The Key to Women’s Health: Collaboration

Collaborative practice is the true hallmark of highly-functioning ob-gyn practices and medical systems. When we use the term ‘collaborative practice,’ we need to focus on the elements that make collaboration a success for our patients.

ACOG benefits when we collaborate with our partner organizations to improve women’s health. The past two weeks have demonstrated extraordinary collaboration.

Dr. Haywood Brown, Chair of District IV, recently led ACOG’s new Well-Woman Task Force, gathering experts from numerous specialties, including physicians from family practice, ob-gyn, pediatrics, and internal medicine, along with nurse midwives, nurse practitioners, and physician assistants. He asked his colleagues to collaborate and define the elements of the annual well-woman visit. Women see a variety of health care practitioners, so we need to ensure that we are consistently addressing the same common elements during a well-woman visit, regardless of patient age or health care provider. The meeting brought focus to the importance of ‘Every Woman, Every Time’ that places women’s health and reproductive needs together.

Carrying on with the collaborative theme, the Council on Patient Safety in Women’s Health Care, convened under Dr. Paul Gluck’s expertise, brought together ob-gyns, family practice doctors, anesthesiologists, midwives, and nurse practitioners, along with the Joint Commission, American Hospital Association, and many others. This group’s “Three Bundles, Three Years” initiative is aimed at improving birth outcomes in every birthing location in the US by tackling the three of the most common complications we see in labor and delivery:

  • Hemorrhage: Every center will have a guideline in place so that we respond effectively when a hemorrhage occurs.
  • Hypertension: Every center will implement the hypertension guidelines outlined recently by ACOG’s Task Force Report on Hypertension in Pregnancy.
  • Blood clots: Every center will focus on reducing the risks of clotting complications, such as pulmonary embolism.

At the SMFM meeting, Dr. George Saade brought together experts to address “Pregnancy as a Window to Women’s Health,” a day-long symposium co-hosted by SMFM, ACOG, and NICHD. We can predict a woman’s risk for later health problems—notably diabetes and hypertension—by evaluating her pregnancy complications or disease processes. Out of this collaborative symposium will eventually come recommendations for care and guidance for future research.

I have already started discussing with my patients at their first prenatal visit how their pregnancy will be a “window to future health.” Afterall, the patient-provider relationship is one of the most important collaborations in our careers.

 

Lessons From Our Ob-Gyn Colleagues in Mexico

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.

image_7Sofia 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.

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