When Dr. Karen Johnson, a San Francisco psychiatrist, was in college more than 20 years ago, she suffered severe menstrual pain. Her doctor told her it was all in her head.
Now doctors recognize that menstrual pain is physiological, not psychological, and prescribe effective drugs for it. And Johnson, who was convinced by that experience and others that doctors for years have misunderstood illness in women, is among those suggesting a new prescription for medicine-developing “women’s health” as a separate medical specialty.
Dr. Lila Wallis in New York City says that when she started out as an internist 40 years ago, her training didn’t prepare her to deal with some of the basic medical problems of her women patients, such as vaginal infections. She had to educate herself about women’s health, she says.
Now Wallis, a professor of medicine at the Cornell University Medical College, is developing a course for primary-care physicians. It comes amid growing concern that treatment of diseases in women-such as AIDS and cardiovascular disease, the leading cause of death in women-is based wrongly on the effectiveness of treatment of those diseases in men.
Like many women working in health care across the country, Johnson and Wallis agree that medical care for women needs improvement. But they represent two opposing schools of thought about how to go about it.
Johnson and others-including many medical students and residents just starting their careers-argue that the only way to guarantee women top-quality care is to establish a separate specialty for women, just as doctors a century ago formed pediatrics when they realized children couldn’t be treated as small adults.
“It’s pretty scary for (women) to be going to physicians who are only trained in men’s health,” asserts Johnson, assistant professor of psychiatry at the University of California at San Francisco. But many others, including Wallis and Dr. Michelle Harrison, assistant professor of psychiatry at the University of Pittsburgh School of Medicine, argue that all fields of medicine need to revamp their training so all doctors can offer women better care.
“I’m not willing to settle for just a little piece of the pie,” Harrison says. “I want women to get respect and relevant care throughout medicine and every specialty.” Toward that end, some medical school professors have begun trying to change medical education.
Dr. Janet Henrich, an associate professor currently on leave from Yale University’s medical school, is working to develop a core curriculum on women’s health to be used in the Yale medical school and residency programs-the basic training for doctors. Part of the curriculum is expected to become a women’s studies undergraduate course to be offered for the first time this fall, according to Yale surgery professor Dr. Linda M. Bartoshuk.
Henrich says the teaching of women’s health largely is limited to electives at some medical schools and that she hopes Yale’s curriculum will become a model for other schools.
Henrich also works part-time at the National Institutes of Health in Bethesda, Md., which has embarked on the $600 million Women’s Health Initiative to study disease in older women.
In response to a request from the U.S. Senate Appropriations Committee that was included in the 1993 federal budget, the NIH is planning a survey of the country’s medical schools to determine how much time and attention the average medical education devotes to women’s health, according to Dr. Vivian W. Pinn, director of the NIH’s Office of Research on Women’s Health. Pinn says her office will be working on the project, expected to be completed in October, the end of fiscal 1993, with the federal Health Resources and Services Administration, as well as with representatives of various medical organizations.
The NIH and the Health Resources and Services Administration also are expected to come up with recommendations for a core medical school curriculum in women’s health, according to the Senate committee’s request. Pinn says Henrich is helping with the NIH project, since Henrich is working part-time as a special assistant while on leave from Yale.
At Cornell, Wallis, who is a past president of the American Medical Women’s Association, has been working with other doctors to develop a continuing education course on women’s health for primary-care doctors. The course is expected to be offered for the first time this fall in a three-day session in New York City.
Wallis says that although many courses have focused on particular medical problems in women such as breast cancer, this will be the first comprehensive continuing education course on women’s health.
The course will focus, for example, on specific medical “hazards” women may face, including cardiovascular disease, which Wallis says physicians often don’t think of as a female problem.
Johnson, who argues that doctors’ misunderstanding of everything from aging to AIDS in women has caused massive suffering and misdiagnoses, helped spark a national debate last summer by urging in the Journal of Women’s Health that physicians form a women’s health specialty. Harrison wrote a companion piece in the journal opposing such a specialty. The issue also was the focus of a conference in October sponsored by the University of Illinois at Chicago.
Johnson says many women in medicine are demanding change now partly because they’ve been around long enough to understand medicine’s shortcomings.
“It’s time. The women’s health movement started 30 years ago . . . and many of the women affected by it are now in positions of power in medicine,” she said in an interview. “We’ve worked in the system, we’ve gotten board-certified and served on committees, we’ve been good girls-and it ain’t enough, folks.”
Many in the health field say doctors haven’t focused enough attention on women’s health largely because women have been excluded from most research studies and doctors for years assumed that knowledge about disease in men could be applied to women.
