Does where you live affect the type of treatment you will get?
June
13 ,
2008
On MSN.com yesterday, they had a great article about differences in medical care across different geographic regions of the country. I, of course would like to zero in on the women's health issues.
The article raised the following interesting points regarding women's health care:
The Western States are doing a bad job with women's preventative health care. In 2006, less than 70% of women over age 40 in "big sky" states like Idaho, Utah, and Wyoming had gotten a mammogram in the past 2 years, compared with the national average of 77%, according to the CDC. The proportion of women getting Pap tests is also relatively low — though both tests have been shown to save lives by detecting cancer in treatable stages. Another preventive tool, cholesterol screening, also lags in many of these states.
Southern women are more likely than women elsewhere to have their uterus removed for problems such as fibroids — 6.2 per 1,000 women in 2004, compared with 3.7 per 1,000 in the Northeast, according to the most recent data from the CDC. (Rates for the West and Midwest fell in between.) Southern women also tended to have a hysterectomy at a younger age, 44, on average, compared with age 49 for women who have the surgery in the Northeast.
As we have discussed numerous times in this blog, the use of hormone replacement after menopause has declined since the release of the WHI trial, (see our blog posts from 2/10/08, 2/17/09, 2/24/08, 3/2/08 an 3/9/08), In Louisiana, the number of women filling estrogen prescriptions shrank about 40% from 2000 to 2006 — but tumbled a full 74% over the same time period in Mew York
Although numerous studies have shown virtually equal survival rates for women who get breast-conserving lumpectomy versus those who have a mastectomy, treatment varies significantly from state to state. In a 2006 study at the University of Louisville, 71% of breast cancer patients in the Northeast had a lumpectomy, compared with just 63% of women in the Southeast.
I got the feeling when I read the article, that the writer was putting most of the blame for these discrepancies on the physicians. Now of course I am biased toward physicians, so I must admit that at the outset. The article seemed to blame several different factors. The way doctors are trained, the patterns of treatment that they are "used to", the policies of different health care insurers, and various other factors.
One thing they seemed to neglect was the different cultures of the patient population that may affect how people choose the types of treatment they will get. I can tell you from personal experience that in some cultures getting a hysterectomy is sen as a "right of passage" that every woman expects, while in other cultures it is frowned upon and looked upon as a last resort.
I am sure that the attitudes of different populations strongly affect the decisions a woman will make regarding her care. I know that if I do the exact same type of counseling with the exact same medical scenario, some patients will choose one route, while others will choose a second or third way to treat their problem. This is how it should be, and I am not so sure we should be pointing fingers at the health care establishment so quickly before we assess the true cause of the problem, or maybe it isn't even a problem at all.
The "Downsizing" of Maternity Leave
June
11 ,
2008
Today's Wall Street Journal reports on the latest trend in corporate downsizing - maternity leave. Sue Shellenbarger writes, "At a time when many consumers are scrambling for cash, working parents face an added source of pressure: a squeeze on maternity-leave pay and time off." Read her full article here.
I'll quote here just a sampling of her scary numbers:
Only 16% of employers offer full pay for childbirth leave, down from 27% in 1998
The average maximum length of job-guaranteed leaves for new mothers shrank too, to 15.2 weeks from 16.1 weeks a decade ago; leave for dads fell to 12.6 weeks from 13.1.
New mothers' average time off work has already taken a nose dive since the early 1980s, the Census Bureau says; only 42% of working mothers took more than three months as of 2002, the latest data available, down from 54%.
So what are people doing to cope? Well, you have two choices. You can work and spend less time with your new child, or you can spend more time with your child and have less money. What a tragic choice.
IT gives us klittle comfort to find out that, according to Shellenbarger, "Employers aren't deliberately targeting new mothers with pay cuts; rather, maternity leave has been caught in the crossfire over rising disability costs in general. Most maternity-leave pay in the U.S. comes in the form of disability pay, allotted for the six to eight weeks typically needed to heal after childbirth. New mothers are being hit by a cost-cutting move among employers toward paying only a fraction of full pay to workers on short-term disability, rather than 100% as was common in the past, as an incentive for employees to return to work as soon as they're able."
OK, so maybe they're not discriminating against new Moms specifically, but the effect is still the same. We can all agree that there are immense sacrifices that new Moms (and Dads) have to take in so many areas of life, but it is a shame that our society cannot find a better way to have healthier happier children, and still make a living.
According to Dr. Brian Mckinstry, wrting in the British Medical Journal, there may be too many women doctors in great Britain! Now, before you excoriate him as a sexist bigot, listen to what he has to say.
This article in the BBC news gives a nice summary of the arguments, but basically his reasoning goes like this:
Women are less likely to be involved in research
Women are more likely to work less hours because of family obligations
More than 60% of Medical school students in Britain are female, so the mix does not reflect the general population.
So now he is arguing for affirmative action for men! Have we come full circle?
I am not sure of this but I think that in the US, there is a more even split between men and women. Part of the "problem" is because in Britain, students choose to go to medical school right out of high school, and they then start a seven year path of college/medical school. In the US, students don't have to choose their career path until their college years. Maybe the boys might need a little more time to msature before they make their decision to devote their lives to medicine. I wonder if the younger boys are still dreaming of "hitting it big" in the business world and after a few years of higher education they may become more idealistic. Just a theory.
Anyway, the counter-argument of course is...who cares? As long as we have competent and caring physicians, what difference does it make what their gender is?
Doctors don't answer e-mails? They must've missed AskMyGyn.com!
June
03 ,
2008
Check out this article by CNN health. According to these guys, most patients would love to be able to email their doctors, but most doctors are afraid to use email. They'll get swamped with emails, they won't get reimbursed for their time, the e-mails might be exposed to other viewers and compromise patient confidentiality, these and more are the reasons why doctors are not using emails. Patients, on the other hand are ready and willing to use email, according to CNN.
What do you think, should we tell them our secret? Why don't they just Ask My Gyn?
