From 2007 to 2010, an average of 281,406,600 medical visits occurred annually in the USA according to data from medical records of national representative visits to office-based physicians and visits to outpatient departments. The current study analyzed 63 million preventive care visits, of which 44% were visits to OB/GYNs and 56% were to primary-care doctors [1]. Women 50 years or older had a higher percentage of preventive care visits to general practitioners (GPs) than younger women: for age 30–49 years, 55% of women saw OB/GYNs vs. 45% who saw GPs; for age 50–64 years, 38% vs. 63%; and for > 65 years old, 19% vs. 81%, respectively (p < 0.001). The OB/GYN visits focused predominantly on reproductive health-related services, whereas visits to GPs provided a wider range of services and higher volume of counseling, even among women of child-bearing age. Women who saw OB/GYNs were more likely to get screened for cervical and breast cancers, Chlamydia and osteoporosis, compared to those who went to primary-care doctors. Contrarily, those who went to primary-care doctors were more likely to get screened for colon cancer, high cholesterol and diabetes and to be counseled about diet, exercise and obesity. To note that the majority of the total medical visits (about 82% of visits to OB/GYNs and 74% of visits to GPs) did not report on counseling. Because physicians have had little to no incentive in most payment systems to document counseling performed during clinic appointments, counseling services may have been underestimated.

Comment

The results of the above study clearly point at a known and rational fact that gynecologists limit their engagement with preventive medicine to OB/GYN-relevant issues during consultations. Because young to midlife women tend to visit OB/GYNs more often than GPs, it seems necessary to preach for a more active involvement of OB/GYNs in a wider range of preventive measures. Preventive medicine for middle-aged women has been one of the main educational goals of the International Menopause Society (IMS), as expressed in the latest version of the IMS recommendations on menopausal hormone therapy and preventive strategies for midlife health [2]. Commitment of OB/GYNs to discuss preventive medicine with their patients should be based on two components. The first is obtaining the knowhow on what to do and how to implement it in routine clinical work. Various relevant guidelines and recommendations probably make this easier. The second is the compensation any physician should receive for giving time to discuss these issues with his/her patients. If this factor is not properly settled with the health maintenance organizations, the incentive to do it will obviously be low. Nevertheless, the IMS believes that being a menopause specialist dictates a more holistic approach. Although most IMS members are either OB/GYNs or reproductive endocrinologists, they should integrate their traditional role in the field of gynecology into another mode of operation that includes screening and counselling menopausal women on prevention of the chronic diseases of aging.

Amos Pines

Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

References

1. Stormo AR, Saraiya M, Hing E, Henderson JT, Sawaya GF. Women's clinical preventive services in the United States: who is doing what? JAMA Intern Med 2014 Jul 7. Epub ahead of print http://www.ncbi.nlm.nih.gov/pubmed/25003954 

2. de Villiers TJ, Pines A, Panay N, et al. Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health. Climacteric 2013;16:316-37. http://www.ncbi.nlm.nih.gov/pubmed/23672656