December 10, 2008
Prior to entering clinical practice, my being a female physician only had meaning for me personally. After experiencing over a decade of clinical practice I understand the impact it has on my patients as well. In 1970 less than 1 in 10 physicians were female; now in 2008 females represent more than 1 in 4 physicians. In my practice, I am reminded of my patient’s appreciation for this on a daily basis. Although I treat both men and women, I find women often seek female physicians. Many of my female patients have expressed their reasons for doing so to me. Often, they feel they can express themselves more openly due to a feeling of commonality. Despite my belief that all physicians, male or female, are trained to provide the best care to their patients irrespective of sexual bias; I must admit that a comfortable doctor-patient relationship is invaluable and facilitates better medical care.
There are several basic elements which should be part of a woman’s annual evaluation. I will touch upon some of your most important.
Screening for cardiovascular disease is a vital part of any evaluation. Despite heart disease being the #1 killer of women in the United States it is still largely viewed as a men’s disease. Heart disease kills 18 times more women than breast cancer. Given this women should have blood pressure monitoring at every annual physical, cholesterol screening annually beginning at age 45 (provided they do not have additional risk factors), and counseling with regard to diet and exercise if necessary. Daily aspirin therapy is also recommended beginning at age 50 for women with no additional risk factors.
Cancer screening is very important. Breast cancer is the most common cause of cancer death in women. All women, beginning at age 40 should be having annual screening mammography and breast exams by their physicians during their annual physical. Patient education on self-breast exam is an essential element and empowers women to take control of their breast health.
Cervical cancer used to be the leading cause of cancer death for women in the United States. However, in the past 40 years, the number of cases of cervical cancer and the number of deaths from cervical cancer have decreased significantly. This decline largely is the result of many women getting regular Pap tests, which can find cervical “precancer” before it turns into cancer. Women should have their first Pap test (a screening of cervical cells) approximately 3 years after first sexual intercourse or by age 21, whichever comes first. Women up to age 30 should undergo annual Pap testing since women under age 30 have a higher likelihood than older women of acquiring high-risk types of HPV that may cause precancerous cervical changes. If a woman age 30 or older has negative results on three consecutive annual Pap smears, she may then have her repeat Pap smears every 2-3 years. Screening for colorectal cancers is comparable for men and women. All adults, beginning at age 50 years and continuing until age 75 years, should have fecal occult blood testing and colonoscopy. Many fortunate individuals only require screening colonoscopy every 10 years. Osteoporosis is a major health risk for 28 million Americans. In the United States today, 10 million individuals already have osteoporosis and of those 80% are women.
Osteoporosis screening with bone densitometry is recommended in women starting at age 65. Mature women need calcium to prevent break down of bone. The amount of calcium that a woman should get per day ranges from 1000mg-1500mg, depending her age group, and hormonal state.
Of course, all women irrespective of age should be screened for substance abuse. Women have higher risk than men for certain serious medical consequences of alcohol use, including liver, brain and heart damage, according to the National Institute on Alcohol Abuse and Alcoholism. Additionally, cigarette smoking plays a major role in the mortality of U.S. women. Among women who smoke, the percentage of deaths attributable to smoking has increased over the past several decades, largely because of increases in the quantity of cigarettes smoked and the duration of smoking. In both of these situations, patient education is vital.
This is just a brief overview of some of the most important issues that should be addressed in the evaluation of a female patient. One must take into account that many medical recommendations are altered depending upon a patient’s specific risk factors and physical condition. Women should talk with their doctors about the services identified in this article to determine whether a preventive service is right for them.