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HPV infections usually resolve on their own

Thursday, October 27th, 2011

It’s become common practice among some OB-GYNs to test for HPV, the human papilloma virus, due to the association of some strains of this sexually transmitted infection (STI) with cervical cancer.

But testing of women under the age of 30 is inadvisable. Because, although at least half of all sexually active men and women will get genital HPV at some point in their lives, the immune system will fight off and remove most of these infections from the body with no treatment. Seventy percent are gone within a year and 90 percent within two years.

It’s that 10 percent of cases we have to watch for. Some of those will lead to precancerous lesions in the cervix which, if left untreated, can develop into cervical cancer. But this process takes from 15 to 20 years. So, testing women under 30 for HPV leads to false positives, more testing, and perhaps invasive procedures in women who are at little or no risk of developing cervical cancer from HPV.

The American College of Obstetricians and Gynecologists (ACOG) therefore recommends that women under 30 not be tested for this STI, and I agree. If a woman under 30 has one of the high risk types of HPV, and if it persists, there will be ample time to find it and treat it. If she has one of the lower risk strains, it will probably be gone with no intervention within a year or two.

– Yvonne S. Thornton, MD, MPH

Posted in General health news, Women's health issues, Women's health news | 2 Responses »
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There’s much more to an annual pelvic exam than a Pap smear

Tuesday, October 25th, 2011

You might have read that the U.S. Preventive Services Task Force now recommends that most women have Pap smears just once every three years instead of once per year.

Does that mean you can skip the OB-GYN appointment until 2014?

No, no, no, and no.

You must have a pelvic exam every year. Pelvic examinations save lives. A Pap smear, which can help identify cervical cancer, is just one part of that examination. Your OB-GYN does much more during your annual. She also looks for any evidence of ovarian cancer, vaginal cancer, myoma (fibroids) and other abnormalities of the reproductive tract.

And while it’s true that cervical cancer is typically a slow-growing cancer that takes an average 10 years to spread, sometimes these cancers “don’t read the books” and spread in a shorter period of time.

In my new health book, INSIDE INFORMATION FOR WOMEN, I tell you in greater detail what to expect when you have a gynecologic examination.

Don’t take risks with your health. Your “annual” is called that for a reason. Make sure you see your OB-GYN for your pelvic examination every year.

– Yvonne S. Thornton, MD, MPH

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Urinary incontinence? Help is available

Tuesday, October 4th, 2011

Many women are too embarrassed to talk to their doctors about urinary incontinence—which means that they may be suffering needlessly for a common complaint that often has an easy fix.

You’d probably be surprised to learn that about half of all adult women share this problem.

What’s behind urinary incontinence? There are several possibilities, including certain medications, but the two most common culprits are the loss of pelvic floor muscle tone, causing stress incontinence (urine escapes during activities such as exercise, laughing, or coughing), and over-active bladder (you feel the need to “go” more often than normal).

Stress incontinence can often be successfully treated with pelvic floor strengthening techniques called Kegel exercises. These exercises are remarkably simple to do, once you have the hang of it, and you can do them anywhere: sitting in traffic, watching TV, even at your desk.

If incontinence is brought on by an over-active bladder, different re-training exercises, including biofeedback and behavioral therapy, may be helpful. And there are several medicines that your doctor may prescribe, depending on the underlying causes.

What’s most important to know is that help is available, and not just in the Depends aisle of your pharmacy. Remember that you’re not alone in dealing with incontinence. Chances are good that about half of the women you know are dealing with some form of this disorder.

Don’t let embarrassment keep you from discussing this all-too-common issue with your doctor.

– Yvonne S. Thornton, MD, MPH

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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

Posted in Contraception (birth control), General health news, Health care policy, Women's health issues, Women's health news | No Responses »
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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

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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

Posted in General health news, Health care policy, Something To Prove: A Daughter’s Journey to Fulfill a Father’s Legacy, The Ditchdigger's Daughters, Women's health issues, Women's health news | No Responses »
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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

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Are You Taking Advantage of The New Health Insurance Appeals Process?

Wednesday, June 15th, 2011

One of the big advantages of the Affordable Care Act (a.k.a. the healthcare reform bill) is that millions of Americans who once had no recourse when their insurers turned them down for coverage, now can appeal. Insurance company turns you down for a transplant? Appeal. Says no to a life-saving procedure? Appeal. Insists that you have to pay for something you believe is covered under your policy? Appeal.

And your appeal won’t be decided by the same administrator who turned you down in the first place. Under the new healthcare reform law, health insurance appeals are decided by an independent decision-maker, one who has no financial stake in the outcome.

This provision can be a lifesaver … but only if you know about it and act on it within the 180-day timeframe permitted.

According to Kaiser Healthcare News:

The provision took effect for most plans Jan. 1. But in response to self-insured plans’ concerns about being able to meet some of the requirements, the government said it wouldn’t require the plans to tell members about their external appeals rights until plan years beginning after July 1. Since most plans start their new year in January, that means they won’t have to notify members about their right to external appeals and how to file them until next year.

However, the government isn’t granting enrollees more time to file appeals, said an official at the Department of Health and Human Services, who spoke only on the condition of not being identified. Patients have 180 days from the date of initial denials to file internal appeals to the plan. If the appeals are rejected, they then have another four months to appeal to outside arbiters.

If nobody tells patients about their rights, this provision, in other words, might not be discovered by the people who need it most until it’s too late.

So, I’m urging you to link to this post wherever you can: Facebook, Twitter, Reddit, any and all social networks. Explain the need to be informed. Tell your friends and family: you have a right to appeal. For some, it can be a matter of life and death.

Don’t let the chance slip away.

– Yvonne S. Thornton, MD, MPH

Posted in General health news, Health care policy, Women's health issues, Women's health news | No Responses »
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Dancing Away the Pounds and Inches

Monday, April 25th, 2011

If you’ve been watching Dancing With The Stars, you know that one of the stars, Kirstie Alley, is getting more out of her appearances than just some fun in the spotlight. According to ABC News, Ms. Alley says she hasn’t weighed herself in several weeks, but she knows she’s lost weight on the show because she’s dropped several dress sizes. The before and after photographs say it all.

This is a far cry from where she was when she started filming “Fat Actress” and her goal is to trim down even further.

Boy, can I relate, as I’m sure so many women can. Like Kirstie Alley (and maybe some of you), I’ve struggled with weight all my life. And like Kirstie Alley, I got down to my slimmest, healthiest weight when I got serious about ballroom dancing (although nobody has yet invited me to appear on Dancing With The Stars).

You can see more pictures of me at dance exhibitions and competitions, here.

Dr. Yvonne Thornton at the New York Hilton Dance Showcase

So many of us women don’t exercise enough and my guess is that’s because exercise, for the most part, isn’t a lot of fun. But dancing? Those of us who dance would do it if it didn’t offer any other benefits. Trimming down and staying fit are wonderful side-effects of a night of pure enjoyment – and there are other health benefits as well.

I’m so happy that dancing is catching on across the U.S. And Kirstie Alley is a great role model for those of us who didn’t start out with super-model bodies or metabolisms.

Give it a try. Even if you’ve never danced before, there’s almost certain to be a studio nearby where you can take your first lesson. You don’t need a partner; most schools will pair you up. You’ll feel great, you’ll look great, and you’ll have a blast.

See you on the dance floor.

– Yvonne S. Thornton, MD, MPH

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What’s a “Health Care Exchange” and Why Should You Care?

Wednesday, March 30th, 2011

One of the biggest changes in health care that comes as a result of last year’s vote to institute health care reform, hasn’t begun to take shape yet. This is the inception of the “Health Care Exchange” marketplaces – due to take effect by January 2014. And once the health care exchanges get rolling, we’ll finally see the full impact of health care reform.

But what is a Health Care Exchange, exactly, and how will it affect you? Think of it as a health insurance “store,” where individuals and small businesses get to choose the best policies for their needs. Only those insurers that meet certain requirements will be allowed to sell their policies in this “store.” For example, each insurer will have to offer plans with certain “essential benefits” and will not be able to deny coverage to those with pre-existing conditions, nor will they be able to exclude coverage for benefits that such people need. Most states will run their own Health Care Exchanges but some might opt to partner with neighboring states, while others might let the federal government run their exchanges.

A big question everyone wants answered: will insurance sold on the Health Care Exchanges be affordable? Here is where health care reform shows its muscle. Insurers, under the health care law, must pay out from 80 to 85 percent of premiums for health care costs. And, according to this article in the Washington Post:

People who make less than 133 percent of the federal poverty level, $14,484 this year, will qualify for Medicaid in all states, under the law. Above that, sliding-scale subsidies for private insurance on the exchanges will be available for residents who make up to 400 percent of the poverty level, about $43,560 this year. Most people will be required to have coverage of some sort beginning in 2014.

But probably the best cost controls come from the transparency of the Health Care Exchange system, because consumers and small businesses will be able compare one policy to another in terms of cost, coverage, deductibles, and exclusions, before they buy. And maybe – just maybe – that will bring health insurance costs in the U.S. more in line with other developed countries where people typically get much better coverage at much lower cost.

– Yvonne S. Thornton, MD, MPH

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