Thursday, December 15, 2016

Professionalism: More than Skin Deep

A recent email I received from a medical community website featured a collection of articles about women in medicine. The first one I read was titled “Does Makeup Matter?” and it discussed the pressures of keeping up appearances in the workplace and how women who wear makeup are perceived (apparently more dominant by other women and more prestigious by men). While the contents of the article are not groundbreaking, what struck me was the overwhelming response readers had to it. Most articles on the site spark little conversation – maybe a comment or two – but in this case the discussion goes on for pages, with contributions from female physicians of all ages and all fields. Some argue that makeup is a waste of time or distraction for women who have such busy and demanding jobs. Others believe that taking the time to look one’s best is a sign of respect to patients. Despite differing opinions, many can agree that wearing makeup is a personal choice and that a woman’s competency as a physician should not be judged by her appearance. This seems obvious, and slightly ridiculous to have to state, but I think this discussion represents the greater inequalities and struggles women in medicine are still facing.

Some women I’ve talked to feel they have never seen or experienced differential treatment in a
clinical setting. Unfortunately, I think they may be in the minority. I hear too many stories of
inappropriate comments made to women on rounds, or patients wanting to hear from male interns
rather than female attendings. As a student, I have been addressed as “nurse” on a regular basis by
patients. I have been told by classmates that I am graded more leniently or pimped less on the
wards because the male attending “likes girls better.” I have even watched a male patient tell a
room of female doctors that he thinks his pulmonologist is smart “despite being a woman.”

At my most recent residency interview I asked a resident about her experience finding mentorship
and research opportunities in GI, the fellowship into which she recently matched. She told me that
she struggled a lot during her intern year because all of the GI faculty members at the program
were male and it was hard for her to “break in.” We discussed how many specialties in medicine are
still so male- dominated and difficult hard it can be to find female mentors. It made me think
about how grateful I am for Drexel’s WHEP and how important it is that institutions have similar
outlets for women in medicine to connect.

As in the rest of the country, sexism in medicine is nowhere near dead. The fact that women are
debating how they are perceived when they wear makeup to the office or the hospital is clear
evidence. I find solace in groups that allow women in medicine to get together and provide support
for one another. However, I continue to hope that in a field that is composed of 50% women, the
necessity for such support will eventually lessen.
                                                                                                                            Alex Pogosky
                                                                                                                            DUCOM 2017

Monday, November 28, 2016

How Will a Trump Presidency Impact Your Health?

No one is sure how the astonishing election of Donald Trump as president will impact health care in the United States. But with the backing of a Republican-controlled Congress, experts are warning Americans — and especially the 20 million who have gained health insurance through the Affordable Care Act  (ACA) — to expect big changes.

Trump has promised to repeal Obamacare (the ACA).

While the Senate may lack the 60 votes needed to completely erase the ACA, it’s clear that Trump plans to challenge the law, which Republican leaders will be happy to help him with.  On the other hand, a number of Republican leaders and Trump himself have said there are provisions that are likely to stay, include keeping coverage for those 26 and younger if they are under their parents’ insurance plan, and banning the bar on people with preexisting conditions from getting insurance.

If all parts of the ACA are eliminated, it could put many Americans’ health in jeopardy.  Doing away with the law could lead to:
  • Up to 25 million Americans losing health insurance. These people are primarily working-class, most with a high school or less education. About 40 percent are young adults and half of them non-Hispanic whites.
  • Insurances going back to denying coverage for pre-existing conditions like hypertension or cancer, or writing stiff premiums — if they offer coverage at all.
  • Young adults under 26 being kicked off their parents’ insurance.
  • Death rates rising — people without insurance have about a 25 percent increase in death rates as compared to those who are insured.
  • Health care exchanges being eliminated.

Trump wants to give states more freedom about how to allocate Medicaid funds by turning the social health care program into a block grant program.

Sounds good in theory, but increasing state’s latitude of funds on Medicaid dollars — usually in the form of state grants — rarely helps the health of the population.  States who cut back on taxes, and therefore have less revenue, can redirect these block grants to other state needs that are not health-related. The impact of poorer health conditions result in sicker, later arrival to care and increased health expenditures, as well as potentially avoidable, adverse health outcomes or deaths.

Women’s access to abortion could be limited.

Full and comprehensive care for women means women can choose when and if they have children, It means they have access to reproductive services and can have planned pregnancies when it makes the most sense for them and their families.  With so-called Targeted Regulation of Abortion Providers (TRAP) laws, lawmakers have already made it challenging, if not impossible, for many women to have access to safe, legal abortions in many states. In June, the U.S. Supreme Court struck down parts of a restrictive Texas law that could have drastically reduced the number of abortion clinics in the state.

But if enough vacancies arise on the Supreme Court while Trump is president, he could appoint conservative justices, who might tip the balance of the court enough to overturn the legal precedents set forth in Roe v. Wade, the 1973 decision that struck down state laws that banned abortion and formed the bedrock for our current protections of reproductive rights. It is likely that Trump will have to fill one, and as many as three, vacancies on the Supreme Court during his term.

The current political regulations by those in government have made it such that most poor women have little or no access to termination as a reproductive option. So, in fact, repealing Roe v. Wade is likely to affect middle and higher income women more than others. During his candidacy, Trump also promised to defund Planned Parenthood. Further, some women are concerned that a Trump administration might end ACA provisions that require insurers to cover intrauterine devices (IUDs) and other types of contraception.

Mr. Trump has demonstrated his unpredictability. It is not clear he is as aligned with other members of his party, ideologically speaking. Hopefully, recognizing the needs of women, he will not support a war on women and women’s health. Hopefully, he will demonstrate a practical stance in this matter — not one blindly adhering to his party’s most extreme members.

Excerpted from an interview with
Ana E. Núñez, MD
Professor of Medicine, Associate Dean of Diversity, Equity & Inclusion



Friday, November 11, 2016

Election 2016: Mourning in America


Think deeply about the words of Hillary Rodham Clinton -

“This loss hurts, but please never stop believing that fighting for what's right is worth it…

We need you to keep up these fights now and for the rest of your lives.  So let's do all we can to keep advancing the causes and values we all hold dear …  breaking down all the barriers that hold any American back from achieving their dreams … people of all races and religions, men and women, immigrants, LGBT people, and people with disabilities.

 And -- to all the little girls who are watching this, never doubt that you are valuable and powerful and deserving of every chance and opportunity in the world to pursue and achieve your own dreams.”

                                                                                                                                                Judith Wolf, MD
                                                                                                                                      Associate Director, WHEP

Friday, October 7, 2016

Image result for pregnancy silhouette

While searching for an article to present for my journal club in July, I knew I wanted to talk about something new and relevant to my chosen field of Ob/Gyn. When I came across a recent article in the NEJM published by a group of Maternal-Fetal Medicine physicians, I was immediately intrigued. The article, titled “Antenatal betamethasone for women at risk of late preterm delivery”, is a double blind randomized control trial  (ALPS trial) that assessed if giving women antenatal steroids between 34.0-36.6 weeks gestation decreased neonatal respiratory complications. At the time, I thought this was a very relevant topic as I had just studied for Step 2 CK and encountered many questions that asked about when to give or not give steroids for lung maturity.  The answer for boards was always that before 34 weeks, give steroids, and after 34 weeks, don’t. 

This study aimed to shed some light on what to do about infants who are born in the late preterm period, between 34.0 weeks and 36.6 weeks. There previously had been little conclusive data regarding the benefits of antenatal corticosteroids for fetal lung maturity in this gray area. Study participants were randomized into a treatment group, who received 2 doses of betamethasone 24 hours apart, or a control group, who received 2 doses of a placebo 24 hours apart.  The primary outcome for the study was a composite result made up of several factors: the use of CPAP or high-flow nasal cannula for at least 2 hours, supplemental oxygen with an FiO2 of at least 0.3 for 4 hours, ECMO, or mechanical ventilation. There were several other secondary outcomes including rates of transient tachypnea of the newborn, bronchopulmonary dysplasia, and surfactant use. The study found that the primary composite outcomes occurred less frequently in the treatment group vs the control group (14.4% vs. 11.6%, RR 0.80, 95% CI 0.66 to 0.97, P=0.02). Several of the secondary outcomes occurred less frequently in the treatment group as well.

Very soon after this article was published, the American Congress of Obstetricians and Gynecologists (ACOG) released a practice advisory stating “administration of betamethasone may be considered in women with a singleton pregnancy between 34.0 and 36.6 weeks gestation at imminent risk of preterm birth within 7 days”. I found out first hand just how relevant this new data was on the first day of my OB sub-internship this month, when we had a patient at 35 weeks and 5 days and the attending turned to me and asked “have you heard of the ALPS trial?” Over the past 2 weeks, I’ve seen 3 patients in the late preterm period receive betamethasone based on the findings from this study. It’s pretty cool to see the positive impact of research on daily practice!


Article reference: Gyamfi-Bannerman C, Thom EA, Blackwell SC, Tita AT, Reddy UM, Saade GR, et al. Antenatal betamethasone for women at risk for late preterm delivery. NICHD Maternal-Fetal Medicine Units Network. N Engl J Med 2016; DOI: 10.1056/NEJMoa1516783. PMID: 26842679.

Kelly Guttman, MS4
Women's Health Pathway