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Legitimate Rape or Legitimate Ignorance?

Thursday, September 6th, 2012

In February, there was a hearing chaired by Daryl Issa for the House Committee on Oversight and Government Reform Hearing on the Contraceptive Coverage Rule.  Unfortunately, the panel was entirely male.  Talk about oversight!  This prompted many female members of congress to walk out of the hearing in protest, much to the confusion of the chair.  When asked about the walkout, Senator Kirsten Gillibrand said, “If our republican colleagues want to continue to take this issue head on, we will stand here as long as necessary.”  In August, women received a fresh reminder of the Republican male’s perspective on rape when Representative Tod Akin proclaimed, “If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.”

Women around the world are wondering what constitutes the difference between rape and legitimate rape.  John C. Wilke, who is not an obstetrician, but a general practitioner of almost 90 years old, and who is the former President of the National Right to Life Committee is the only doctor who supports Akin’s remarks regarding whether or not the reproductive system of a woman shuts down during rape.  With such credentials, it goes without saying that he may have a bias and outdated view of rape and the female body, and experts disagree with his supposedly medical explanation for his belief.  In fact, one in 15 raped women become pregnant, no matter what definition of rape you choose.  Are Akin and Wilke suggesting that those rapes were not legitimate?  I doubt it seemed that way to the women when it was happening.

The most disconcerting part of all of this is that representative Akin has the power to influence laws in our country.  In this day and age, we hope that men have at least the decency and empathy to listen to the voices of women in our country, and, heaven forbid, include us in panels and decision-making regarding our own reproductive rights.  Hopefully, there are a lot of women and understanding men out there willing to make their vote count in order to make a positive change for all of us.  I wonder, is it pure prejudice keeping men like Akin in the dark when it comes to women’s health issues and reproductive rights, or is it legitimate ignorance?


– Yvonne S. Thornton, M. D., M. P. H.

Congress Upholds the Health of Americans

Monday, July 2nd, 2012

When Obama was elected president, most of America was anticipating his universal healthcare plan.  When the actual implementation of that plan looked as though it would be blocked though, many worried that he would be unable to deliver on his promise.  Luckily, Congress decided to uphold most of what has become known as “Obamacare,” and Americans in desperate need of affordable healthcare are celebrating.

According to the US Census of 2010, 49.9 million Americans were without healthcare and that number was on the rise.  Experts say this is in part due to the rise in unemployment and poverty, but also the weak economy causing businesses to cut back on expenses.  By 2014 though, all that will change.  Because the Supreme Court decided that Obamacare is indeed constitutional, more than 300,000 children who have pre-existing conditions will now find health insurance coverage.  That means that being sick will no longer prevent them or anyone else from getting the care they need to treat their sickness.  Additionally, kids will be able to remain on their parent’s health insurance plan until they turn 26, saving families a lot more money in the long run since they won’t have to pay for separate care.  Preventative healthcare benefits like mammograms will also be covered without copays, hopefully encouraging more people to take these precautions to catch issues before they became bigger and more expensive health concerns.

Although some find these new requirements to be a problem for small and growing businesses, businesses with wages less than 50,000 a year will actually receive tax credits for providing coverage.  Otherwise, these benefits will be paid for by increased taxes on Medicare Payroll for couples making more than $250,000 a year, unearned income like capital gains, and added fees for insurance companies, pharmaceutical companies and medical device manufacturers to name a few.  And to prevent those companies from simply upping their premiums, they will need to be more transparent about their costs and justify any “unreasonably” large healthcare premium increases.

Obviously not everyone is happy about the recent ruling, but as healthcare improves, I think all Americans will appreciate the improved health of our nation in the coming years.  Personally, both as a mother and a physician, I am thankful that the Supreme Court has finally ruled on behalf of the people.


– Yvonne S. Thornton, M. D., M. P. H.



Friday, May 11th, 2012

2012 -- The All-Male Leadership of ACOG

I just returned from the 60th Annual Clinical meeting of ACOG (Women’s Health Physicians).  I can’t explain it, but after being a member for over 30 years, it bothered me to no end to see ALL men on the dais as representatives of women’s health as if women couldn’t make policy about their own health.  When I was a resident, 95% of obstetricians were male.  Now, women comprise over 46% of practicing obstetricians and almost 80% of the OB/GYN resident physicians, YET all you see in the  governing body and officers (who set policy for the care of women) are 12 elderly Caucasian males.   Their very presence as leaders do not reflect the diversity of the ACOG membership today, yet there they are. No Blacks, No women, No minorities.  It’s as if ACOG were stuck in a time warp of 60 years ago!!  Since 1951, there have been only two female Presidents of the College and the last one was almost twenty years ago!  It seems so anachronistic and so wrong.

The male obstetricians have had the power to dictate and oversee women’s health for decades and it appears that they are NOT relinquishing it to any female any time soon; even if it pertains to women’s health!! It is a shame that in the 21st century, no one at ACOG (American College of Obstetricians and Gynecologists) is reaching out for inclusion of women and minorities in its upper echelons.  A picture is worth a thousand words.

– Yvonne S. Thornton, M. D., M. P. H.

Introduction of ACOG’s leadership

When Did My Uterus Become Politicians’ Business?

Tuesday, May 1st, 2012

As a working mother, I have made many decisions over the years regarding my health and the health of my family.  Those decisions were always made after careful consideration that included years of education, the beliefs of my family, and my own personal needs.  Not once during those processes did I ever consult with or even consider that politicians should also be debating those decisions.  It is shocking how much interest the government is suddenly taking in women’s reproductive health.  What should be personal choices made by American women, have now become the focus of debates for men who are looking for political gains and who frankly don’t have the biological parts necessary to even consider these topics.

Because Rick Santorum felt the need to prove his belief in traditional family values, he mentioned that women who are the victims of rape, should, “make the best of a bad situation,” in regard to their unwanted pregnancies.  While this may have helped him get a few more conservatives on his side, it did nothing to stop the suffering of women who, if he had his way, would continue to live out their traumatic experience by carrying and delivering the children of their attackers.  Trying to prevent unintended pregnancies altogether is even too much for Committee Republicans to keep their hands off of these days.  They would like to eliminate $12 billion of healthcare funding that would otherwise go to preventive services.  This would reduce access not only to birth control, but also cancer screenings and other types of care and services, especially those used by low-income women.  Republican Candidate Mitt Romney would like to create tax cuts that would benefit millionaires, hoping to spur job growth, but those cuts would come at a cost to programs that help women.  Obama seems just as puzzled by this as many American women, saying, “These are folks who claim to believe in freedom from government interference and meddling. But it doesn’t seem to bother them when it comes to a woman’s health.” The absence of women in power has become very obvious because of these issues.  Hopefully, they will inspire more women to vote and maybe even to run for office.

No matter what her position, every woman has the right to make her own decisions regarding her health, including her reproductive health.  Pressure from politicians, employers, and religious organizations should have no influence on her decision.  It is up to each individual woman to decide what beliefs to follow.  That’s why it is so great to be American in the first place.  We have certain freedoms that allow us to live our lives the way we choose.  While talking points like women’s reproductive health can mean big business for bureaucrats, they’re interfering with the personal freedoms of women and decisions that are, frankly, none of their business.

— Yvonne S. Thornton, M. D., M. P. H.

Great Scores Don’t Necessarily Mean Great Doctors

Monday, April 16th, 2012

If you’re planning to go into the medical field like I did, then you’re probably aware of the strict application process most medical schools will put you through.  If you don’t have the right grades or MCAT scores, you might not get into the school of your choice, no matter how badly you want to help people.  Unfortunately, this means top medical schools are letting in bright students who are great test takers, but who can’t take care of patients.

Being a physician is about much more than memorizing information from medical encyclopedias and science classes.  I’ve found that a strong sense of empathy and compassion for others, as well as a generosity of spirit has been crucial to my success in medicine.  It allows me to put myself in my patients’ shoes, which in turn gives me a better sense of what to ask and what to look for.

Many aspiring doctors don’t have the grades to get them into the top schools, but they may have more emotional intelligence than the students who beat them out for those spots.  Eventually, the positions of physicians are filled with very smart people who just don’t seem to take the time or care patients need.  It takes patience to listen to everything a patient has to say and then to dig even deeper.  It’s not about solving a puzzle as fast as possible.  It’s about understanding underlying issues that may not be obvious at first glance and knowing how to uncover them tactfully. It all goes back to bedside manner, which seems to have disappeared in an absurd dichotomy of doctors having the attitude “I know it all and you know nothing”. Doctors must listen to patients. Our patients know their bodies better than their doctors do. After all, patients live in their bodies. We only visit those bodies.

Luckily, after three years of study, the American Medical Association has realized this and is encouraging medical schools to look deeper into their potential students than just their test scores.  As a result, many are adding comprehensive interviews that attempt to find out who the applicant is as a person, not just as a student.  The Association of American Medical Colleges has also announced that it will be changing the scope of the MCAT exam to include more emphasis on psychology, sociology, and biology.  President of the AAMC, Darrell Kirch, said about the changes, “Being a good doctor is about more than scientific knowledge.  It also requires an understanding of people.”  I couldn’t agree more, and I hope this changing philosophy will help bring patients more compassionate and effective doctors.

— Yvonne S. Thornton, M. D., M. P. H.

Free Birth Control Coverage is Now the Rule

Wednesday, August 3rd, 2011

In keeping with the Institute of Medicine’s recommendations that free birth control be made available to all under their insurance policies, a new rule from the White House mandates birth control coverage without co-pays or deductibles. The new rules also cover domestic violence screening and breastfeeding assistance without co-pays or deductibles.

Starting Aug. 1, 2012, new health insurance plans will be required to cover women’s preventive care without charging a co-pay or deductible. The new guidelines require health insurers to provide FDA-approved birth control, including emergency contraception such as the morning-after pill, HIV screenings, and well-women visits, among other services.

The guidelines also include an amendment that allows religious institutions that offer insurance to their employees the choice of whether or not to cover contraception services.

– Yvonne S. Thornton, MD, MPH

Free Birth Control For All? Yes!

Friday, July 22nd, 2011

When you’re on a strict budget, out-of-pocket costs can convince a woman to forego birth control. But getting pregnant is a much more expensive proposition and comes with a lifelong commitment — one that many women are neither emotionally or financially ready to make.

The new health care law requires the Department of Health and Human Services to create a list of health services that new health insurance plans must provide without deductibles or co-pays. And the National Academy of Sciences’ Institute of Medicine (IOM) has prepared a report recommending that birth control be on that list.

…the Guttmacher Institute estimates that 98 percent of sexually active women will use contraception at some point during their reproductive years, and that cost concerns are frequently cited as a reason for inconsistent use or use of a less then optimal method.


In fact, Guttmacher said in testimony submitted to the IoM earlier this year, “Women citing cost concerns were twice as likely as other women to rely on condoms or less effective methods like withdrawal or periodic abstinence.”

Along with the recommendations concerning birth control, the IOM recommended a number of other preventive care services for women be made available without deductibles or co-pays:

…annual “well-woman” visits; screening of pregnant women for gestational diabetes; screening for sexually transmitted diseases, including HIV; more support for breast-feeding mothers; and counseling and screening for possible domestic violence.

I urge HHS Secretary Sibelius to accept the IOM recommendations. Women’s health issues have taken a backseat for too long.

– Yvonne S. Thornton, MD, MPH

How To Build a Better Doctor

Wednesday, July 13th, 2011

Ask anyone, if she could change one thing about her doctor, what would it be?

I’d bet that most would say that they wish their doctors spent more time really listening, really communicating, instead of rushing in and out of the exam room. Too many otherwise excellent doctors fail in the communications department. They act like they have more important things to do than set aside time for a relaxed heart-to-heart with a patient about her concerns. Arrogance isn’t an occupational hazard, but over a long career in medicine, I’ve met too many physicians with this counter-productive attribute.

I’ve always taken the time to listen to my patients, even if it meant that I didn’t get home by dinner or, when the kids were little, by their bedtime. But, to my mind, that’s a big part of what it means to be a good doctor.

At long last, it looks like medical schools are taking notice that a lack of people skills can be a real problem, and doing something about it. The New York Times reports that medical schools are evaluating prospective medical students’ social skills  through a series of “mini-interviews” along with their grades and test scores, and taking all into consideration when deciding who to admit to medical school:

The new process has enormous consequences not only for the lives of the applicants but, its backers hope, also for the entire health care system. It is called the multiple mini interview, or M.M.I., and its use is spreading. At least eight medical schools in the United States — including those at Stanford, the University of California, Los Angeles, and the University of Cincinnati — and 13 in Canada are using it.

…Virginia Tech Carilion administrators said they created questions that assessed how well candidates think on their feet and how willing they are to work in teams. The most important part of the interviews are often not candidates’ initial responses — there are no right or wrong answers — but how well they respond when someone disagrees with them, something that happens when working in teams.

Candidates who jump to improper conclusions, fail to listen or are
overly opinionated fare poorly because such behavior undermines teams. Those who respond appropriately to the emotional tenor of the interviewer or ask for more information do well in the new admissions process because such tendencies are helpful not only with colleagues but also with patients.

Medical schools have the capacity to train only a fraction of the students who want to become doctors. Those who are turned down often have test scores and grades that are about as good as those who get in.

A process that focuses on the whole person, not just numbers on a page, will ensure that those limited opportunities at medical schools are offered to people who will become the best doctors possible.

I applaud this new focus and hope that the same sort of screening is applied when evaluating residents, as well.

– Yvonne S. Thornton, MD, MPH

The Problem With Part Time Doctors

Friday, June 24th, 2011

As anyone who has read either of my two memoirs knows, I’ve worked long hours as a ob-gyn/maternal-fetal medicine specialist, throughout my career. While it’s been a challenge, at times, and I’ve had to juggle like crazy to be the kind of mother my children could always count on, it was the life I signed up for.

I don’t regret my career choices.  Becoming a doctor is as much a calling as a profession.

So, when I read an op-ed by a woman anesthesiologist, which criticizes a recent trend among women doctors to think of medicine as a part-time career, it struck a chord.

This section, in particular, offers food for thought:

Since 2005 the part-time physician workforce has expanded by 62 percent, according to recent survey data from the American Medical Group Association, with nearly 4 in 10 female doctors between the ages of 35 and 44 reporting in 2010 that they worked part time.

This may seem like a personal decision, but it has serious consequences for patients and the public.

Medical education is supported by federal and state tax money both at the university level — student tuition doesn’t come close to covering the schools’ costs — and at the teaching hospitals where residents are trained. So if doctors aren’t making full use of their training, taxpayers are losing their investment. With a growing shortage of doctors in America, we can no longer afford to continue training doctors who don’t spend their careers in the full-time practice of medicine.

… The Association of American Medical Colleges estimates that, 15 years from now, with the ranks of insured patients expanding, we will face a shortage of up to 150,000 doctors.

When you look at training in the medical profession as a scarce resource, provided to a small number of people, in whose hands others place their lives, you can see that it isn’t the kind of career choice you make lightly. It’s a commitment. And those who don’t feel the need to fully commit, who think of it as a profession in which they can dabble, do a disservice to the patients who need them, as well as to those who would have committed fully to the profession, if only they could have gotten into medical school.

In our do-your-own-thing society, this might seem like a harsh, even an unfair judgment. But medicine isn’t practiced for the benefit of the practitioner. It’s a service to our fellow men and women. And as long as there are so few of us that some people have long waits for needed care, those who choose this profession must be willing to be there when they’re needed. And if they can’t? There are plenty of other professions with lesser requirements.

– Yvonne S. Thornton, MD, MPH

Desperate Enough For Jail

Wednesday, June 22nd, 2011

The story of James Verone, who lost his health insurance when he lost his job with Coca Cola, epitomizes the dysfunction in our country’s health care system, until now. Health care reform would have given him access to insurance by 2014. He would have qualified for Medicare in 2017. But he can’t wait — he needs health care today. Because he has a growth on his chest today. And with no other way of getting a doctor to diagnose him and treat him, he decided his only chance was to get sent to prison, where health care is free.

But how would this lifelong law-abiding citizen find his way to prison?

He decided to politely rob a bank – just for a dollar – and ask the teller to call the police:

James Verone … limped into a bank in Gastonia, N.C., this month and handed the teller a note, explaining that this was an unarmed robbery, but she’d better turn over $1 and call the cops. That, he figured, would be enough to get himself arrested and sent to prison for a few years, where he could take advantage of the free medical care.

Just to make sure that no one was confused about his intentions, Mr. Verone made sure to let the teller know that he would be sitting on a couch in the bank, waiting for the police. Before he set out for the bank that morning, he also mailed a letter explaining his scheme to a local newspaper, The Gaston Gazette.

“When you receive this a bank robbery will have been committed by me. This robbery is being committed by me for one dollar,” the letter read. “I am of sound mind but not so much sound body.”

The next time you hear someone you know say that we should repeal health care reform, I hope you’ll share this blog post with that person.

– Yvonne S. Thornton, MD, MPH