annually.
An annual physical exam, including height, weight, blood pressure, mouth/dental; check of the neck for swelling/thyroid problems; examination of breasts, abdomen, pelvis and skin.
Yearly evaluation and counseling on issues concerning sexual activity; fitness and nutrition (including folic acid and calcium intake); interpersonal and family relationships; domestic violence; work satisfaction and lifestyle stress; cardiovascular risk factors (including family history, cholesterol profiles, obesity, diabetes); personal hygiene; high-risk behaviors, including occupational and recreational hazards; breast self-exams; skin exposure to ultraviolet rays; suicidal thoughts; depressive symptoms; drug or alcohol use.
Laboratory testing should include Pap smear (annually, beginning no later than age 21; after age 30, every two to three years after three consecutive negative tests and no signs of disease); a tetanus booster every 10 years.
High-risk groups (or those with symptoms) may also need: hemoglobin (red blood cell) assessment; bacteriuria testing; mammograms; a fasting blood sugar test; sexually transmitted disease testing; HIV testing; genetic testing/counseling; rubella assessment; tuberculosis skin testing; lipid profiles (for cholesterol); thyroid stimulating hormone testing; hepatitis C testing; colorectal screening; bone density screening.
High-risk groups may also need the following vaccines: Hepatitis A and B, pneumonia, varicella and measles, mumps and rubella.
Ages 40 to 64: All of the above, plus:
Mammography every one to two years beginning at age 40; yearly at age 50.
Lipid (cholesterol) assessment every five years beginning at age 45.
Yearly fecal occult blood testing for colorectal cancer or flexible sigmoidoscopy every five years, or yearly fecal occult blood testing plus sigmoidoscopy every five years, or double contrast barium enema every five years or colonoscopy every 10 years beginning at age 50.
Fasting glucose testing every three years beginning at age 45.
Thyroid stimulating hormone screening every five years beginning at age 50.
Counseling and evaluation on hormone therapy.
Influenza vaccine annually beginning at age 50.
Ages 65 and over: All of the above from both groups, plus:
Yearly urine analysis, mammogram, bone density screening.
Evaluation and counseling on visual acuity, hearing, depression.
More information
For more information on women's health care, visit the National Women's Health Information Center and the National Women's Health Resource Center.
- SOURCES: Steve Goldstein, M.D., professor, obstetrics and gynecology, New York University School of Medicine, New York City; Bryan R. Hecht, M.D., chairman, American College of Obstetricians and Gynecologists' Committee on Gynecologic Practice, professor and chairman, Department of Obstetrics and Gynecology, Northeastern Ohio Universities College of Medicine; ACOG Guidelines For Primary Care' November 2003 Obstetrics and Gynecology
- New guidelines spell out what checks are needed and when.
- Copyright © 2003 ScoutNews, LLC. All rights reserved.
- This is a story from HealthDay, a service of ScoutNews, LLC.
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