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Why your Ob-Gyn should be board-certified

Wednesday, July 22nd, 2009

It’s almost impossible to judge a professional’s skills if you’re not a member of that profession. Only a radiologist can say whether another radiologist accurately read a CT scan. Only a dentist can attest to the quality of the crown another dentist fits over a molar.

So how do you, a layperson, judge the qualifications of your doctor? If they drive fancy cars, wear designer clothes, and charge the highest fees in the community, you can be sure they’re successful. But does that mean they’re qualified? You can ask your girlfriends or your sister or mother to recommend someone. You can determine whether you have rapport with a physician. But that won’t tell you about qualifications, either.

If you want to know whether the kind, caring person you select has the minimum qualifications, there’s one way to determine that. Go here to see whether your doctor is board-certified.

Board certification isn’t mandatory. Once a doctor gets a medical degree and a state license to practice medicine and surgery, he or she can practice any specialty. No law requires a doctor to complete a four-year residency in a specialty, such as ob-gyn, in order to be called a specialist. Nothing prevents a doctor from giving him or herself the title of obstetrician or fertility expert or perinatal specialist or really, almost anything.

But only board certification assures you that the doctor has earned that title.

A board certified doctor has gone a giant step further than a physician who hasn’t passed her boards. After completing a residency program, passing a written test in the specialty, and practicing for a year or two, she’s gathered up all her cases and submitted them to an august body known as the American Board of Obstetrics and Gynecology. Before these distinguished university professors and chairs of departments, she’s been extensively questioned about real and hypothetical situations and asked about diagnoses, patient management and treatment.

As an oral examiner for the American Board of Ob-Gyn since 1997, I’ve certified hundreds of new ob-gyn candidates who have proven their capabilities under difficult circumstances. And there were some who did not pass because they didn’t meet those high standards.

So I speak from experience when I say that board certification is the minimum you should expect from your doctor.

Yvonne S. Thornton, MD, MPH

Danish study links hormone replacement therapy to ovarian cancer. Should you worry?

Tuesday, July 14th, 2009

In the news today is a Danish study, published in the Journal of the American Medical Association (JAMA), that indicates there may be an increased risk of ovarian cancer among users of hormone replacement therapy.

While this may sound like scary new information, it’s not actually news. Thirteen years ago, for my masters degree in public health, I wrote my final epidemiology paper on the link between hormone therapy and ovarian cancer.

Other studies link hormone replacement therapy, especially estrogen alone rather than estrogen plus progesterone, to breast cancer and endometrial cancer.

After reviewing the available information, you and your doctor may still decide that estrogen’s benefits outweigh any risk. Or you may want to try a different tactic to alleviate menopausal symptoms. As I mentioned in a previous blog post, other treatment options, including SSRIs and blood pressure medications, may work as well and cause fewer concerns.

– Yvonne S. Thornton, MD, MPH

Only in America: insured – but bankrupted by medical bills

Wednesday, July 8th, 2009

There was a story recently in The New York Times about a married couple in Austin, Texas, who thought they were covered by medical insurance. They discovered otherwise when one of them actually needed to use it:

“Too many other people already have coverage so meager that a medical crisis means financial calamity.


One of them is Lawrence Yurdin, a 64-year-old computer security specialist. Although the brochure on his Aetna policy seemed to indicate it covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the treatment he received at an Austin, Tex., hospital.


He and his wife, Claire, filed for bankruptcy last December, as his unpaid medical bills approached $200,000.”

You might assume that, because both my husband and I are doctors, affiliated with two of New York’s most prominent hospitals, we’d never face the issue of inadequate insurance.

If so, you’d be wrong.

When my daughter was in graduate school, she became ill and needed to be hospitalized. She had health insurance through her school. Her hospitalization, CT scans, and other tests, were covered.

But the hospital discharged her before she was completely well and she continued to have severe pain. That’s when we learned that her medical expenses under her policy were capped at $25,000 – and she’d used up the maximum during her first hospital stay.

Because my husband and I had the resources to cover the staggering bills that resulted – physicians, another hospitalization, surgery, tests – our daughter was able to get the care she needed and not go into debt.

But what if we couldn’t be there for her?

It’s not unusual for people, even those who are insured, to lose everything once a major illness strikes. I know of one couple in Michigan. Both had good jobs and health insurance. Then, she got cancer and he needed a heart bypass. His treatments were only partly covered and they fell into debt. They lost their jobs and with it, their insurance. They went bankrupt, lost their home, and just about everything else.

I wish I could say this was unusual but it happens all the time. A recent study showed that 62 percent of bankruptcies in the U.S. in 2007 were due to medical costs. What’s more alarming is that, at the time those people became ill, 78 percent had health insurance. They either lost it when they lost their jobs due to illness or it was inadequate to cover their medical expenses.

And this should illustrate, as nothing else can, why this country desperately needs a public option in healthcare coverage, one that can’t be taken away if you’re too sick to work, one without the fine print that explains how the insurance company isn’t going to cover you when you most need it.

I know there are politicians in Washington, making all sorts of arguments about how, if we allow a public option, we’re on our way to socialized medicine or rationing or, who knows what the latest nonsense is. I’m here to tell you that that’s all it is: nonsense.

These guys rake in tons of money from the health insurance lobby and others who want to keep making huge profits by denying you care when you need it most. Don’t let them fool you as they’ve fooled the American people for so many years. Call your senators and tell them you’re mad as hell, and you’re not going to take it any more. Tell them that all you want from them is a public option so you can be certain help will there when you need it to keep your family well.

– Yvonne S. Thornton, MD, MPH

More media attention for the study

Friday, June 5th, 2009

Forbes reports on my study, showing that obese pregnant women should limit weight gain as does Medline.

Other media outlets giving the study prominent coverage are United Press International, Yahoo News, The Baltimore Sun, US News and World Report, and even the Times of India.

– Yvonne S. Thornton

Oprah and medical advice

Thursday, June 4th, 2009

Let me start by saying that I love Oprah. And I am forever grateful to her for having me on her show because appearing on Oprah helped me introduce my memoir, The Ditchdigger’s Daughters, to a huge audience. I’m sure it contributed to making my book a bestseller.

All that said, I have to agree with this Newsweek article. The authors argue that the medical advice given by some of the guests on The Oprah Winfrey Show is dubious at best, especially the claims about bio-identical hormones made by celebrities with no medical knowledge or training.

– Yvonne S. Thornton, MD, MPH

My study on obesity and pregnancy in the news

Wednesday, June 3rd, 2009

I’m pleased to see that the media is getting the word out: obese pregnant women should be eating healthier diets and limiting their weight gain.

In the past few days, I’ve been interviewed by a number of news organizations about the study. You can see some of the reports at the following links:

WebMd

The Atlanta Journal-Constitution

Science Daily

The Los Angeles Times

and Health Day

– Yvonne S. Thornton, MD, MPH

Study’s author concerned that new guidelines for pregnant obese women don’t go far enough

Tuesday, June 2nd, 2009

You may have read the headlines last week that The Institute of Medicine (IOM) is changing its guidelines for obese pregnant women. Instead of recommending that women who are obese gain at least 15 pounds during pregnancy, the IOM now recommends a weight gain of 11 to 20 pounds.

It’s a start. But, as the lead researcher of a new study of obese women, pregnancy and weight gain, I’m concerned that obese women are being told to gain any weight.

My study, which is being published today in the Journal of the National Medical Association, found that obese pregnant women who followed a well-balanced diet and gained little or no weight had maternal-fetal outcomes that were equal to or better than those who gained substantial weight.

As a specialist in high-risk pregnancies who has delivered more than 5,500 babies over a 35-year career and supervised the delivery of 12,000 more, I wasn’t surprised by the findings of our study. I know that those extra pounds mean extra risks for both mother and baby. Obesity greatly increases the chance of developing complications in pregnancy such as preeclampsia, stillbirth, and blood clots, among others.

Twenty-three of the more than 200 obese women in our study lost weight. The average weight gained was just 11 pounds. And yet, these women and their babies were at least as healthy as those who put on substantial pounds. There were fewer babies weighing 10 pounds or more, fewer cesareans, and the mothers were less likely to develop gestational diabetes.

You can read more about the study, here.

So, if you’re carrying significant extra weight, forget the old adage about eating for two. Believe it or not, for a pregnant woman of normal weight, only an additional 300 calories per day is needed during her pregnancy – the equivalent to a quart of skimmed milk per day.

– Yvonne S. Thornton, MD, MPH

My interview with Bob Salter of WXRK

Monday, June 1st, 2009

This weekend, Bob Salter of WXRK radio, interviewed me about my memoir, THE DITCHDIGGER’S DAUGHTERS, and about my new study, showing that obese pregnant women should gain little or no weight. You can download the interview here. I’ll have more on this blog about the study, tomorrow.

– Yvonne S. Thornton, MD, MPH