Every Woman, Every Time – In Chicago and Beyond

ACOG’s Annual Clinical Meeting in Chicago is just over a week away. I’d like to tell you about the three fabulous speakers that I selected for my President’s Program. I know that each of them will bring alive the spirit of my presidential theme, “Every Woman, Every Time.”

First up will be Dr. Lesley Regan who leads global women’s health efforts for the Royal College of Obstetricians & Gynaecologists in London. She also chairs the Committee for Sexual and Reproductive Rights for the International Federation of Gynecology and Obstetrics. In “Human Rights and Women’s Health in the 21st Century,” Dr. Regan will address every woman’s basic rights to health care, as well as the challenges that different cultures around the globe face in providing this care.

Our second lecturer is Dr. Mark Hanson, director of the Academic Unit of Human Development and Health at the University of Southhampton in the United Kingdom. Dr. Hanson has focused his work on new ways to reduce disease processes and improve health by championing preventive interventions during preconception, throughout pregnancy, and in infancy and childhood. In his lecture, “The Developmental Origins of Health and Disease (DOHaD) Challenge,” he’ll provide his insight into why investing in the health of our current generation is the best way to invest in the health of future generations.

The final speaker will be the distinguished Dr. Tyrone Hayes, professor of biology at the University of California–Berkeley. In “From Silent Spring to Silent Night: The Impact of the Environment on Reproductive Health,” Dr. Hayes will illustrate why we must study the impact of environmental chemicals on our health. As I have said many times, and as Dr. Hayes will demonstrate, ob-gyns need to lead efforts to shift the burden of proof away from physicians and the public back to the chemical industry. Companies must prove that chemicals are safe before they are released into the environment and the marketplace.

This year’s annual meeting promises to have something for everyone—great lectures, wonderful camaraderie with colleagues, and an opportunity for all of us to celebrate our wonderful careers in obstetrics-gynecology. See you in Chicago.

A Strong Voice for Women’s Health Research

Marsha B. Henderson-FDA

Marsha B. Henderson, assistant commissioner for women’s health at the FDA.

As ob-gyns, we provide health care for women every single day, sharing their stories and hearing their concerns. And as ob-gyns, we know that many diseases and treatments affect women and men differently. Perhaps no organization frames this gender difference in medicine better than the Society for Women’s Health Research (SWHR).

SWHR was “born” in 1989 when Dr. Florence Haseltine gathered friends and colleagues from medical and scientific organizations across the country to address the critical need for more research focused on women. Meeting at ACOG headquarters in Washington, DC, the group agreed on the need not only for more gynecological research at the National Institutes of Health (NIH), but also for increased research in women’s health across many specialties. This multi-disciplinary, multi-organizational effort has thrived ever since.

Last week, Drs. Hal Lawrence, Sandra Carson, Barbara Levy, and I were honored to attend the Annual SWHR Gala Dinner to celebrate the work of Marsha B. Henderson, assistant commissioner for women’s health with the U.S. Food and Drug Administration (FDA). Ms. Henderson is the first recipient of SWHR’s Dr. Estelle Ramey Award for Women’s Health Leadership. In her key role, she coordinates FDA policy, research, and outreach efforts to protect and advance women’s health. Ms. Henderson also advocates for the participation of women in clinical trials and for sex, gender, and subpopulation analyses. Bravo to Ms. Henderson for her outstanding work!

On a related note, we are delighted that SWHR has joined ACOG and many other organizations that are urging the House Energy and Commerce Committee to hold a hearing to examine the progress made by NIH and the FDA on including more women and minorities in medical research. We will keep you updated on any developments on this front.

Ob-Gyns: We Are Natural Leaders

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Attendees pose at the Robert Cefalo ACOG Leadership Institute.

Our Fellows and Junior Fellows are the backbone of ACOG. They are the workhorses, the change artists, the ones who challenge us to do so much more. We rely on their vision, insight, and their ability to lead.

Last week I had the opportunity to attend the annual Robert Cefalo ACOG Leadership Institute conducted at the University of North Carolina-Chapel Hill. I’ve attended the 4-day conference as a student in years past, but this time I participated as faculty and enjoyed myself just as much this time around. If you take leaders from across the United States, provide a beautiful environment with jam-packed days of excellent speakers and challenging projects, throw in the analytical tools to help us understand ourselves better, you have a recipe for success.

Add to this mix a workshop meant to question how we look at problems, how we collaborate, and how we need to work with others and you can understand why each ACOG District has committed to sending their leaders to this conference. Notice that I avoid using the term “future leaders.” I maintain that we, as ob-gyns, are already leaders.

The importance of this conference is that we look for leaders in all stages of development. I met residents who had just started their involvement as Junior Fellows, as well as seasoned District Chairs. Each attendee left with a greater appreciation of the commitment it takes to be a leader. And ACOG, in turn, is ready to commit to these leaders because we know they will be carrying our important messages forward.

Investing in improving communication skills, in team building, and in understanding our own leadership styles will make all of us more successful. In the end, we all benefit.

Yes: Contraceptive Care IS Preventive Care

Dr. Jeanne Conry speaks at the #NotMyBossBusiness rally on the Supreme Court steps on March 25, 2014.

Dr. Jeanne Conry speaks at the #NotMyBossBusiness rally on the Supreme Court steps on March 25.

I had the unique opportunity to stand on the Supreme Court steps this morning and share my experience as an ob-gyn, and the experiences of my patients back home in California, as the Court hears arguments in the Hobby Lobby case. My patients are among the millions of women who need and deserve contraceptive coverage.

I have treated thousands of women in my career and have seen firsthand how birth control and contraceptive counseling have helped them. For some, it helped to avoid an unintended pregnancy. For others, it helped to delay pregnancy until the time was right. For others, it has helped other medical conditions. But they all had one thing in common: Their family planning decisions were personal and their boss was not in the exam room. That is the way it should be, for every woman, every time.

Contraception, like all medical decisions, should be based on an individual woman’s needs and health – and nothing else. Contraceptive care IS preventive care. It enhances health and improves quality of life for women and for their families. By covering contraceptive care, we are making women’s health a priority, and we are investing in FUTURE generations.

Dr. Jeanne Conry with Cecile Richards, President of the Planned Parenthood Federation of America and the Planned Parenthood Action Fund, at the #NotMyBossBusiness rally on March 25, 2014.

Dr. Jeanne Conry with Cecile Richards, President of the Planned Parenthood Federation of America and the Planned Parenthood Action Fund, at the #NotMyBossBusiness rally on March 25.

Access to contraceptive care can make a world of difference to each woman. It improves the health of our nation and helps our health care system work better for all of us. Contraceptive coverage puts birth control within reach for more American women.
I’m proud to lend my voice to this important issue through my remarks this morning at the Supreme Court (#NotMyBossBusiness) and also here:

I’d also like to recognize important contraception and women’s health messages from two of my physician colleagues whose voices made a difference today:

Advocating for Women’s Health: Finding Common Ground

I have had many opportunities, particularly in the past year, to discuss how important women’s health issues are to investing in our country. Recently our Committee on Government Affairs and staff carried that message to the highest level at ACOG’s 32nd Annual Congressional Leadership Conference (CLC) in Washington, DC. With themes like ‘meeting you halfway,’ we were instilled with faith in our congressional leaders who are looking for collaboration, consensus, and progress. Women’s health should be a nonpartisan, centrist issue. After all, blue and red together create purple, the theme color for this year’s “Every Woman, Every Time” CLC.

A large conference like the CLC can be a scheduling nightmare in the best of circumstances. But add six inches of snow on the day of the main conference and all could have failed. What do you do if you are hosting a roundtable discussion with a congressman who was out of state and snowed in? No problem—we had Skype. Another snowbound yet determined congresswoman was delivered to the CLC via a four-wheel drive. A keynote speaker’s flight was cancelled, so he rented a car and drove four hours to deliver his lecture for us. Where there’s a will, there’s always a way.

At this year’s CLC, we prepared for four important “asks” before we met with our congressional leaders. We discussed SGR repeal, graduate medical education funding to improve access and create residency slots, legislation around gestational diabetes screening and research, and medical liability reform with Safe Harbor legislation. AMA President Elect Dr. Robert Wah, an ob-gyn, summarized many of these issues and then wrapped them all together in a great package. Our final launch was a greeting by Congresswoman Jackie Speier (D-CA 14th District), followed by a rousing presentation by Dr. Ernie Bodai as he described the role of advocacy in getting the postage stamp for breast cancer awareness passed. Finally, we were ready to go to Capitol Hill with our ‘asks.’

Now, what is my ‘ask’ for you? To get involved. You are our leaders and we need you to advocate for women and physicians. Plan now on attending the 33rd CLC in 2015 with Dr. John Jennings.

Guest Blog: The Value of Education and Outreach to Improve Global Women’s Health

Taraneh Shirazian, MD

Millions of women around the globe lack basic rights—rights to health care, rights to family planning services, and the right to lead long, healthy lives. Pregnancy and childbirth are major threats to women in underserved areas of the world with over 300,000 women dying yearly from their associated complications, unattended by trained medical professionals. While most of these deaths are preventable, these women need a voice to bring the world’s attention to what is truly a global crisis in women’s health.

As ob-gyns, awareness of the scope of issues faced by women internationally should be integral to our education. Only with this foundation can we prepare ourselves for the monumental challenges of global health care delivery. Ultimately, it is our collective responsibility as women’s health care providers to give voice to and promote care for these women, whether or not we choose to work at home or abroad.

It has been my work and passion over the last seven years to develop educational resources for health care providers interested in global women’s health, including a new online course. Preparing for cultural and ethical aspects of health care delivery abroad is critical and just as essential as our medical knowledge. These skills can also allow us to take better care of women here in the US.

All women’s health providers should educate themselves on these global women’s health topics, including maternal mortality, obstetric fistula, family planning, and female genital cutting.

I encourage you to be part of a global voice for women.

Taraneh Shirazian, MD, is assistant professor and director of Global Health in the department of ob/gyn and reproductive sciences at Mount Sinai School of Medicine in New York.

Building a Better Ob-Gyn—Retooling Resident Education

I recently had the honor to speak with some of our specialty’s greatest leaders—the educators and directors of our obstetrics and gynecology programs across the United States.

It was my first time attending the Association of Professors of Gynecology and Obstetrics (APGO)/Council on Resident Education in Obstetrics and Gynecology (CREOG) Annual Meeting. I was rewarded with inspirational and creative presentations on the challenges facing us about how we educate and how we learn. Do we learn best from the standard lecture and exam model? I don’t think so. Even I realized in medical school over 30 years ago—when I was balancing life with a newborn, a medical school heavy on lectures, and tests every few months—that students retain information better with interactive learning and retain more with case examples.

The APGO/CREOG meeting included engaging roundtable discussions on leadership and advocacy. Ob-gyn professors are looking at how best to train students for the next steps in their education. For instance, do we need to prepare students by instituting “boot camps” before they begin their first year in residency? How do we set milestone expectations for residents in their training? Our educators face the ongoing challenges of developing and maintaining ob-gyn resident surgical skills, teaching empathic patient care, and promoting and sustaining strong leadership in ob-gyn.

Residents and medical student attendees presented poster sessions on how they learn, what training was most effective, and the challenges they face. Some of the best parts of the program were the one-on-one discussions I had with these leaders in women’s health who are at the very early stage of their careers. Of course, I took the opportunity to discuss our national maternal health initiative, describe ACOG’s Well-Woman Task Force, and put in a plug for advocacy and our annual Congressional Leadership Conference (CLC).

Educating the future generations of ob-gyns in today’s challenging and quickly-changing health care environment will require the type of creative and provocative ideas that came out of the APGO/CREOG meeting. Here’s to all the ob-gyn professors and residency program directors who have been devoted to education for all the hard work that they do.

 

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.

 

Behind Many Olympic Champions Stands a Mom

I confess: I am an Olympics junkie. In 2012, I had the good fortune to spend two weeks in London for the Summer Olympics. Now, I’m getting ready to watch the Winter Games. I say I’m a junkie because I watch anything and everything leading up to the Olympics, and then I watch any event I can. Luge—wow! Snowboarding—so cool. And there’s curling, of course. And ice skating, downhill skiing, hockey, and speed skating. I love them all!

Now why would I mention this personal passion in my blog? Because of the moms. I enjoy the commercials that highlight the sacrifices of athletes—the arduous practice, the long journey, and living away from home are just a few of them. Then, the athletes acknowledge that it was their mothers who helped them succeed. Well, of course.

As we celebrate the Olympic Games, let’s remember that caring for all moms is our investment in the next generation. Optimum health does not happen by accident. Just as their child’s Olympic success depends on maintaining healthy lifestyle choices, including proper nutrition, avoiding tobacco and alcohol, and getting enough sleep, so, too, do moms need to make their own health a priority.

The Affordable Care Act ensures that moms—indeed all women—are covered for annual well-woman preventive health care with no co-pays or deductibles. Annual well-woman visits are important to help keep mothers healthy and strong so that they can raise healthy children. It’s all full circle!

So, let’s take a minute to applaud these mothers and remind all women that their children’s health begins with them. Here’s to the Olympics, to athletes, and to moms everywhere.

 

The ACA and OTC Medications – What Physicians Need to Know About Changes in Coverage

January 1 has come and gone, but many of us are unaware of some of the changes with the Affordable Care Act, particularly related to coverage of medications and supplements that became effective in 2014. For our patients who are enrolled in ACA-compliant plans, certain over-the-counter (OTC) medications are now covered at no cost when written as a prescription. Translation: Write prescriptions for these medications when medically necessary.

As an example, aspirin is now a covered medication under the ACA for women ages 55–79 when the benefit of reducing heart attacks outweighs the risk of gastrointestinal bleeding. The cost of OTC emergency contraception is also covered if a prescription is written for it. Vitamin D supplements are covered for women ages 65 and older to prevent fractures. And folic acid supplements are covered for women capable of becoming pregnant.

This change in insurance coverage comes at a time when research is looking closely at the benefits of supplements. Certainly all of us are confused at times when related research appears in the media and the benefits of vitamins and supplements are questioned. That’s why we as physicians need to make recommendations to our patients based on their individual needs. This ensures that reproductive-age women don’t forgo important and proven supplements—for instance, folic acid to reduce birth defects like spina bifida—based on a single study.

As physicians, we are in a position to not only recommend, but to reinforce the use of these medications and vitamin supplements for preventive health. It’s up to us health care providers to recommend and prescribe them.

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