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into its essence: Making a diagnosis,
writing a prescription and feeling that
he has completed his business. But this
does not always fill women's needs.
Appropriate doctor/patient communication
is not just a nice frill.
Studies have shown that high blood
pressure and diabetes are better controlled
when there is good communication
between doctors and patients.
So reducing fragmented care by
training one specialist to provide contextual,
comprehensive primary care
to 52% of the population—and an
even larger proportion of users of the
health-care system—may help hold
health costs at a reasonable level while
actually increasing quality of service.
And we do need to extend care to
more women. According to the Commonwealth
Fund's Commission on
Women's Health, 36% of uninsured and
13% of insured women do not receive
needed care. Because women are more
likely than men to be poor and
employed part-time or not at all, they are less likely to have
access to needed medical care than men. Within the current
paradigm, older women, poor women, women of
color, disabled women, lesbians and bisexual women, in
particular, very rarely receive the level of care appropriate
to their needs. More than one-third of women do not seek
or receive Pap smears, mammograms, pelvic exams, breast
exams, or a complete physical. The rate is even higher for
elderly women. Many women have significant risk factors
for heart disease, lung cancer and osteoporosis, but no
knowledge of risk reduction.
OTI: What do you say to the charge that a women's health
speciality is simply a marketing tool, or that it's designed
to solidify the power of women physicians
EILEEN HOFFMAN: Many of the "women's centers"
now being developed by hospitals are, indeed, just a
marketing tool. Pink curtains in the dressing rooms may
be the only significant change. The centers are created to
do tests on women—bone scans, mammograms, and so
on. Many centers do not offer comprehensive, integrated
medical care. So I understand why people are wary.
Some critics are concerned that a specialty in women's
health will attract predominantly female providers, which
will make it less prestigious and underpaid. It's true that
women doctors are leading the efforts in women's
health-care reform. This has led some male physicians to
suggest that a specialty in women's health may be just a
ploy by female physicians to corner the market. And
there are some male physicians who worry about their
economic futures, now that women patients explicitly
Dropping the laboring woman on the bed was an ancient method of hastening
childbirth among the ancient Greeks in the time of Hippocrates.
prefer women physicians—a kind of arbitrary discrimination
men have rarely experienced. But let's be clear:
Women's health refers to the sex of the patient, not the
sex of the physician.
The need for a specialty becomes clearer when you
consider nutrition. No physician questions the value of
good nutrition in maintaining maximum health and
speeding recovery from medical conditions and surgical
treatments. However, physicians cannot specialize in
nutrition and most medical students have little or no
nutritional training. The same fate awaits women's health
unless it becomes a specialty. Currently, students and
physicians interested in women's health must make a personal
effort to learn about the field.
So it is not until women's health is institutionalized and
becomes a focus for research that substantive changes will
be realized. I think the only way to assure that women
receive medical care on par with men is the development
of a formal interdisciplinary primary care specialty in
women's health. Training would include sex- and genderspecific
information assuring that women's health and illness
is examined within the context of their complex
hormonal and social milieux. Politically, it is from the
power base of a specialty in women's health that efforts to
mainstream better treatment into the internist's office and
the gynecologist's office are most likely to be successful.
A specialty in women's health will be an explicit
acknowledgement from the medical profession to women
that it will no longer use men as the standard. I think it
should be the next demand of the feminist movement in
the health arena. This is an excellent way for medicine to
regain the trust it has lost among women patients. •
ON THE ISSUES WINTER 1995
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