Ob-GYN: Now As Convenient As Your Local Big-box Store > Back To Resources

Bridget B Winston - Spartanburg Herald-Journal - April 6, 2004

WHEN JANET LISTER needed a hysterectomy last October, her gynecologist discovered there was more work to be done. She also needed two other procedures.

Her doctor, Dr. Bang Giep, an OB/GYN with Spartanburg OB-GYN, told her he could do all three procedures at once - and she wouldn't have to stay overnight in the hospital.

Lister was skeptical at first. She wondered how one doctor could do all three procedures.

"It was all done laparoscopically," Lister said.

"It was all done in one day, and all I used was Motrin afterwards."

Lister's experience is proof that today's OB/GYNS are doing more than Pap smears and annual breast exams.

As medical technology has advanced, the doctors are also doing more outpatient surgical procedures than ever before.

"Traditionally, a gynecologist would do a hysterectomy, a C- section and a D and C (dilation and curettage)," said Ashley Benson, an

OB/GYN with the Women's Clinic. "As technology has advanced, we've been able to treat (a full range) of problems."

Their offices have also become one-stop shops for patients who want to control their blood pressure or diabetes, lose weight, address emotional issues or solve other medical problems.

"Most of them come in with a cold or asking questions about their kids," Giep said. "It's easier to come to one doctor. A lot of times we serve as a primary care physician.

"The one thing we don't do is belly-button piercing."

And the doctors seem to prefer their roles as a one-manband who can perform minor surgeries, deliver babies and manage women's day- to-day health concerns.

"I got into OB/GYN because I wanted to take care of women's health needs," said Dr. Dean Davis, an OB/GYN with Piedmont Women's Healthcare. "You can't say just because it's not gynecological, it's not a health issue."

The trust quotient

OB/GYNs often play the role of primary care physician because their patients simply trust them more than any other doctor - especially if the doctor has delivered a baby for the patient.

"There is a bonding that goes on between a patient and an obstetrician," Benson said. "It's a different type of physician- patient relationship. As a physician, you share in a very special event, so it follows that they would come back to you with questions or concerns."

While the recent controversy surrounding hormone replacement therapy has scared many patients, it has opened doors for conversations about other health risks.

"Since we have found that HRT has so many implications for things beyond menopause, it has really opened the conversation about heart disease and osteoporosis," Benson said.

"Patients want to be able to get information from their doctors and make their own decisions. It's a good feeling. They're placing some trust in me."

Doctors often counsel their patients on emotional and mental issues, as well, as a result of that trust relationship.

"They come in and have a lot of stress in their lives," Giep said. "They don't want to see a psychiatrist because of the taboo.

Giep and Davis both say they prescribe antidepressants to a number of their patients.

"Women today come in here and think there's something wrong with them because they can't cope, they're stressed at home and with their kids," Davis said. "Nobody can work two full-time jobs. They don't have time for counseling, so you do what you can within the framework of an office visit."

Not your mother's hysterectomy

In the past, the solution for heavy periods was limited to birth control pills, which had negative side effects for many women, and a D and C or a hysterectomy, both major procedures, Giep said.

Gynecologic procedures have become more sophisticated in recent years, and so have patients.

"Women are more knowledgeable now," Giep said. "They've been on the Internet and talking to friends. They want something that will work, but will also allow them to get back to work and their families."

Fibroids can be treated with uterine artery embolization, in which a radiologist blocks the blood flow to the uterus.

And for the past 10 years or go, local doctors have been treating heavy periods with endometrial ablation, in which heat or an electric current is used to ablate the lining of the uterus to reduce or eliminate bleeding.

Better technology in the past year has produced better results, Davis said. The procedure can reduce bleeding by 50 percent - or even totally eliminate it.

For Teresa Lee, the endometrial ablation procedure reduced the negative effects of a tubal ligation.

"I started experiencing lots of pain when I had my menstrual cycle and heavy, heavy flow," she said. "It just got worse and worse."

Davis performed the outpatient procedure and she was able to go home, pain-free, after a few hours. She noticed an immediate difference, Her periods are now much lighter and more comfortable.

"It is really a good option for women who want to maintain a high level of activity," Benson said.

Women also seem more comfortable with a procedure that will preserve their uterus, Giep said.

"They think (hysterectomy) is more of a final thing," he said. "Many of them want to keep their uterus."

But while the number of hysterectomies has gone down across the country, Giep said the rate has remained steady in the South, where women tend to do what their mothers did a generation ago.

And often, there is good reason for a hysterectomy. "There are some things where a hysterectomy is the gold standard," Benson said.

But even hysterectomies aren't what they used to be.

"What you have is a dramatic change in how they're done," Davis said. Not all women need an abdominal hysterectomy, in which an incision is made in the abdomen to remove the reproductive organs. It's an inpatient procedure that requires up to six weeks of recovery time.

Now, hysterectomies can be done vaginally or laparoscopically, with just a few tiny incisions. In a laparoscopic supracervical procedure, the ovaries and uterus are removed through three small incisions, while the cervix is preserved.

"Any gynecologic procedure now can be done through small incisions rather than large incisions," Giep said.

OB/GYNs can also offer more methods of birth control and sterilization within their offices. In addition to birth control pills, IUDs and diaphragms, there are now patches, injections, even a vaginal ring.

Within the next two years, Giep said, local practices will offer Essure, a permanent sterilization method in which coils are implanted in the fallopian tubes without an incision. Body tissue grows into the coils, blocking the tube.

Also coming soon to the gynecologist's office - a blood test that screens for ovarian cancer.

"That's going to be a step in the right direction," Davis said. "Ovarian cancer is one of the deadliest cancers and we don't have a screening for it."

Outside the box

Traditionally, medical students training to be OB/GYNs were trained in matters within the scope of obstetrics and gynecology. It wasn't until they were faced with their patients that they decided whether they would address a broader spectrum of issues.

"You go through residency and come out thinking you're going to deal strictly with OB/GYN issues," Davis said. "Then you fracture into two groups - those who deal with primary care issues and those who hold the line and refuse to do anything (beyond OB/GYN)."

But when Benson entered her residency six years ago, medical schools were just beginning to require OB/GYN students to devote six months to primary care, internal medicine and emergency medicine. And Benson is glad her education is broadbased.

Benson and many gynecologists like her are happy to address issues outside the scope of gynecology because they like to consider the overall health and wellbeing of their patients.

And insurance companies have seemed to follow the lead of the medical schools, allowing women to visit an OB/GYN without a referral from a primary care physician.

Benson said the issues most common among her patients are sexual dysfunction, weight loss and maintaining their overall health. Giep adds smoking cessation and mole removal to the list.

Benson said her practice offers pulmonary function testing (which used to be the domain of cardiologists), urology tests, cancer screenings and bone density tests, among others.

"And we're doing thyroid screenings like nobody's business," she said.

Thyroid problems can cause heavy periods. But by solving the period problem, the doctor also helps the patient control her thyroid problem.

For problems such as hypertension, OB/GYNs can treat mild cases in the hopes of preventing further complications. But they know when it's more appropriate to refer the patient to a specialist.

"When you tackle those issues, you're taking care of the beginning of it," Benson said. "When it progresses, you send them on."

OB/GYNs have long been doing procedures that were once referred to a urologist, Davis said.

"We've been doing bladder surgery forever," he said. "Gynecology became a surgical specialty because of trauma from childbirth," including incontinence.

Most recently, a tension-free tape can be used to secure the urethra and bladder to prevent leakage, for example. A laparoscopic "bladder tacking" procedure is now being used to treat urinary incontinence as well. After 24 hours in the hospital, patients can resume their normal activity.

"There are certain things that definitely need to be left to a urologist, .ut for women who are more comfortable talking to a woman (physician), there aren't many female urologists," Benson said.

Many women prefer to talk to their OB/GYN about urologic issues especially if the urinary incontinence was the result of a pregnancy. Other women get urologic procedures done at the same time a hysterectomy is done, Benson said.

OB/GYNs also find themselves playing the role of lactation consultant and pediatrician when their patients are pregnant.

"During the pregnancy, they'll ask you just about anything you can think of," Benson said. "They want to know everything they can to make sure their baby is healthy. It's one of the few times you can talk people into doing what's good for them because it's for the baby."

And at Spartanburg OB-GYN, the practice has gotten into the dermatology business as well. They offer laser hair removal to their patients as an added convenience.

"Most of our patients ... are going to shave somewhere," Giep said. "Instead of going to a dermatologist or a plastic surgeon, we do that for them."

Unfortunately, it's a luxury that most insurance companies won't cover, Giep said.

Giep also knows of other OB/GYN practices that have begun offering Botox treatments and massages, but his office has not gotten into the day-spa business.

Lister is grateful that OB/GYNs have become a source of information and advice on a host of topics.

"Women used to be bounced around all over the place trying to find out what was wrong," she said. "It's nice to have one doctor (who) you can go to and can tell you everything that's going oft.

"We've been in the dark for so long." Copyright New York Times Company Apr 06, 2004

(C) 2004 Spartanburg Herald-Journal. via ProQuest Information and Learning Company; All Rights Reserved

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