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Speaking her language - finally

THE BALTIMORE SUN

Women's health care, long neglected by male-dominated medicine, is undergoing revolutionary change. Across the country, the health care industry is aggressively courting female patients and asking to tailor medical care to suit their needs.

The result is a vast array of new services, from educational seminars about breast cancer and domestic violence to comprehensive clinics that care for women from puberty through their post-menopause years. There's even an innovative clinic in Palo Alto, Calif., that specializes in helping older women smooth the passage through menopause.

"The trend is moving toward comprehensive women's care," says Linda Merkey, who oversaw the five-year, $13 million creation of Baptist Women's Center in Oklahoma City, one of the nation's most progressive facilities. "Women are wanting to take care of themselves and their families. . . . They want [that care] delivered by caring professionals -- doctors and nurses who will listen."

It's a difficult trend to quantify. There are no hard statistics on the number of women's health clinics, for example, because they're loosely defined. But industry officials agree that the range and number of women's services is growing, reflected by the rising number of people specializing in women's care.

The National Association of Women's Health Professionals, begun five years ago to serve women's-care specialists, already has 800 members. The movement is bound by a common philosophy: Give women what they want -- a voice in their health care, education in prevention and, ultimately, responsibility for their well-being.

"Health is not something that a doctor does for you. Health is something that you create in your life," says Dr. Charlea T. Massion, 42, an Aptos, Calif., family physician and co-founder of the Women's Health Forum, a national newsletter for doctors and medical students.

Given increasing health care competition, providers are eager to craft more appealing, convenient women's services. While a man often can be served by one doctor, women have their health care fragmented among an unwieldy array of three or more physicians. Gynecologists care for their reproductive health and an internist might oversee breast-health concerns and give diagnostic tests, while a family practitioner is their primary physician.

"I think it sort of splits up their body, and no one health care provider has an overall view of them," says Dr. Massion, who's also a clinical assistant professor at Stanford University.

Concerns that this patchwork approach to women's care has dangerous gaps are supported by recent studies showing that tests for cervical and breast cancer are often overlooked -- particularly if the doctor is a man.

Women's growing dissatisfaction with this haphazard approach is fueling the demand for specialized care.

"The baby boomers are reaching midlife, and they're facing breast cancer and menopause and osteoporosis," says Susan Millar, the marketing specialist for women's services at Alta Bates Medical Center in Berkeley, Calif.

"They're not going to face these issues like their mothers did. They're used to being active in the decisions concerning all aspects of their life. Just like when they became active participants in childbirth -- Lamaze classes grew and fathers were brought into the delivery room. Now they're reaching a different phase of their life, and they want to know about it."

Women are packing educational seminars at hospitals.

When Alta Bates sponsored a seminar by writer Gail Sheehy after the release of her best-selling book on menopause last year, they sold out 400 $15 tickets in a day. "It was the most talked-about thing around town, and women were frantic to

come and hear Gail talk," Ms. Millar recalls. The hospital ended up filling a 1,700-seat auditorium.

In San Jose, Calif., women routinely jam Good Samaritan Hospital's 300-seat auditorium for seminars ranging from juggling work and family to living longer.

"We get calls from women saying, 'Boy, you're fulfilling a need,' " says Gina Fogelstrom of the hospital's parent company, Health Dimensions Inc. Last year, Ms. Fogelstrom was asked to coordinate women's and children's services at the firm's three area hospitals, Good Samaritan, San Jose Medical Center and ** Gilroy's South Valley Hospital.

TTC Some medical groups specialize in offering care for women and by women. At the Women's Health Group in Portola Valley, Calif., co-founder Dr. Barbara A. Peters says talking with a woman about her family life can be just as important as taking her pulse.

"Women tend to want to talk and communicate about feelings and their family and how that relates to their health," she says. "And I think it does, and it's wonderful to address that instead of just looking at the physical, because that's only one component of the human being."

A pioneer in women's care in the San Francisco Bay area for a decade, the group's all-female staff -- five obstetrician-gynecologists and a nurse-midwife -- considers its patient relationships a lifelong collaboration.

"Women who come to see us are looking for more of partnership than a paternalistic relationship with a physician," says Dr. Peters, 39.

"They're given the information and encouraged to participate. . . . What you eat, whether you exercise and what your attitude is about your health has a tremendous amount to do with how healthy you are."

The doctors say they not only care for women's bodies, but also about the social adversities they face -- alcoholism and depression, single parenthood and violence.

For example, Ms. Massion notes a Stanford researcher's finding that one-quarter to one-third of women in chronic pain studies had been molested as children.

"If a women comes to the hospital complaining of abdominal pains, she'll get ultrasound tests, endoscopies [probes] and X-rays and biopsies," she says. "But if no one asks her if she has a history of sexual abuse, you can spend thousands of dollars and come up with nothing and tell the woman that her pain is in her head, when she's feeling it in her abdomen. No one's satisfied."

Women say specialty centers give them something simple they haven't found before: physicians who speak their language -- and listen, too.

Kay Lloyd, 49, of Los Altos Hills, Calif., recalled futilely searching for two years to find a physician who could explain her exhaustion, aching joints and uncharacteristic crankiness.

"I'd just been begging people for years to explain this bizarre stuff that was going on with me. At times I thought, 'Maybe I'm losing it,' " says Ms. Lloyd, a mother of four grown children.

But when she asked her male gynecologist, "Could this be menopause?" he replied that she was too young.

Finally, Ms. Lloyd says, a friend in her mid-40's asked: "Hasn't your doctor checked your estrogen level?" "I said, 'My what?' "

The friend suggested Lifespan, a 2-year-old Palo Alto clinic specializing in caring for women in their peri-menopausal years. The clinic grew out of the longtime obstetric-gynecology practice of Dr. Davis Baldwin and nurse-practitioner Patricia Baldwin, a husband-wife team.

Ms. Lloyd credits the Baldwins with fine-tuning hormone-replacement therapy -- she wears a skin patch -- and giving her the guidance that helped her reclaim her life.

"I've got energy. I feel great," Ms. Lloyd says, adding that relief came within days. "It's like someone threw a switch."

WOMEN'S CARE

These three forces are helping reshape women's health care:

*As have auto makers and firearm sellers, the health care industry has realized that women wield financial clout. They make 75 percent of the decisions for their familyUs health care, according to the American Hospital Association. Hospitals hope a satisfied female customer also will bring them her husbandUs heart surgery, her child's tonsillectomy and her aging motherUs stroke-prevention care.

*As the baby boomer generation matures, womenUs needs are shifting from childbearing services to care for menopause and its accompanying risks of heart disease and bone loss. Women are hungry to learn ways to stay well. They want education about nutrition and exercise and the benefits of non-traditional practices, such as acupuncture and meditation.

*As the female risks for heart disease, lung and breast cancer increase, a generation of assertive working women isnUt sitting around worrying. Taking a cue from AIDS activists, women are uniting in grass-roots educational networks and successfully pushing for expanded research on female health care.

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