Time constraints make it difficult for the average physician to think about their patients holistically. After all, they often see a different patient every 20 minutes.
Within this tight timeframe, the physician must consider and provide recommendations that account for the unique needs of the patient. That includes their health history and circumstances in their life that may impact their health.
On top of that, during each appointment, physicians are responsible not only for delivering high-quality care but also for fostering a relationship with each and every patient. This can be difficult given the heavy workloads most physicians already bear.
However, taking the time to form a relationship with each patient is absolutely critical to patients’ health and wellbeing. This is especially true for women, who face systemic and disproportionate barriers to accessing quality healthcare.
Medical training teaches us that every patient is different. However, we are not necessarily taught how to account for these differences. Nor do we learn how to address the challenges some face when trying to access costly treatments or medicines.
Policy, regulatory or managed care limitations are often out of our control, such as insurance not covering the birth control option the patient wants. Changes to federal funding could make this even worse, directly impacting a physician’s ability to offer the best options to women with lower incomes.
The “red tape” and politics related to these issues can drive physicians to avoid discussing them with patients. However, physicians cannot ignore these very real barriers many women face.
A holistic approach is critical in women’s health
Treating the whole patient is especially critical in women’s health where many physicians find themselves inadvertently providing “one-stop-shop” care. While women ideally would go to a variety of physicians to take care of all their concerns, the reality is that many turn to one physician for most of their needs.
This doesn’t mean that physicians should work outside of their primary specialty. But they should be prepared to listen to all concerns presented by patients and consider a holistic approach for their care. No matter the physician specialty, this can include asking about sexual/reproductive health, mental and physical health.
Physicians can use this information to refer a patient to the proper specialists and to provide her with relevant information and resources. It also gives the physician a better idea of the patient as a whole, which makes it easier to provide medical advice and treatment tailored uniquely to her.
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Overcoming the stigma related to talking about reproductive health
When it comes to discussing reproductive health, specifically, we must be mindful of the lifetime of the stigma some women have faced when talking about their reproductive health and sexual history. It is not uncommon for women to hide certain symptoms of reproductive health problems. For example, they may be uncomfortable discussing their sexual health and menstrual cycles.
Women may also be afraid to raise concerns with their physician for fear of asking a “dumb question.” This fear can prevent women from having quality conversations with their doctors. It can also lead many to leave the physician’s office with unasked questions and a lack of information about the best treatment options for them.
Physicians can play a pivotal role in overcoming this issue by educating and empowering their patients. First, we can give patients the opportunity to ask about these topics. We can open safe dialogs about their experiences with the following topics:
- menstrual cycles,
- sexual health,
- mental health
- domestic violence
- and, other topics that the patient’s wellbeing.
By prompting our patients and asking in-depth questions, we can kickstart a good conversation that empowers the woman to speak openly about her health needs.
Women need to understand their options
We also need to ensure that patients are aware of all their options. You would be surprised at how few women I speak with (or even doctors) know that there are 18 FDA-approved birth control methods. The best available treatments for that individual patient may not be considered if a woman or her physician are not educated on the options.
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Far too often, I hear horror stories about women who had issues with their contraception. Too often, these negative experiences cause women to stop using contraception altogether. Only later do they learn that there was a better option that was more suited for them.
I have also met countless women who were prescribed a contraceptive that was unaffordable because they didn’t have insurance for whatever reason. Both cost and insurance play a huge role in a woman’s ability to obtain medicines. We must keep this in mind in the examination room when discussing recommendations with patients.
Physicians need to understand the woman’s experience more broadly
While women are all too familiar with the obstacles they face, their physicians may not be. It can be easy for us to not look at the broader picture when we are speaking with our patients. Instead, we should be looking closely and reading between the lines.
We should ask ourselves the following questions:
- Does she sound like she is afraid to share her sexual history?
- Does she allude to a lack of open conversations about birth control with her family or friends?
Physicians can take this opportunity to put themselves in the patient’s shoes and see it from their perspective. We can try to understand why they are scared. And what we can do to make them feel more comfortable.
Physicians’ role in women’s lives
Physicians can play a powerful role in combating the systemic challenges women face in accessing healthcare. Once physicians become more aware of the different issues faced by patients, we can then arm them with the right information.
Simply asking a question that a patient is afraid to bring up herself can make a huge impact. It can spark a conversation. When we create an open and honest dialogue with our patients, we empower them to ask more questions and educate themselves.
Patients who are informed can achieve better health outcomes, including those that are related to reproductive health.
Understanding nuances such as stigma, affordability and other challenges women face in accessing healthcare enables physicians to provide better, more personalized care.
We may not be able to solve every problem, but we can push ourselves to understand the whole patient and guide them toward the best treatment options.
Only with a concerted effort can we make the exam room a safe, educational and empowering space that allows every woman to have more productive and personal conversations about her health.
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This post was first published on August 26, 2019. It was reviewed and updated on March 10, 2020.