July, 2011

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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