There are relatively few famous fictional OB/GYNs. Among the most notable is Dr. Wilbur Larch, the hero of John Irving’s great novel, The Cider House Rules. Dr. Larch is based on the life of Irving’s grandfather, who was the physician in chief of the Boston Lying In Hospital at the turn of the 20th century. Dr. Larch’s motto was “I must be of use.”
I truly hope that this website will be “of use” for all of its readers. Women really want to understand the changes that our bodies, indeed our lives undergo as we mature through our reproductive and post-reproductive years. To my sensibilities, a good OB/GYN should be a woman’s health physician, rather than exclusively a reproductive specialist. Female health encompasses all of our body’s organ systems, and we need an integrative appreciation of how these systems interconnect and evolve.
I developed this site with the aim to educate both women and physicians learning how to care for them. One primary focus of the site will be the `madameovary videos`, medium-length discussions focusing in on a single topic. Our initial two topics are menopause and cancer; each of these are discussed in two segments, split naturally by subtopics. Shortly we will be adding new videos on other women’s health issues. I have also provided several flavors of companion written content, in the form of excerpts from my published guides, pdf copies of a few of my academic papers that I think are especially `on point`, and a list of important recent references on the subject matter. Additionally, under the Media pulldown category, there are a number of (video and audio) clips that cover a wide range of related content, presented in both structured and more free-flowing formats.
Finally, I would encourage all of my visitors to look at my Blog. This is co-written and researched with my MIT-educated mathematician husband, and is built upon daily discussions over the last 30 years of the evolution of medicine and health care within our society. The initial set of Posts was developed as a single intertwined unit, introduced and motivated by the first entry, which is entitled `Prologue: Why I Left Electronic Medical Recordkeeping`. We hope that this will provide a clearer understanding of some recent changes to health care, and their potential longer-term implications, and that many more folks “outside of a small circle of friends” will be inspired to act to improve the system in ways large and small. Let us all be of use.
I was unsure whether to expect the best of times or the worst of times with my introduction to electronic medical records (EMRs). My group practice of obstetrics and gynecology had been considered a premier group in our town for many years, and we were supposed to be excited to have been selected as among the first private offices to join into Yale-New Haven Hospital’s conversion to the Epic Systems Corporation (Epic) EMR. For years, I had heard numerous positive comments from colleagues and residents who used VistA, the EMR of the Veterans Health Administration. By all accounts, VistA was quite user-friendly, easy to learn, well-supported, and an overall plus for both physicians and patients. In contrast, more recently, I had heard lots of negatives about academic hospital-based EMRs, that they were dysfunctional, a huge time sink and a pain to use. The benefits of the EMR, for example, that all of your medical information would be instantaneously accessible to of all your care providers, certainly have been prominently trumpeted. So I approached `opening day` with cautious optimism, yet with eyes wide open.
We provide very brief mini-Abstracts for each essay that follows.
It is hardly news anymore that electronic health records (EHRs) are the bane of many doctor-patient relationships. EHRs are often detested by doctors and viewed at best with mixed feelings by patients, as a necessary evil to achieve the advertised benefits of digitized records. Patients now typically see their physicians spending most of their… Read more »
Hold your Enemies Close and your Friends Closer In January 2015, Ricardo Alonso-Zaldivar and Jack Gillum of The Associated Press reported that the health insurance site Healthcare.gov had been sharing user data with companies like Google, Twitter and Facebook, as well as with a host of online advertising providers. They wrote that the administration… Read more »
A number of prominent health law experts agree that patients have very limited recourse to protect themselves against violations of privacy. They have concluded that more state and federal legislation is necessary, because there are major holes in the way current health care law is written. Some enlightening and relatively nontechnical details are given… Read more »
EMR or EHR? The terms “electronic medical record (EMR) and “electronic health record” (EHR) are often used interchangeably, both by many physicians and by the public. I was curious as to the official differentiation between the terms, and after some poking around, found some perspective that should be as definitive as any. In January… Read more »
The ability to review or transfer EHRs from one doctor or hospital to another (interoperability) is one of the major selling points for the adoption of EHRs, and is indeed essential to the smooth functioning of the health care system. However, as I wrote in the Prologue, even within Connecticut, we more resemble the… Read more »
Full EHR interoperability has recently received a lot of attention as a core attribute of a smoothly functioning national health care system. This is appropriate. However, interconnection may be of secondary importance compared to a related topic, namely the extent of a patient’s complete medical history that exists within the electronic record. Much less… Read more »
Moving Out It has become increasingly challenging to stay in business as a private-practice primary-care physician. In recent years, hospitals have purchased large numbers of independent and physician-owned practices. The descent in the numbers is striking. A 2014 Physicians Foundation survey of 20,000 U.S. doctors found that 35% described themselves as independent, down from 49%… Read more »
In the last couple of years, I have seen a substantially increased number of retirements among local physicians, including both senior core academic medical faculty at Yale and `private community` clinicians. Many more of my medical friends and colleagues have told me that they plan to retire shortly, even though until fairly recently, they… Read more »