HIV Screening Should Be Routine
Posted on December 5, 2013
This past Sunday marked World AIDS Day. The truth is every day is a good day for us to encourage our patients to know their HIV status and to educate women on ways to reduce their risk of infection.
Some facts: According to the Centers for Disease Control and Prevention, women account for 20% of all new HIV infections each year. Most women with HIV (84%) are infected through heterosexual sex. The remaining women acquire HIV through intravenous drug use. Of the more than 1.1 million Americans living with HIV today, almost 24% of them are women. Unfortunately, women of color, particularly African-American women, continue to be disproportionately impacted by HIV and AIDS. Even though black women make up only 13% of the total US population, they account for 64% of all new infections each year.
A few years ago, many physicians probably screened patients for HIV only if they were high risk, were pregnant, or requested the test. Today, I believe that is changing. ACOG’s guidelines issued in 2008 recommend that ob-gyns routinely screen all our patients between the ages of 19 and 64 for HIV, regardless of their individual risk factors. Sexually active women younger than age 19 and women older than 64 who have had multiple partners in recent years should also be tested.
A lot of progress has been made in the fight against HIV/AIDS, but we haven’t won the war yet. Approximately one-quarter of Americans who have HIV don’t know it. The best defense our patients have is knowing their HIV status. Women who know that they are HIV-positive can take steps to reduce HIV-related illnesses, avoid unintended pregnancy, and protect their sexual partners from infection. Another benefit is that pregnant women who know their status can greatly reduce the risk of mother-to-child transmission of HIV (to less than 2%) by taking antiretroviral therapy.
My hope is that as more women gain health insurance coverage under the Affordable Care Act, more of them will get tested for HIV and receive appropriate health care. Getting more people tested and receiving treatment for HIV will go a long way in preventing new infections. As ob-gyns, we must increase our efforts to routinely screen all our patients for HIV, particularly in areas where HIV infection rates are highest.
A Week of Thanks, A Year of Thanks, A Life of Thanks...
Posted on November 27, 2013
We have some special holidays in the United States, and Thanksgiving is one of my favorites. I know I should give thanks for a wonderful life every day, but sometimes I don’t take the time. So let me take a moment now to share some of the many things for which I’m grateful.
As ACOG President, I am thankful for the Fellowship of physicians who devote their lives to women’s health by providing exceptional care and by sacrificing their personal lives for their patients’ care. We are a profession of givers. We are there to hold the hand of a patient with a life-threatening illness and to hand a newborn into the arms of a loving family. We teach and mentor, we laugh and cry—with friends, colleagues, and our patients.
I am thankful for the past six months in my role as ACOG President. I have been given the enormous opportunity to represent our Fellows before Congress, across the country at our regional meetings, and with our colleagues from around the world. This week ACOG hosted the leaders from the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the United Kingdom’s Royal College of Obstetricians and Gynaecologists (RCOG). We discussed our shared goals and promised to do much more together.
As one can only imagine, we all face many of the same dilemmas. Even in health care systems as diverse as the US fee-for-service environment to the United Kingdom’s National Health Service, we appreciate the common threads. Each of our organizations is developing systems to provide ob-gyns with the best guidance for delivering health care. Each of us is deliberating changes in our workforce, and we are devoted to improving patient care within our own country and abroad. We can do so much more as we collaborate.
So this week I give thanks to the wonderful organizations of ACOG, SOGC, and RCOG, and their great leaders. And I’m thankful for each of you, our Fellows, my blog readers. What are you thankful for?
Wishing each of you a Happy Thanksgiving.
Guest Blog: Connecting With Social Media: The Doctor Will Tweet You Now
Posted on November 22, 2013
As an ob-gyn and active user of social media, I enjoy being able to connect online with friends, family, and colleagues. Turns out, I’m in good company: Nearly all physicians in the US are now on social media, and more and more of us are using social for professional purposes.
Social media opens up an exciting new world for physicians and health professionals: Sharing important health messages with the community, promoting your practice and services, or communicating with colleagues via professional social networks, to name a few. And the medium is great for relaying information quickly and easily: With the touch of your finger, you can relay a message or post an image about anything to a few people or the entire world, and we can truly make a difference with social media.
With the great possibilities and benefits of social media also comes caution for those of us in the medical community. Instantaneous access to information is great, except when it’s information that may be misinterpreted, misunderstood, or may contain inappropriate or unprofessional expressions or images. It can result in health professionals being seen as insensitive and unprofessional, and even more seriously, violate privacy law and HIPAA.
OK, but you’re thinking—I would never post anything inappropriate, and this doesn’t happen very often anyway, does it? Unfortunately, there are more and more online incidents like the above examples involving health professionals. A recent survey of state medical boards revealed some surprises about professional violations: About 92% reported at least one online violation that led to major actions such as license revocation, and the problems occurred across every age and demographic group.
The offending examples of what caused the problems may also surprise you. One ob-gyn was scrutinized for venting her frustrations online about patients’ tardiness. A patient is suing an anesthesiologist who put stickers on her face, and the nurse shared it on social media. Posts such as these have caused strained relationships, public complaints, and led to disciplinary action from employers, medical boards, and judges.
As health professionals, we need to harness the power of social media while avoiding the issues and risks. To help make this possible, ACOG has developed a Social Media Guide, including some do’s and don’ts of posting. There’s also a short video that I produced with my colleagues from the ACOG Junior Fellow Congress Advisory Council, which shows the type of behavior to avoid—including how humor online may be misconstrued and taken out of context.
Here are five of my essential tips to ensure social media professionalism for health professionals:
- Pause before you post.
- When in doubt, leave it out.
- Avoid posting pictures from your personal life that could be misunderstood when viewed in a professional context. This might include pictures involving alcohol (including alcoholic glasses, cups, or bottles); tobacco/smoking, being intoxicated or using other substances; or pictures of you or others in suggestive or provocative attire such as bathing suits.
- Avoid posting about specific situations related to your work or a patient, even if you’re not identifying anyone in particular.
- Remember that it’s easy for your personal life and professional life to blend together online, so avoid personal expressions of anger, grief or venting online.
What are your favorite tips on social media for health professionals? I believe that it’s our responsibility to help each other learn how to use social media to interact with our colleagues and patients. As the medical and technology fields continue to change rapidly, it’s important for health professionals to share critical medical knowledge that the public depends on to make sound medical decisions. We have an opportunity to provide medical facts and advice, and the public wants to hear from us.
Meadow M. Good, DO, is chair of ACOG’s Junior Fellow Congress Advisory Council. You can follow her on Twitter @MeadowGood.
Why Men's Health Matters to Ob-Gyns
Posted on November 14, 2013
“Movember.” That’s the subject line of a recent email that landed in my inbox.
My first reaction was that this was a misspelling. Then I thought, what the heck is that? It turns out that my male ob-gyn colleagues have decided to draw attention to men’s health by shaving their mustaches and beards at the start of the month. They’re having a contest to judge who grows the best mustache and beard by month’s end, all in the spirit of men’s health. Why? They want to ‘change the face’ of men’s health through awareness and education.
Launched in 2003 in Australia, Movember is now a global effort in which men grow a “Mo” (moustache) for 30 days during the month of November in an effort to raise awareness about men’s health.
What better way to raise awareness of men’s health than through ob-gyns? After all, we know that women tend to make health care decisions for the family, and often a woman is the one to bring (or drag!) her partner or parent in to the doctor for care. Perhaps if we share some men’s health statistics with our patients, the messages will reach more men. Movember has certainly created a buzz around my entire department, and often that “buzzzzzz” is the key to messaging.
Here are some key messages about men’s health to consider (from the us.movember.com website):
- 24% of men are less likely to go to the doctor compared with women.
- 1 in 6 men will be diagnosed with prostate cancer in his lifetime. In 2013, more than 238,000 new cases of the disease will be diagnosed and almost 30,000 men will die from it.
- Testicular cancer is the most common cancer in males between the ages of 15 and 35. In 2013, 7,920 men will be diagnosed with testicular cancer and 370 will die from it.
- 1 in 13 men will be diagnosed with lung cancer in his lifetime.
- While not common, men can get breast cancer. About 2,240 new cases of breast cancer will be diagnosed among men and about 410 will die from it in 2013.
- An estimated 13 million men, or 11.8% of all men over the age of 20, have diabetes.
- More than 6 million men are diagnosed with depression each year. Almost four times as many males as females die by suicide each year.
As arguments continue around the Affordable Care Act, my message remains consistent: Prevention matters. We need to do everything we can to make healthy lifestyle choices for ourselves and our families. Regardless of whether it’s a male or a female, whether it’s prenatal care for a woman or aneurysm screening for a man—preventive health care is an investment in this AND future generations. Preventive health care is something we should all support.
Lessons From Our Ob-Gyn Colleagues in Mexico
Posted on November 7, 2013
Last week, I had the wonderful opportunity to take part in The Federacion Mexicano de Colegios de Obstetricia y Ginegologia (FEMECOG) meeting in Mexico City. The outstanding program provided the most up-to-date discussions on all aspects of women’s health to about 4,000 of Mexico’s 14,000 ob-gyns. Imagine if ACOG was able to share cutting-edge information with 30 percent of our Fellows at one meeting.
Our own Dr. James Martin, former ACOG President, was a bit of a ‘rock star’ as he delivered seven different lectures on preeclampsia. He was surrounded by physicians afterward asking for photographs with him! The variety of lectures at this meeting was impressive—and certainly challenged my understanding of Spanish. Our hosts—from outgoing FEMECOG President, Dr. Jose Montoya, to the newly elected FEMECOG President Ernesto Castelazo, and his spouse, Gabriela—made every moment enjoyable. ACOG Mexico Section Chair, Dr. Francisco Ruiloba, and his spouse, Gabriela, attended to every detail during our stay in Mexico City.
One of the best discussions we had was about medical student and residency training in image (2)Mexico. Students there have four years of medical school, followed by a one-year internship that is required before medical school completion. Every student from each of the almost 80 medical schools must complete one year of public service to underserved populations in Mexico City or in the deepest jungles of Mexico.
Our hosts, Felipe Gonzalez and Maru Morales, discussed their concern when their eldest daughter, Sofia, accepted her public service assignment in Santa Cruz, Huamuxtitlan, in Guerrero, one of Mexico’s most remote locations. No one was willing to serve there the year before. I can only imagine leaving my daughter in a remote valley for a year of service.
Sofia says her time in Santa Cruz was one of the best and most important years of her life. In fact, Sofia thrived as she provided primary care to the 1,000 local inhabitants of the surrounding countryside. She said she learned self-reliance and independence. She saw 40 patients a day because she was one of only a handful of physicians in the surrounding towns. About 45 minutes away from her was a support clinic to handle deliveries and advanced emergency care.
Sofia treated patients with diabetes and hypertension, but she also gave hope to so many in other ways. She started exercise classes in the town square (Zumba in the plaza!) to emphasize healthy lifestyle choices for everyone. She talked friends, colleagues, and a university into donating computers because there were none in town. The computer center near the town kiosk is now named the ‘Dr. Sophia Gonzalez Center.’ At her graduation, Sophia was the first recipient of her university’s newly established “Best Social Service Award.”
I also had an opportunity to discuss the desire of ob-gyn residents in Mexico to work with ACOG through our Junior Fellow programs. ACOG’s programs are inspiring the many ob-gyn residents throughout Mexico to want to exchange skills and interests with ob-gyn residents here in the US. What better opportunity than to develop exchange programs so that we can foster mutual respect, understanding, and knowledge from our diverse programs.
As we look closely at our health care system, it’s clear that we have much to learn from other countries. Most of us enter medicine with an interest in serving others, but we have never had a system dedicated to achieving such lofty goals. Although many academic programs have a global presence, often we can achieve more by collaborating closely with our ob-gyn colleagues in other countries.
New Contraception Counseling Aid Available for Ob-Gyns
Posted on October 31, 2013
As I said in my presidential address at the Annual Clinical Meeting in May, we need to address reproductive health and well-woman care at every single point of contact that women have in our health care system. If we are going to be successful in reducing the high rates of unplanned pregnancies in this country and all of the related maternal and infant health problems that go along with them, then we really only have one option: We must counsel and encourage all of our patients to use effective contraception.
The good news is that more women will have health insurance as the Affordable Care Act continues its roll-out. And under the ACA, more good news: Women now have access to all FDA-approved contraceptives without a co-pay. Coinciding with this, a new ACOG Committee Opinion in the November Obstetrics & Gynecology endorses the CDC’s US Selected Practice Recommendations for Contraceptive Use, 2013 (US SPR). The US SPR helps ob-gyns and other providers counsel our patients about how to use these contraceptives most effectively. This is a companion piece to the US Medical Eligibility Criteria for Contraceptive Use, 2010 (US MEC) that ACOG endorsed in a 2011 Committee Opinion. The US MEC provides guidance for determining which contraceptives are safe for women who have certain medical conditions.
The US SPR is arranged by contraceptive method and is easy to follow. It addresses a host of common as well as complicated issues related to contraceptive use that both doctors and patients may encounter. For instance, it provides guidance on which specific exams and tests we need to provide before prescribing a particular contraceptive method. It helps us advise our patients about exactly what do when they forget to take their daily birth control pill or are late in returning for their next injectable contraceptive. It also explains how to deal with side effects, such as breakthrough bleeding, and when and for how long to use backup contraception.
I think one of the many important points contained in the US SPR is that any contraceptive method can be started at any time during the menstrual cycle, as long as there is reasonable certainty that a woman is not pregnant.
I encourage you to read through and utilize both the US SPR and the US MEC. An eBook for the US SPR will be available soon. As I said at the ACM: Whether it’s a pill, patch, ring, injection, implant, insertable, or a ligation, we can address reproductive health for what it represents—an investment in our future.
Every Woman, Every Time. It’s up to us.
A Window Into Life With Progeria
Posted on October 24, 2013
One of the benefits of being ACOG President is having a great platform to draw attention to important issues and opportunities in the world around us. Today I’d like to tell you about my friend, Dr. Scott Berns, his wife, Dr. Leslie Gordon, and their son, Sam, who are bravely dealing with something many of us know little about.
I have known Scott for many years because we have collaborated on a host of projects through ACOG and the March of Dimes
. We both share a goal of improving maternal health care so that moms and babies have safe and healthy outcomes. This summer, Scott shared with me a very different project that he is involved in, one that is deeply personal and a true labor of love.
On October 21, HBO premiered the documentary “Life According to Sam
.” The feature film is about Sam, Scott and Leslie’s 16-year-old son. Sam has one of the rarest genetic conditions in the world, a premature aging disorder called Progeria. It’s such a rare condition that most ob-gyns have never experienced it in their practices. “Life According to Sam” allows us to capture the essence of Sam, a resilient young boy who wants us to see him as he is, to engage in his delightful personality, and to work for a cure for Progeria.
In 1999, after Sam was diagnosed with Progeria at age two, Scott and Leslie established the Progeria Research Foundatio
n (PRF). Since that time, they have raised awareness and identified other children with Progeria around the world. In this relatively short time period, they have progressed from increasing awareness to funding research to conducting clinical trials. Now, thanks to their commitment, there is hope for a treatment.
Since its inception, the PRF has provided more than $5 million in grants to scientists from around the world for research into the cause, treatments, and cure for Progeria. The organization also manages an international registry, maintains a cell and tissue bank for research, provides diagnostic testing for children who may be affected, hosts scientific conferences, and coordinates clinical drug trials at Boston Children’s Hospital.
Although the average life expectancy for children with Progeria is 13 years, Sam will turn 17 on October 23. This is all due to Scott and Leslie’s commitment to their son and other children with Progeria. I encourage you to learn more about the Progeria Research Foundation and its exciting work at progeriaresearch.org
. “Life According to Sam” will be rebroadcast on the HBO network during the month of November.
ADMs, CME, and You: Just What the Doctor Ordered
Posted on October 17, 2013
I have almost completed the "sweep" of our fall Annual District Meetings. Once again, I’m impressed with the dedication of my ob–gyn colleagues across the United States. These meetings are proving to be educational, collegial, and administrative. I say ”administrative” because we discuss the "goings on" of each region, including the political factors impacting each of our states, the public health dilemmas we face, and the effect of changing practice patterns. I look forward to these information exchanges and to sharing insights with my colleagues about the forces influencing our practices and our patients.
For me, the educational component of the ADMs has been most exciting. In a time when physicians are increasingly getting their CME online, the ADM courses provide more than just the course information. They provide perspective and insight from the experts in the field in real time. At the District I, III, and IV ADM in Puerto Rico, Jeffrey F. Peipert, MD, PhD, argued for a paradigm shift in our approach to contraception in his presentation about the St. Louis CHOICE Project
. With wider use of LARC (long-acting reversible contraception), we can significantly reduce our nation’s high rate of unplanned pregnancies and abortions and start to see healthier pregnancies. Dr. Peipert provided abundant pearls about how easy LARC is to provide to our patients and how it can improve reproductive health outcomes. We can all use this valuable information in our practices.
At the same ADM, Louis J. Guillette, PhD, gave a rousing talk about the impact of the environment on reproductive health. As it turns out, we both did research at the University of Colorado at almost the same time and even shared members of our thesis teams. Who would guess that our paths would cross 35 years later around shared interests? Dr. Guillette’s message: Increase awareness among our patients—without alarming them—about the vast amount of research implicating environmental factors on our health. And, Deborah A. Driscoll, MD, helped to simplify for us the complex world of genetic testing and familial cancers. Thanks to her, genomic microarray-based technologies are now part of our vocabulary.
Increasingly, physicians are earning more of their CME online. The reality is we are all crunched for time and online CME opportunities are valuable options. But online courses don’t allow for that in-person learning that is so often accompanied by practice pearls. Nor do they provide an opportunity for us to have personal, individual conversations with our colleagues which are so important. I hope that you’ll make plans to attend your next ADM…it’s definitely worth your time.
Remember, registration for the 2014 Annual Clinical Meeting in Chicago opens November 5, just a few weeks away!
ACOG and ACA: Investing in Women’s Health
Posted on October 10, 2013
As many of you know, I started my ACOG presidency announcing 2013 as “The Year of the Woman” because for the first time we, as a nation, are investing in women’s health care with the Affordable Care Act. It is an investment in our future when we provide all women with preconception care, prenatal care, and contraception.
I spent last week in Washington, DC, discussing the impact of environmental chemicals on our reproductive health
with our elected officials. And what a week it was! I saw firsthand the dedication of the furloughed employees who were trying to help everyone. I heard the frustration of many DC residents as they faced reduced work hours and uncertainty about what the next day or week will bring.
Amidst all of this chaos, the ACA’s health insurance exchanges opened for business. Yes, there are going to be some difficulties along the road with implementing health care reform, but there will be fewer of them when we work together to make health care changes a success.
I was in the hair salon recently and found out that the women working there had no health coverage. I opened my iPad and showed them how to enroll in Covered California
. In no time, they logged in, found affordable benefits, and were singing its praises. These are working women who had gone without coverage because they could not afford it and their small businesses did not provide health benefits. All of these women—some young, some single moms—all shared one uncertainty: What would they do if they became sick? They had not even considered getting preventive health care.
We need our government to open for business, we need to work on our health care delivery system, and we need to remind everyone that women are finally getting what we said is essential all along: Screening for cervical and breast cancer, screening for intimate partner violence and depression, contraception coverage, and prenatal care. Worrying about not being able to afford or even get health insurance because of a pre-existing condition can now be a thing of the past. Losing your health insurance coverage during the course of a difficult disease when you need it the most can also be a worry of the past. What a wonderful year!
Guest Blog: How I Learned to Speak Up for Women
Posted on October 3, 2013
ACA, SGR, CR, E&C—the list goes on. I thought once I became an ob-gyn, my days of being lost in the world of strange acronyms were over. Then I arrived on Capitol Hill. Thanks to the wisdom of the District XI leadership, I proudly accepted the honor of becoming the first McCain Fellow from our district. This opportunity allowed me to spend two weeks this past September with the Government Affairs staff of the American Congress of Obstetricians and Gynecologists (ACOG).
Every February, I attend the ACOG Congressional Leadership Conference
(CLC) in Washington, DC. During an exciting three-day meeting, ob-gyns learn about the legislative issues most likely to impact us and our patients. We then visit congressional offices to present ACOG’s legislative “asks.” It is an invigorating process—particularly when you are doing it with 300 other ob-gyns. Personal politics aside, this was an amazing opportunity for me and for the women I was there to represent.
When I came back to DC this past September as the McCain Fellow, I was worried that I had forgotten all I had learned seven months earlier at the 2013 CLC. However, after a day of warm-up, I felt ready to speak intelligently to Congressional members and their staff about ACOG’s legislative priorities. That doesn’t mean I felt I could do it as well as the lobbyists or that I did it without anxiety. But I did it. And it’s not enough. That’s the great responsibility that comes with my “forever” status as a McCain Fellow. It’s not enough to advocate for my colleagues and our patients; I have to convince others that they need to do the same. We must be the voice of those who have none.
Many doctors tell me that they hate politics and that they can’t stand the partisan bickering. When I was younger, a little more naïve, and very idealistic, I wanted a career in politics but became disillusioned by what I saw happening in our government. With the benefit of a little age, wisdom, and perspective, I now realize that we live in the greatest country in the world. I can speak up and disagree with our leaders without going to jail. I am not tortured for my opinions nor is my family taken from me. As a woman with two doctorates and two master’s degrees, my opinions are valued. Not just because I am educated and not despite the fact that I am a woman, but because I am an American. Our system is far from perfect, but it’s ours. If we really want to make a difference for women, we will embrace it rather than rail against it.
So what can you do? If you have a few days to get away, plan on coming to next year’s CLC. If you have a little more time or a particular interest in advocacy and health policy, apply to serve on ACOG’s Government Affairs Committee. Don’t forget, local opportunities offer a chance to get involved with minimal time away from your practice. Most of all, be aware of every opportunity to advocate—for yourself, for the next generation of ob-gyns, for your patients, and for women everywhere. It is an honor and a privilege to do what we do. With your contribution to our advocacy efforts, maybe we can keep the legislators out of our exam rooms.
For information on getting involved in advocacy, go to http://bit.ly/1brBOLV
Susan P. Raine, MD, JD, LLM, is vice chair of Global Health Initiatives, and associate professor in the department of obstetrics and gynecology, at Baylor College of Medicine in Houston.
Chemicals and Pregnancy Don't Mix
Posted on September 26, 2013
In our society, exposure to chemicals is unavoidable. As a physician with a PhD in environmental biology, I have a longstanding interest in the many chemicals we come in contact with every day and their impact on our health. These answers do not come quickly. It can take many years and millions of exposures to fully assess the potential impact that chemicals have on humans.
Unlike the pharmaceutical industry—where the burden is on drug makers to prove a new medication is safe—there is no requirement that any chemical be registered or proven safe before release. Of the more than 84,000 chemicals produced, fewer than 200 have been studied, only 12 have been restricted, and FIVE banned in 35 years. With such lack of regulation, we can’t assume these chemicals are safe, especially as a growing field of research suggests that some lead to reproductive health problems and can negatively affect developing fetuses.
This week, ACOG and the American Society for Reproductive Medicine (ASRM) released a new statement
warning of the reproductive health effects of exposure to certain environmental chemicals. The goal of this document is not to scare pregnant women or those considering having a baby, but to increase awareness in the health care community and with our patients about chemical exposures and to promote efforts to reduce these exposures where possible. (Find more resources
on environmental chemicals and reproductive health here.)
Ob-gyns must be attuned to the risks of environmental exposures and understand how our patients might be affected. For example, minorities are more likely than whites to live in the counties with the highest levels of outdoor air pollution and to be exposed to a variety of indoor pollutants, including lead, allergens, and pesticides. Farm workers are also at higher risk for health problems because they repeatedly come in contact with toxic chemicals in pesticides. Knowing about our patients’ potential exposures will help us anticipate related health outcomes and properly educate them about their risks.
ACOG and ASRM recommend that health care professionals:
- Learn about toxic environmental agents common in their community
- Educate patients on how to avoid toxic environmental agents
- Take environmental exposure histories during preconception and first prenatal visits
- Report identified environmental hazards to appropriate agencies
- Encourage pregnant and breastfeeding women and women in the preconception period to eat carefully washed fresh fruits and vegetables and avoid fish containing high levels of methyl-mercury (shark, swordfish, king mackerel, tilefish)
- Advance policies and practices that support a healthy food system
- Advocate for government policy changes to identify and reduce exposure to toxic environmental agents
By advocating for a cleaner environment now, we can stand up for the health of our patients and of many generations to come.
Talk to Your Pregnant Patients About Immunization
Posted on September 19, 2013
As an ob-gyn, I believe in the importance of vaccines. They are one of our best options for preventing the spread of certain infectious diseases. Usually, this is the time of year that we start reminding women to get their annual flu vaccine, especially during pregnancy. But based on the troubling recent reports of whooping cough (pertussis), measles, and mumps outbreaks across the country, it’s clear that flu isn’t the only vaccine reminder that our patients need.
These recent disease outbreaks are worrisome, especially since pertussis, measles, and mumps had been extremely rare in the US. Because of many years of widespread vaccination against these diseases in the US, the population had developed “herd immunity”—because most of the “herd” was immunized and not susceptible to infection, the few not vaccinated still received protection. But in recent years, anti-vaccine sentiments have grown, and more and more children are skipping important immunizations, leaving many vulnerable to these diseases. Outbreaks often start when an unvaccinated person comes in contact with a disease (usually during a trip abroad) and brings it back to a community where a number of people are unvaccinated.
Pregnant women and infants are hit especially hard by disease outbreaks. Pregnancy causes changes to the immune system that make women more vulnerable to infections like pertussis and flu, and most vaccines cannot be administered to infants until they are about six months old. Vaccination of the mother during pregnancy becomes especially important because it provides protection for both mom and baby. Ob-gyns have a real opportunity to increase vaccination rates during pregnancy, a time when we see our patients more regularly and have repeated opportunities to discuss the benefits of immunization. While the measles, mumps, and rubella vaccine should not be given until after delivery, the tetanus, diphtheria, and pertussis (Tdap) vaccine can be given during pregnancy. The Centers for Disease Control and Prevention now recommends that all pregnant women receive the Tdap vaccine with every pregnancy. ACOG also recently issued updated recommendations on Tdap immunization for pregnant women.
Some women may worry about the safety of vaccines. Research has overwhelmingly shown vaccines are safe and are not linked with autism. Because of all that’s at stake, ethical considerations prohibit extensive scientific and medical research during pregnancy. However, millions of pregnant women have received immunizations over the years with minimal side effects and no serious adverse events linked to the vaccines. Learn more on ACOG’s immunization website: www.immunizationforwomen.org.
Aiming for A BPA-Free Pregnancy
Posted on September 10, 2013
This week, the Breast Cancer Fund released a new and important report drawing attention to prenatal exposure to Bisphenol A (BPA). BPA is a synthetic estrogen and known endocrine disruptor. It is a relative of diethylstilbestrol (DES), a drug that caused genetic mutations and increased reproductive health problems and certain cancers among women whose mothers had taken the drug during pregnancy in the 1940s–1970s. Used widely as a can lining in canned foods and for plastic production, BPA has become ubiquitous in the US food supply. According to the new report, more than 92% of Americans have BPA in their bodies. Unfortunately, most research on BPA is based on animal models, which leaves us to infer risks to humans rather than to study them in a controlled fashion.
Based on animal models, support is building that BPA exposure in utero and shortly after birth is linked to future health problems including breast cancer, prostate cancer, metabolic changes, decreased fertility, early puberty, neurological problems, and immunological changes. To reduce BPA exposure among infants, the substance was banned from use in baby bottles in 2012. However, by the time a child is delivered, some level of exposure has already happened. Pregnant women who consume BPA expose their developing fetus to the compound, often during the first weeks of pregnancy, a crucial time for fetal development.
At this point, potential toxins are released freely into the environment and used broadly without any research assuring their safety before their use. ACOG’s most important role will be in supporting legislation that prevents exposure to chemical sources until those chemicals are studied and deemed safe for us. In the meantime, this new report encourages reproductive health providers to make women aware of the potential risks of BPA. It provides guidance on simple ways to reduce BPA-exposure, such as using glass, ceramic, or stainless steel for food storage, avoiding cooking or reheating in plastic containers, and choosing fresh or frozen foods instead of canned. Anything we can do to increase BPA awareness among physicians and patients will help us to collectively move in the right direction so we can all be BPA-free.
Broadening the Reach of Well-Woman Care
Posted on September 5, 2013
In years past, the primary care physician was a patient’s main point of contact for health care. Today, it’s not uncommon for a patient to regularly see three or more doctors for a combination of primary and specialty care needs. But even though we share patients, we don’t often collaborate across specialties on how to provide the best care for individual women. This can cause obvious complications—such as errors in prescribing medications—but, more importantly, it can lead to missed opportunities for improving health and wellness during face-time with our patients.
As part of my presidential initiative, I convened a task force of women’s health professional organizations, including primary care physicians, obstetrics nurses, midwives, physicians assistants, and others, to discuss well-woman care and look at ways we can work together to take advantage of each patient interaction. Bringing all these groups to the table to talk consistency and continuity in treating the whole woman is an important step toward more comprehensive care with Every Woman, Every Time she sees a doctor.
A woman’s reproductive health and goals affect many facets of her care. For example, a neurologist needs to be aware of a patient’s desire to breastfeed or become pregnant before prescribing certain medications. And I believe that contraception is as important a topic for a reproductive-age woman with diabetes as her blood sugar level is. Every woman of reproductive age, seeing any provider, should be asked about her reproductive goals. And while we ob-gyns talk extensively about reproductive concerns, we should be talking to patients about wellness-related issues such as a woman’s risk factors for heart disease and the importance of getting to or maintaining a healthy weight.
To make meaningful changes in the way we think and conduct patient care, all of us in the medical community must deliberately seek out the bigger picture. We will have to work together to set shared goals and establish referral relationships. As ob-gyns, we should make a point to reach out to our colleagues in other specialities, underscoring the importance of preconception care and reducing unplanned pregnancies, and encouraging them to always consider the reproductive health of their female patients.
The Easy Way to Keep Up with Advances in Practice
Posted on August 29, 2013
In a perfect world, ACOG’s evidence-based practice guidelines
would be issued and physicians would instantly start to incorporate them into practice, allowing patients to quickly begin reaping the benefits of the newest, most relevant research. In reality, changes in practice don’t happen overnight and it can take a while until new recommendations are widely adopted. A recent study
on oophorectomy, or ovary removal, at the time of hysterectomy suggests that physicians haven’t caught up with ACOG’s current practice guidance. Previous studies have found the same to be true for other recommendations such as breast cancer screening, bed rest during pregnancy, HPV vaccination, and Pap screenings.
A major component of improving the care we provide our patients is using the latest scientific research findings and medical advances in daily practice. Ob-gyns on the front line of research and patient-care serve on the ACOG committees that develop our practice guidelines. When necessary, committees call on the assistance of additional subject area experts to enrich the recommendations and ensure that the most recent and relevant data are included. The result: solid, evidence-based clinical guidelines. However, the widespread adoption of new guidance can be challenging.
Besides those who disagree with what we’re recommending, there are also people who aren’t aware of new guidance or who prefer to take a wait-and-see approach. Confusion about new recommendations contributes to slow acceptance, as can complex recommendations that make it hard for doctors to choose how they will treat or screen for certain conditions. No matter the reason, not following the latest guidelines can deprive our patients from receiving the best contemporary care.
ACOG guidelines are not mandates, and there are no ACOG police that enforce their use. However, staying abreast of new research, recommendations, and standards of care is the hallmark of engaged and committed professionals. We owe it to our patients to be up to date on discussions that may affect their health care.
I know that in busy practices, it can be challenging to keep up with research. I urge Fellows to read through new guidelines as they are issued each month in the Green Journal
. If you find yourself with guideline-related questions, ACOG’s Practice Division
is available to assist you.
Guest Blog: Navigating ACA, SGR, and Changes in Ob-Gyn Practice
Posted on August 22, 2013
As the Affordable Care Act (ACA) is rolled out, expanded insurance coverage will encourage more women to obtain preventive care. Payment models will shift from “fee for service” to capitated or bundled payments. This applies to both Medicare and government plans, and private insurers who usually follow The Centers for Medicaid & Medicare Services’ (CMS) lead.
With more doctors accepting new Medicare patients and an expected increase in patients with insurance of all types, we must adapt our practices to accommodate them and provide more comprehensive care. This will be easier if you are in a large practice. It might be a large merged practice like mine, perhaps a hospital or health system, or even a “virtual network” of clinically integrated separate practices. We will need to perfect a team approach, no matter what form it takes. We can be much more efficient if we collaborate with other providers, such as certified nurse-midwives and advance practice nurses.
This shift to new practice models has been in the works for years. In 1997, as I saw some of these changes on the horizon, I helped create Women’s Health Connecticut, a statewide ob-gyn private practice. Now with almost 200 ob-gyns and 35 collaborative providers, we are one of the largest single-specialty women’s healthcare groups in the country, and have raised the quality of care given to patients in our state. This model is also developing rapidly in Florida, North Carolina, and many other states.
In addition to developing better practice models, we must solve the physician payment piece of the puzzle. The unfortunate reality is that under the CMS sustainable growth rate (SGR)—a formula originally intended to control physician-related Medicare costs—doctors are not fully reimbursed for the costs of treating patients. If actually applied, the SGR would reduce payments to physicians each year. At this point, if allowed to kick in, the SGR would require a cut exceeding 25% in physician reimbursements. Each year, Congress passes legislation that postpones the cuts. To more definitively deal with the SGR problem, while further containing health care cost increases, Congress is considering a more comprehensive re-design of the payment system.
Because of my experience in growing a profitable new model of practice that delivers improved patient care, ACOG President Dr. Jeanne Conry has asked me to chair ACOG’s SGR Task Force. The task force will help ACOG develop and review legislative proposals to eliminate the SGR and to significantly redesign the payment system in a way that rewards quality and appropriately covers the cost of providing care.
When we keep our practices healthy, we are able to provide better care to our current and future patients. I have no doubt that ACOG will continue to provide guidance and assistance in adapting to the changes in the health care environment, and I am proud to be able to help.
Mark S. DeFrancesco, MD, MBA is an ob-gyn and chief medical officer at Women’s Health Connecticut.
No Sushi during Pregnancy…and Other Hard-to-Swallow Rules
Posted on August 15, 2013
I love sushi—living in California this is no surprise. Lucky for me my office is across the street from one of the best local sushi restaurants in town. It’s a favorite destination for me, my staff, and my patients. I recommend it to everyone—EXCEPT my pregnant patients. Why? Because I am inherently cautious.
We know raw fish is more likely to contain parasites or bacteria than cooked fish is. Sushi-related infections are rare, but this doesn’t erase my concern about the risk of adverse outcomes, mercury exposure, and the potential complications of treating an infection should one occur. As an ob-gyn, this is my job. It’s my business to consider potential problems, make my patients aware of them, and advise them to avoid unnecessary risks. If you really want to have some sushi, it’s a good idea to eat only cooked or vegetable sushi.
My goal is not to worry or alarm my patients, but to make suggestions based on solid, high-quality research. I use evidence to guide my recommendations, support my practice, and help my patients make healthy decisions for themselves and their fetuses. That’s why a recent essay by an economist and mom, who asserts that many common pregnancy recommendations are not fully supported by evidence, caught my attention.
Ob-gyns understand there’s often conflicting data and that the changes we suggest during pregnancy can sometimes be overwhelming: nine months can seem like an eternity when you have to give up your favorite things. Sometimes we even look back and realize our advice missed the mark. I remember a time when bed rest was prescribed for many patients with preterm labor, which we now realize accomplished little. But as doctors, we’re continuously learning. Advising patients to avoid things that we KNOW can cause harm is a good practice. Why take the risk of drinking alcohol when you know it could cause a problem? Given the risks, most patients don’t want to use their own child as a test subject.
In other areas, the evidence is very clear. For example, obesity and its impact on pregnancy, the fetus, and a woman’s long term health. Research has shown that excess weight gain increases the risk maternal and neonatal complications. Obese women have a higher risk of having children born with birth defects. Excess pregnancy weight also increases the risk of maternal obesity eight to 10 years after delivery, especially if women do not lose their pregnancy weight within six months. I would argue that we have not focused enough on weight gain. Ob-gyns could go even further to support women on appropriate weight gain and exercise during pregnancy and healthy weight loss and exercise after delivery.
Certainly it is up to women to make their own decisions during their pregnancy. It’s also important for ob-gyns to remember not to lecture patients, but to partner with them to help them achieve the healthiest pregnancy possible. We must stay tuned in to the recommendations put forth by ACOG and the dedicated practicing physicians who spend countless hours reviewing the latest literature and developing guidance and best practices for ob-gyn care. And it’s also OK to listen to that precautionary voice in the back of your head. Evidence first, but better safe than sorry.
Oral Health and Pregnancy: Tell Your Patients to Say "Cheese"
Posted on August 8, 2013
A healthy smile is more than a way to make a good first impression. It can be a strong health indicator, too. Poor dental health has been linked to heart disease, diabetes, and respiratory infections. Maintaining good oral health through the years is extremely important and pregnancy is no exception.
Pregnancy can cause changes in the gums and teeth and roughly 40% of pregnant women have some form of periodontal disease such as gingivitis (inflammation of the gums), cavities (tooth decay), and periodontitis (inflammation of ligaments and bones that support the teeth). Despite this, 56% of pregnant women report that they have not been to the dentist during pregnancy.
Dental care during pregnancy has been a source of confusion for women, their doctors, and dentists. Some people mistakenly think that pregnant women cannot be treated for oral health problems. However, the opposite is true. Pregnancy is an excellent time to discuss dental health with women, and ob-gyns can play a major role.
In a new Committee Opinion, ACOG urges ob-gyns to support good dental hygiene among pregnant patients by performing routine oral health assessments at the first prenatal visit and encouraging women to see a dentist. This can also help us reassure our patients that common treatments and procedures, such as teeth cleaning, dental X-rays, and root canals, are safe during pregnancy.
We can also reiterate important healthy mouth basics:
- Limit sugary foods and drinks
- Brush teeth twice daily with a fluoridated toothpaste
- Floss once daily
- Visit the dentist twice a year
With just a few questions and suggestions, we can help patients—some of whom may not have seen a dentist in years—take a step toward a healthier mouth. And, the benefits may reach beyond mom. Studies show that women with good dental hygiene are also less likely to pass cavity-causing bacteria on to their babies—two for one protection. By performing oral health screenings, ob-gyns can help ensure a healthier smile for women and their babies. So check in with your patients about their dental health and make sure they’re smiling for all the right reasons.
A Positive Step Toward Preventing Unplanned Pregnancy
Posted on July 30, 2013
The recent US recession did more than make us simply tighten our belts. It’s made many families think long and hard about contraception and when to have children. Research has shown that more women are delaying pregnancy since the start of the recession.
Tough economic times have also led to an increased need for publicly funded family planning services, especially among poor women, who are more likely to have an unintended pregnancy than women of higher socioeconomic status. Today, the Guttmacher Institute released some encouraging statistics—researchers found that publicly funded family planning efforts led to 2.2 million fewer unplanned pregnancies in the US in 2010. Guttmacher estimated that if not prevented these pregnancies would have resulted in more than 1 million unplanned births and more than 760,000 abortions. Additionally, the study showed that every dollar spent on contraceptive services yields $5.68 in public health care cost savings.
These new data underscore what women’s health professionals have known all along: that publicly funded family planning services provide an invaluable safety net for reproductive-age women. It’s great news to see these programs make a real difference in preventing unplanned pregnancy and its consequences.
ACOG has long supported the expansion of the Title X Family Planning program—the nation’s only family planning program dedicated to serving low-income and uninsured individuals regardless of their ability to pay. We will continue to advocate on behalf of the nearly 9 million women who use publicly funded services to ensure that all women—no matter their income—have access to the reproductive health services they need.
Community Walks Take Public Health Messages to the Streets
Posted on July 25, 2013
Last week, I walked one mile on my lunch hour. That may not seem like much exercise, but it certainly inspired me! Why? Because it was a community walk, in downtown Sacramento that started at the farmer’s market near our state capitol. Talk about messages on health—fresh food, fresh air, and exercise—this walk has it all. Each week, physician volunteers are invited to lead folks in a one-mile walk, answer questions, and reinforce health messages all in the shadow of our state capitol during lunch hour so that many state employees can participate. I know that I have pointed out that we are leaders in so many ways, and I really think this captures it. As physicians, we can lead in our hospitals, in our office practices, certainly through ACOG, but it is also great to look for community opportunities to get health messages out there.
Roughly 200 people attended our walk. They are my inspiration. I reminded them about the benefits of exercise: reducing their risk for heart disease, breast cancer, and colon cancer and feeling better in general. Then I gave them my favorite acronym on staying FIT:
Frequency: Exercise FIVE days a week
Intensity: Exercise so you cannot walk and talk at the same time (I call it “huffy-puffy”)
Timing: Exercise for at least 30 minutes
The setting at the farmer’s market is fun because there are opportunities to reinforce the importance of eating healthy fresh fruits and vegetables, reducing exposure to pesticides, and taking a half hour a day to devote to exercise. For those not ready for 30 minutes, I often try the “10 Minutes for Me” Challenge. I ask a nonexerciser to take 10 minutes every single day for 30 days and walk, saying “I have 10 minutes for me” so that they set his or her priorities differently. At the end of 30 days, these once-nonexercisers get the message that it is more about time than energy, and they add another 10 minutes of walking. The goal is to get a nonexerciser up to 30 minutes a day within three months!
Thankfully, the temperature has not yet hit 100 degrees (it was ONLY 95 on the day of our walk). But these walks do not have to be limited by weather. We all have mall walking programs nearby, and we can encourage participation in those. There are some well-known programs in Maryland and Virginia that have had regular participants for over 20 years. Those seniors are enough to inspire anyone.
So, lace up your shoes and get out into the community. No matter where you live, your words and actions can make a difference.
It Takes a Village to Increase Breastfeeding Rates
Posted on July 19, 2013
It’s disappointing that in 2013 we still regularly read stories about mothers being shamed for breastfeeding in public. Despite the fact that breastfeeding is a natural, age-old practice that has nourished babies for millennia, it remains a source of much debate. As an ob-gyn, I don’t see breastfeeding as controversial. In fact, I think it’s as close as we get to a “win-win.” The key point is to support women in their choice, whether their decision is to breastfeed or not, and to recognize that for some women breastfeeding can be very difficult. This is why as ob-gyns, we can partner with others to support women’s needs and desires and advocate for workplace accommodations that help promote breastfeeding on the job.
The benefits to mother and baby are clear. Breast milk is truly nature’s perfect baby food—it provides infants with complete nutrition, helps build strong digestive and immune systems, and protects against childhood illness such as respiratory infection and cancer. Breastfeeding also helps women bond with their newborns, contributes to faster postpartum weight loss, and decreases a mother’s risk of developing breast or ovarian cancers in the future.
Fortunately, the majority of women will be able to successfully breastfeed. ACOG recommends exclusive breastfeeding—without supplementing with formula—until infants are 6 months old. National efforts to increase breastfeeding rates are helping. Today, 75% of women initiate breastfeeding
. However, research has shown
that many women stop breastfeeding earlier than intended. Only 14% of women exclusively breastfeed at 6 months, well short of the 60% goal set by the US Public Health Service for Healthy People 2020.
To increase the duration of breastfeeding, it will take a village. Ob-gyns, pediatricians, family members, child care providers, workplaces, and communities all play a role. As ob-gyns, we have many opportunities to support our patients’ desire to breastfeed. We can counsel women during pregnancy about the benefits of breastfeeding, and we can put plans in place to ensure immediate and smooth initiation after delivery. We should be available to help our patients who experience physical problems by quickly evaluating and treating breast issues (such as mastitis) and referring them to lactation specialists or breastfeeding experts who can assess logistical problems. We must also remember that the challenges don’t end at the hospital and serve as vocal advocates of creating breastfeeding-friendly hospitals, communities, and workplaces—our own offices included.
The bottom line: Breastfeeding is healthy for mom and baby. While we should always be compassionate and nonjudgmental to our patients that can’t or choose not to do it, we should continue to support and encourage the practice in any way we can.
A Rough and Tumble Time for Women in Texas
Posted on July 11, 2013
What a week! If you’ve been following the epic battle over abortion legislation in Texas like me, you may be feeling exhilarated and inspired by the developments there. What Texas women have done is remarkable. They’ve thrown a hand in the face of legislators who are trying to regulate what goes on behind closed doors, in the privacy of a doctor’s office, between a patient and her doctor. Women have made it known—loud and clear—how they feel about TRAP (Targeted Regulation of Abortion Providers) laws being passed on their turf, and the Texas Legislature couldn’t help but listen.
During this pivotal moment in time, we at ACOG raised our voices along with the women in Texas. We denounced these unnecessary bills
, making it clear that scientific facts are important, that politicians should get out of our exam rooms
, and reiterating what should be obvious: Women are fully capable of making important decisions about their own health
and should be able to do so without interference from the government. As ob-gyns, it’s our job to inform and support these decisions.
We know that TRAP legislation is being considered in a number of other states. Unfortunately, this isn’t the first—or the last—attempt by politicians to confuse the conversation with inaccurate and misleading information and without regard for what women want. But it’s clear to me that women will continue to stand up for their reproductive rights. And we at ACOG will stand ready to respond with scientific facts, conviction, and common sense on behalf of the women we serve.
International Meetings with a Focus on Local Care
Posted on July 8, 2013
As ACOG president, I have the honor and privilege of representing US ob-gyns on an international level. This has been most exciting. In the last two weeks, I have attended the annual meetings of the Society of Obstetrics and Gynaecology of Canada (SOGC) in Calgary, and the Royal College of Obstetrics and Gynecology (RCOG) in Liverpool. It was particularly rewarding to watch our very own Dr. James Martin, an ACOG past president, become an honorary fellow of RCOG for his extensive work in hypertension. At these meetings, I was struck by the diversity of the attendees and the deep interest in global women’s health. I was also surprised and inspired by the similarities in priorities we share with our overseas colleagues.
RCOG is working toward a goal of improving maternal outcomes. RCOG President Dr. Tony Falconer, shared reports and responses to the UK’s National Health System and discussed safety in labor and delivery. He referred to all of the fellows as the “eyes and ears of the profession” who will need to address lifelong leadership and quality goals. RCOG is also setting expectations at UK delivery centers for all who provide care. Just as they are looking to improve outcomes, so are we. With our National Maternal Health Initiative, we can focus on both quality and safety in every delivery center in the US by developing standards and expectations on how to provide the best care.
Dr. Chiara Benedetto, the first female president of the European Board and College of Obstetrics and Gynaecology, is working with each of the European nations to develop expectations for the well-woman visit. We hope to accomplish the same thing in the US with our partners in family practice, internal medicine, and pediatrics, including nurse practitioners, nurse-midwives, and physician assistants. Clearly, we all agree that we must address the health of women BEFORE they conceive through improved well-woman care and contraception.
The take-home message: We are all facing the same pressures. Ob-gyns around the globe are extremely dedicated physicians who want what is best for our patients. We need training, standards, and support in developing the systems to provide the best care, and time is of the essence. As many have said, “We do not need to reinvent the wheel.” This is an especially important point as we share our global initiatives and recognize the importance of engaging each country in improving maternal health care and outcomes. We can make changes for Every Woman, Every Time, because—no matter where we live—if we put our patients first, we will succeed.
A Quick Guide to Social Media Professionalism
Posted on June 27, 2013
No one doubts that this is the era of digital communications and social media, and it’s coming along with numerous changes in our hospital and clinic practices. There can be a pretty steep learning curve when new technologies are introduced. Just as you’re trying to learn one platform’s purpose, audience, or lingo, a new or different application is demanding your attention. Add to that the constant bombardment by advertisements for webinars and online courses that promise to help us understand the complex world of social media, including the sometimes slippery slope that we walk as we communicate with our patients over online networks and promote our expertise and practices in the high tech world. It’s hard to tell where to start.
ACOG’s Junior Fellow Congress Advisory Council (JFCAC) recently developed a DVD that I think every practice needs to purchase. It’s a short, four minute video, yet it gives a very real message about the challenges we face as we expand into social media. The JFCAC goal was very simple: to increase awareness of unprofessional online behaviors and inappropriate use of technology, and to encourage physicians to think before they post. Mission accomplished! The video is engaging and does a great job of highlighting the consequences of posting inappropriate information or unprofessional pictures while using social media and technology applications. It points out that seemingly innocuous jokes and personal expression could lead to a tarnished reputation, ethical and legal violations, and disciplinary actions.
After watching the video, I had a more clear understanding of how to use social media thoughtfully and responsibly. Some of these points may seem obvious, but it is definitely worthwhile to review, especially as so many of us transition from using Facebook, Twitter, and other social media platforms as a professional tool instead of for casual purposes.
I purchased the DVD to share with my Human Resources department for a new physician orientation. I believe every hospital and certainly every residency program can use it. Check it out here
. For more tips on social media for ob-gyns, see ACOG’s Social Media Guide
A Major Victory for Women’s Health and Ob-Gyns at the AMA
Posted on June 20, 2013
As I’ve said many times, this is an amazing time for women in the US. And the news just keeps getting better: We now have a dedicated, life-long advocate for women’s health in line to lead one of the most influential medical organizations in the country.
I was thrilled this week to witness the election of Robert M. Wah, MD, as president-elect of the American Medical Association (AMA). The AMA sets national, cross-specialty guidelines for physician ethics and medical education standards, and it also serves as a thought leader and central voice for doctors in the US. As only the third ob-gyn to be elected as AMA president, I am confident that Dr. Wah will always keep the health and needs of women of all ages at the forefront. He is someone who understands both specialty care and primary care, physician and patient needs in surgical and outpatient settings, private and public health needs, and most importantly in my opinion, the role of women as the drivers of health care.
Dr. Wah is an ob-gyn from Northern Virginia with a string of accolades too long too list. He currently practices and teaches at the Walter Reed National Military Center in Bethesda, MD, and the National Institutes of Health. Prior to his election, he was active in many areas of the AMA and also has served on ACOG’s Executive Board and Health Care Commission.
ACOG lobbied for and wholeheartedly supports Dr. Wah’s election. We believe he will not only serve our specialty well, but all physicians, women, and their families, too. We’re excited in anticipation of the great changes he will inspire during his tenure.
Teaming Up with Our Nurse-Midwife Friends
Posted on June 13, 2013
Earlier this month, I had the good fortune to attend the American College of Nurse Midwives (ACNM) annual meeting in Nashville, TN. What a fabulous meeting in a great location. The meeting program was diverse and holistic, with an emphasis on the same issues ob-gyns are struggling with: improving safety in our birthing centers, improving global women’s health, and changing the delivery of care right here at home so that we see healthier moms and babies.
An ACOG delegation—including myself, Executive Vice President Dr. Hal Lawrence, Past President Dr. Richard Waldman, and President Elect Dr. John Jennings—attended the opening ceremonies and were greeted with a thunder of applause, an acknowledgment that collaboration in improving women’s health and access to care is a shared goal of our organizations. ACNM also gave ACOG a very special award: the Organizational Partner Award for aiding in the development and practice of midwifery. This award was very meaningful to us. It was recognition that ob-gyns and nurse-midwives do collaborate, share delivery services, and very much depend on one another. The changing face of health care ensures that our professions will continue to interact, innovate, and work together.
Change is tough, because often it means separation from our comfort zone and having to adopt different behaviors or different approaches. Some physician practices have quickly incorporated midwives, and others have not. According to trends in the ob-gyn workforce, we do not have enough physicians in our specialty to meet the challenges ahead. The reality as we look toward the future? It is likely that many models of collaborative practice will be adopted by more and more physicians, both out of necessity and because it just makes sense. Expanding our access to patients with physician assistants, nurse-midwives, and nurse practitioners when possible both serves our patients and allows ob-gyns an opportunity to focus on the work that specifically requires our special skill set. We will need to look closely at how we provide care, and particularly on how we collaborate on the delivery of care, over the next decade. I’m personally looking forward to sharing more information on successful strategies to provide our patients with the best coordinated care we can.
Guest Blog: My Life As A Gellhaus Fellow
Posted on June 6, 2013
An introduction by Thomas Gellhaus, MD: ACOG has an incredible commitment to advocacy for our patients and our members. For many years, ACOG has offered programs—such as the annual Congressional Leadership Conference and the McCain Fellowship—that provide ob-gyns with an interest in advocacy an opportunity to learn more about the legislative process and speak to Congress about women’s health issues. However, there were no programs specifically geared toward our younger MDs, ACOG Junior Fellows, and ob-gyn residents.
I founded the Gellhaus Resident Advocacy Fellowship in 2010 to provide just such an opportunity. Since then, we’ve had 14 residents complete the program, and three additional residents have been selected for 2014. During their month-long advocacy and policy immersion experience with ACOG’s Government Relations division, residents complete a project and also write a short summary of their experience. Many, if not all, of the past Gellhaus Fellows have gone on to do further advocacy and policy work.
I was bitten by the advocacy bug in 1994, and hopefully many more ACOG members will with this opportunity. It is evident from Sara Tikkanen’s article below that she has also been bitten!
My Life as a Gellhaus Fellow
When I first found out I had been chosen as a Gellhaus Fellow, I was ecstatic. I was excited to go to Washington, DC, for a month during my chief year to learn more about ACOG, our government, and advocacy. After my initial excitement had settled, I was somewhat nervous, primarily because I wondered: “Do I know enough to make a difference?”
Soon after my arrival, I was put at ease by the fantastic staff at ACOG who gave me a crash course on women’s health advocacy. After attending my first few Hill meetings and other government relations events, it became clear that I indeed knew a thing or two about medicine, and I was in a unique position to provide a new and different perspective to the legislators who actually make decisions that directly impact our ability to practice medicine.
During my time at ACOG, I have mainly focused on the issue of the ob-gyn workforce as it relates to the Affordable Care Act. In my opinion, now is the time to focus on the impact that 10 million more women needing gynecologic care will have on hard-working physicians already stretched thin with time and resources. I have tried to highlight the importance of continued Graduate Medical Education funding so that we can increase our workforce. A great example of this is the The Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act which would help create more residency slots.
I have also focused on the importance of tort reform so that current practitioners can continue to provide care without the burden of high medical liability insurance premiums. I have participated in discussions addressing the implications of the Medicare Sustainable Growth Rate, the flawed formula used to determine physician payment rates, and the efforts to repeal it. A vast majority of the lawmakers I have spoken with agree that we need a fix. While few seem to have a concrete solution in mind, all are open and eager to discuss possible solutions.
My time here has been wonderful and eye-opening experience. It’s motivated me to become more involved as a resident at the University of Iowa, and upon graduating, as practicing obgyn in the great state of Wisconsin. I’d like to thank Dr. Gellhaus and the staff at ACOG for making this month possible.
In reflecting on my experience, the most important thing I’ve learned is that I have an obligation to be an advocate, not only for my patients but also for ob-gyns and physicians as a whole. Decisions which directly impact our ability to care for our patients and ability to practice medicine are being made by legislators who do not know nearly as much about medicine and the day-to-day challenges associated with being a physician as the physicians themselves. I challenge each Fellow and Junior Fellow to take an active role whether that be at a hospital, state, or federal level. Only by being involved can we make a difference.
Sara Tikkanen, MD, is an ob-gyn resident at the University of Iowa Hospital and Clinics
Smoking Cessation Front and Center with “Talk With Your Doctor” Initiative
Posted on May 30, 2013
As “Physician to the United States,” the US surgeon general speaks with a strong voice about a variety of health concerns, with a focus on prevention and wellness. January 2014 will mark the 50th anniversary of the first Surgeon General’s report to conclude that smoking cigarettes causes lung cancer. Five decades later, 43 million American adults continue to smoke, and cigarette smoking kills an estimated 440,000 Americans each year.
I was happy to represent ACOG last week, standing with Surgeon General Regina Benjamin, MD, the Centers for Disease Control and Prevention, and our colleagues at other physician organizations to launch “Talk With Your Doctor,” a campaign to encourage patients to come to us, their physicians, and learn how to succeed with smoking cessation. As OBGYNs, we need a strong voice here. We see the short- and long-term impact of smoking on women and on their families. It is imperative that we assist all of our patients in their efforts to quit smoking, especially our pregnant patients.
A woman who stops smoking at the start of a pregnancy can reduce her risk of pregnancy complications. We ob-gyns need to help our pregnant patients understand that smoking cessation brings immediate results and immediate successes.
The most important step is to ask, and then to respond. We need to treat smoking the same way we have treated vital signs—as a measure that we routinely screen for and assess—and be prepared to support patients who are ready to kick the habit. Surveys have shown that most of us ASK about smoking, yet only one-third provide assistance or a program. Cessation programs are most effective in helping people quit smoking.
When we see our patients, we all need to remember the FIVE A’s:
- Ask about tobacco use.
- Advise to quit.
- Assess willingness to make a quit attempt.
- Assist in quit attempt.
- Arrange follow-up.
ACOG has developed a smoking cessation during pregnancy guide for clinicians to help pregnant patients kick the habit. Check out this helpful resource and be ready when a patient says “I was told to ‘Talk With My Doctor.’”
Farewell to Our Friend and Colleague, Dr. Sterling Williams
Posted on May 23, 2013
ACOG is a great organization because we stand for women’s health, women’s reproductive rights, and the needs of our physicians. It is in supporting our physicians that we excel. We have developed some incredible leaders and departments at our national headquarters in Washington, DC, that really support these goals. ACOG’s education department is certainly one of the standouts.
I was so sad to hear news of the passing of Dr. Sterling Williams this week—ACOG’s Vice President of Education—because he devoted his life to education and helped each and every one of us ob-gyns. Just a few days before I became President, Sterling and I had lunch together. He was excited to share news of his family, the transition he was considering as he retired from ACOG, and to discuss all of the changes he was contemplating. He had invited me to participate in one of his great achievements this year, a simulation training program.
Sterling understood the many challenges in our profession as well as the importance of preparing residents for the future and of keeping ourselves up to date on advancements in practice to provide the best care for our patients. But Sterling did so much more. He was a true Renaissance man who glowed in the accomplishment of receiving his doctorate last year, who performed in a world-renowned chorus with his incredible baritone voice, who had television and movie roles with Bill Cosby and Spike Lee. And more than anything else, he was a man who wanted to see each and every ACOG Fellow succeed.
A Lesson In Breasts, Starring Angelina Jolie
Posted on May 16, 2013
Sometimes, public interest in the lives of celebrities helps us in medicine. For years, I have wished that a celebrity would champion the importance of contraception, planned pregnancies, and reproductive choices. Someone to share that planning for a pregnancy, optimizing health, taking preconception folic acid, and making healthy choices was fashionable. Alas, I’m still waiting for this to happen.
But this week, Angelina Jolie did a great service by bringing attention to the very difficult choices women face in the complex world of breast cancer, screening, prevention, and genetics. It was almost 40 years ago when First Lady Betty Ford openly discussed her breast cancer, mastectomy (surgical removal of the breast), and the importance of a screening mammogram. There was a surge in screening mammography after her revelations, and she personally helped Nancy Brinker get the Susan G. Komen Foundation started. It’s a great example of a well-known individual making a big impact on women’s health.
Hopefully, Ms. Jolie’s announcement will have a similar effect. She has taken the key message of preventive health, and used a very important term, “empowerment.” Clearly, her decision to have a double mastectomy in order to lower her cancer risk was not made lightly—it was made with a collaborative team that factored in her family history, risk factors, and the individual options available to her. In describing her experience, Ms. Jolie addressed the concerns many women have about their family support, family impact, and perception of self. She discussed how rare BRCA gene mutations increase a woman’s risk of developing cancer and the health disparities that stand in the way of more screening and treatment for women with these inherited risk factors. These are the issues our ACOG Fellows face daily—determining which patients need a comprehensive screening approach, providing the appropriate care, and having a team well-versed in genetics and risks to tailor the care to the individual.
Quite frankly, we as ob-gyns can’t know it all, but we sure can get a team that collectively does! We need to be knowledgeable in the appropriate screening protocol (ACOG recommends routine screening for hereditary breast and ovarian cancer). We also need to be prepared to counsel patients with elevated risk, and to call on the expertise of geneticists, surgeons, oncologists, and radiologists to collaboratively manage a patient’s care. It is up to us to be aware of risks for our patients and develop the best available system to help them make personal decisions.
Finally, Women's Health Gets Its Due
Posted on May 9, 2013
It is an amazing time for women in the US. The recent passage of the Affordable Care Act (ACA) shows that women’s health has been embraced as a national priority. Implementation of this landmark legislation will improve and expand health care for millions of women. From yearly well-woman visits to cancer screenings and domestic violence screening and counseling, to breastfeeding support and contraceptive coverage, more women’s health services will be accessible and affordable than ever before.
It’s with this backdrop that I take the reins as president of The American Congress of Obstetricians and Gynecologists, and I couldn’t be more excited. As a nation, we’re finally recognizing that health care is about more than solving accute health crises. It’s about promoting wellness to prevent disease. For ob-gyns, providing top-notch health care includes having meaningful interactions with women and providing them tools not only to maintain their physical health, but to improve their physical, mental, and emotional health, too.
Ob-gyns will be greatly affected by the new law, but we’ll also have a chance to make a great impact. We will be gaining new patients and collaborating with colleagues to optimize their health. We should strive to make the most of these patient-doctor visits and encourage women to put their health first—take advantage of the services ACA offers; get preexisting health conditions under control; make time for eating right, exercise, and the stress-relieving activities that they enjoy. These are fundamental health reminders that we must convey to every woman, every time.
As an ob-gyn, I believe that no medical specialty knows women’s health better than we do. We have a duty to speak up in the best interest of women’s health. During my year as ACOG president, I plan to take every opportunity to advocate for women. I challenge ACOG Fellows to let your voices be heard as well. Talk to your legislators and your community about women’s health, but most of all, talk to your patients. Working with them one-on-one to build the foundation for a healthier future is where we can make the biggest difference.