Message from the chair: Challenges to patient-physician relationship
Laurie C. Gregg, MD
The patient-physician relationship has evolved over the course of our careers. Thirty years ago, a patient seeking care for menorrhagia might have been offered expectant management or hysterectomy. Today, the treatment options barely fit on the notepaper I hand to the patient. We now partner with patients in shared decision-making, offering many solutions with unique risks and benefits.
Patient-centered care and shared decision-making can increase patient engagement, reduce risk, and improve outcomes. These benefits are highlighted in the ACOG Committee Opinion “Effective Patient-Physician Communication.” Physicians must guard against outside interference, which threatens the quality of care. Some legislators’ intrusions on women’s health have crossed the line.
Recently in the New England Journal of Medicine, ACOG Executive Vice President Hal C. Lawrence III, MD, and leaders from the American College of Physicians, American Academy of Family Physicians, American Academy of Pediatrics, and American College of Surgeons cited more than 700 bills introduced at state and national levels restricting care in the exam room. The article, “Legislative Interference with the Patient-Physician Relationship,” was published in the October 18 issue of the journal.
ACOG Fellows who review these bills see political agendas, rather than evidence-based best practice, driving care for women. When good medical care is threatened, ACOG leadership will strongly advocate for the women affected.
Drawing out postpartum depression
Judy Mikacich, MD, California Maternal Mental Health Collaborative co-chair
In September 2011, physicians, mental health professionals, and women’s health advocates came together for the first time to discuss awareness of and care for perinatal mood and anxiety disorders (PMAD.) Founded and led by Joy Burkhard, MBA, a member of the Junior League of Los Angeles, the group refers to itself as the California Maternal Mental Health Collaborative. The collaborative’s mission is to bring stakeholders together to exchange ideas and form relationships to increase and improve maternal mental health awareness, diagnosis, and treatment.
Research suggests that 10%–20% of women will suffer from perinatal depression or anxiety, 3% will suffer from post-traumatic stress disorder as a result of delivery, and 0.2% will suffer from postpartum psychosis. Untreated, these disorders can have devastating consequences on the mother, her baby, and her family.
The collaborative hosts one-day forums where leaders, politicians, advocates, and researchers from across the US gather and share their ideas at panel discussions and problem-solving luncheons. Our first forum was convened at the State Capitol in Sacramento in May, which is Perinatal Depression Awareness Month in California.
At this meeting, the collaborative connected Magellan, a behavioral health insurance company, and two well-known psychologists. Together they identified certified PMAD training programs for Magellan’s providers. A credentialing program will commence in early 2013 and will be a model for other insurers. It will make it easier for women and referring physicians to find qualified providers and better care.
Hanging posters or placing fliers in ob-gyn offices with information on postpartum depression is a great way to help women find support and let them know they are not alone.
On Thursday, January 24, 2013, the collaborative will host a panel discussion and luncheon in Los Angeles, featuring psychiatrist Laura Miller, MD, and other prominent stakeholders. I invite all District IX members to join us. View program and registration information.
To improve public awareness, the collaborative partnered with Postpartum Support International (PSI). PSI staffs a nationwide volunteer hotline for troubled families. With the help of the collaborative, PSI has developed marketing materials for doctors’ offices. These materials (such as the poster featured below) can be ordered or downloaded free of charge on the California Maternal Mental Health Collaborative website.
Legislative victories for women’s health
Laura L. Sirott, MD, District IX secretary and Committee on State Legislation chair, and Shannon Smith-Crowley, JD, MHA, District IX director of government relations
The 2011–12 legislative session was another successful one for ob-gyns and women’s health. The high percentage of bills we supported that passed the Legislature and were signed by the governor was remarkable given California’s ongoing budget crisis.
Critical women’s health bills are summarized below. Click on the featured links to learn more.
Senate Bill 1538—Mammograms and breast density
District IX and the California Medical Association (CMA) helped modify this bill, which requires women to be notified if their mammogram shows they have highly dense breasts. The bill will be implemented on April 1, 2013. District IX and the American College of Radiology plan to develop materials to assist you in discussing breast density and breast cancer screening with your patients. Click on the above link to access a brochure from the American College of Radiology.
Assembly Bill 2348—Registered nurses and dispensation of drugs
District IX supported this bill allowing registered nurses under physician supervision to dispense certain hormonal contraceptives. Patients who receive these contraceptives are required to have ongoing medical care consistent with national guidelines.
Assembly Bill 2356—Tissue donation
This bill states that single women and lesbian couples attempting self-insemination at home with a donor should be treated the same as a “sexually intimate couple.” Therefore, they should be able to use fresh, non-quarantined sperm. Read additional analysis of this bill.
Senate Resolution 65—Women in pain
This resolution encourages increased awareness and activity to improve the quality of life of women in pain. The CMA Foundation is planning on adding this issue to its existing required CME course.
Three more bills of note are: Assembly Bill 2530—Inmates in Labor; Assembly Bill 1640—CalWORKs benefits and pregnant mothers; and Assembly Bill 1731—Newborn screening program for congenital heart disease.
Remember, District IX advocates for women to regulatory agencies such as Medi-Cal and the California Board of Pharmacy as well. To stay up to date on the District IX legislative agenda, use our legislative tracking system and “like” the District IX Facebook page.
Adoption 101 for ob-gyns
John P. McHugh, MD, District IX newsletter editor and Section 7 chair
As an ob-gyn, patients come to you for advice on pregnancy, childbirth, and fertility. Your training enables you to assist with the medical aspects of care, but it may leave you unprepared to advise patients considering adoption.
Our 5,000 District IX Fellows play a critical role in helping every woman obtain the information and support she needs. California ob-gyns counsel a tremendous number of women and couples on options for both unplanned pregnancy and infertility. As the largest state in the US, California also has the largest number of in-state adoptions in the nation.
ACOG can help you be more open and prepared to counsel patients on their concerns. Its updated Committee Opinion “Adoption” provides you with recommendations regarding your role in the process.
A few key highlights are:
- Physicians should provide information on adoption to appropriate patients
- Physicians need to inform women in a balanced manner of all reproductive options
- Physicians should be aware of local resources for adoption
- Physicians caring for women in labor who are relinquishing their child for adoption should be aware of and supportive of the difficult emotional situation for the birth mother. The physician’s duty is to the birth mother, not the adoptive parents
- Physicians must not serve as brokers between birth mothers and adoptive parents but should refer all cases to adoption agencies
If you’d like to learn more:
Ob-GynPAC needs your support
This year, ACOG’s federal political action committee, Ob-GynPAC, raised nearly $1 million from ob-gyns across the country. The PAC supports candidates who support ACOG’s legislative priorities. To continue to advocate for you and your patients and to reach its million-dollar goal, the PAC needs 100% support from District IX Fellows. Learn more and donate today. (You will not be favored or disadvantaged by reason of the amount of your contribution or a decision not to contribute. Contributions from foreign nationals are not permitted.)
Get covered California! An update on the Affordable Care Act
Up to 2 million Californians will be able to purchase health insurance through the exchange created by the Affordable Care Act in 2014 and 2015. In addition, the 3 million Californians currently covered under Medi-Cal will be enrolled in this exchange. Learn more.
Medi-Cal requiring physicians to re-enroll in January
California physicians will soon be asked to re-enroll in Medi-Cal as one of the provisions of the Affordable Care Act. Notices will be sent to business locations on file beginning the second week of January 2013. When you receive a notice, please complete the required documents within 35 days to ensure timely reimbursement. Learn more.