The OB/Gyn in GP's Clothing

Edition: August 2001 - Vol 9 Number 08
Article#: 1035
Author: Wayne Care

The New OB/Gyn


When I was young (as the last dinosaur gasped his last breath), my town and many like it had a single physician; a general practitioner. This doctor delivered babies, did minor surgeries, handled pediatrics and geriatrics, indeed, was in charge of your health from birth to death.


With the advent of managed care, physicians are now ''gate-keepers'' of health, determined to practice preventative medicine and improve our health. One of the most significant changes this has caused is that many women now name their OB/GYN as their primary care physician. No longer confined to obstetrics, or that famous euphemism ''female troubles,'' this physician is now charged with overseeing the total health of the patient.


When a woman visits her gynecologist now she is just as likely to ask her cholesterol level, and her chances for osteoporosis, as she is about cramping, or fertility. This specialty, which for years was among those that did the least ''in-office'' testing, now presents huge opportunities. Let's explore some of them.


Glucose


Diabetes has become an epidemic in America. The OB/Gyn has always had to be concerned with glucose levels in expectant mothers since it is not uncommon for pregnant women to develop gestational diabetes during their pregnancy. Most OB/Gyns already do glucose screening with one of the many glucose meters available. For those patients at risk, OB/Gyns either perform in house, or send out Glucose Tolerance Tests (GTT). GTT's required the patient to drink a glucose beverage, with a set amount of glucose, (usually 50mg) then they are tested three times over a three hour period to see how well the glucose has broken down. During the pregnancy, the patient is monitored (using glucose, Hemoglobin A1c or fructosamine) and may be prescribed medication as well as dietary changes.


Osteoporosis


Earlier generations believed that developing a hunchback or ''widow's hump'' in older women was a foregone conclusion. With recent advances in the detection and treatment of osteoporosis, this could become a thing of the past. The opportunity for selling bone densitometers to physician offices is phenomenal. When osteoporosis is discovered early enough, there are a wide array of treatments available. Instrumentation is available as smaller screening devices, or large table models.


Cholesterol


Coronary Heart Disease kills more women than any other disease. Once thought to be a disease of males, women have leapt into the medical news over recent years with their own statistics. CHD is frequently based on the narrowing of at least two arteries, atheroschlerosis, or arteriosclerosis. Death can be sudden, 5-7 minutes. In areas where defibrillation is used immediately the survival rate improves dramatically. If the physician prescribes medication, such as any of the ''statins'' they also need to perform tests for liver function.


Cholesterol is a must for primary care physicians. CLIA waived instrumentation is available that performs lipid profiles and liver function testing.


Some of the other screening tests recommended for females are:


• Urinalysis strips- every age every visit.


• Occult blood- annually for women over 40.


• RH factor-every pregnant woman


• Hemoglobin- annually for women over 19.


• Mammography- annually for women over 40.


• Flexible sigmoidoscopy or colonoscopy- every ten years over 40.


• Chlamydia testing for sexually active women.


The question is what tests the OB/Gyns in your territory are performing, as well as where they purchase their equipment and test materials.


What questions do you ask when you meet with them? I would recommend being specific. Rather than asking do you do any testing, ask do you have any patients with gestational diabetes? How many times has a conversation ended when you ask if they do testing and they say no? Once the no word is spoken they stop thinking about what you are trying to present.


Target questions so that you get actual answers and involve them in the process. Always listen! Let them talk. If you are committed to making a presentation and talking you will never hear their concerns.


Some other questions:


• How do you treat osteoporosis?


• How do you identify patients with osteoporosis?


• How do you treat your patients with high cholesterol?


• How do you monitor your patients with gestational diabetes?


• Do you see patients for STDs?


You are not a medical educator as much as a reminder of medical fact and alternatives. Have your facts at hand, don't push, but encourage. Let them talk and they will lead you to the next question, and the next answer to their needs.


Good luck, great selling, and learn to listen!


Glucose Testing is Critical


Diabetes affects more than 15.7 million Americans. Unchecked diabetes leads to a number of other disease states, such as


congestive heart failure, kidney (renal) failure, and neuropathy. According to the American Diabetes Association approximately 135,000 cases of gestational diabetes occur annually in the United States.


The Wrong Equality is Achieved


Since Suffragettes first marched to get women the vote, and others fought tirelessly to have them earn a fair wage, there has been a battle for equality. According to the American Heart Association in 1998 women accounted for 226,467 deaths due to Coronary Heart Disease (CHD), almost 49.2% of all deaths from CHD.


Boning Up on Bone Density


There are approximately 10 million patients diagnosed with


Osteoporosis, while an additional estimated 18 million have low bone mass and are not yet diagnosed or in treatment. 1.5 million fractures a year are caused by osteoporosis at a cost of about 14 billion dollars annually.


Source: National Institutes of Health.



About the Author: Wayne Care recently joined Quality America, Inc. as Vice President of Sales and Marketing, Quality America, based in Asheville, NC, publishes OSHA Safety Manuals, an OSHA newsletter and an entertaining OSHA retraining video. All are available through distributors. Care has 30 years experience in the medical distribution field with McKesson Medical group, Foster Medical Supply, Bischoff's Surgical Supply, and American Hospital Supply.