This feature was written by Studio MSP writers. While some of our advertisers were sourced, no advertiser paid to be included.
Courtesy of Shutterstock
Female Gender Symbol
The client-patient relationships a woman fosters throughout her life represent a history that’s been years (sometimes grueling, usually rewarding) in the making: there’s the dentist, who you go so far back with, she comps the occasional whitening treatment; your hair stylist, with whom you not only engendered a relationship, but a full-on artistic collaboration; the financial advisor who shoots you a courtesy text when tax time is nigh; and of course, the obstetrician/gynecologist who knows you as a person (not just a body) from the inside-out.
A relationship so significant, in fact, that 44 percent of routine care visits made by women were to her OB/GYN over a 3-year period, according to a Reuters Health study. Given their do-it-all lifestyles and tendency to put their children’s health before their own, it’s no surprise that many women view their OB/GYNs through a dual lens: getting seen for reproductive-related issues during their childbearing years, and preventative health purposes before and after the fact.
But does this all-inclusive approach mean we’re shortchanging ourselves? Are the fields of primary care and OB/GYN really as interchangeable as we treat them? Are there distinct ‘markers’ set out for when (and if) we make the jump from OB/GYN back to primary—where we all started as children? Experts from across the care spectrum illustrate what the health journey looks like in a woman’s lifetime—but not without its fair share of nuances.
The Whole Body
The World Health Organization (WHO) defines primary care as “a regular point of entry into the health system,” serving as a hub of coordination within the medical community. The primary care provider (PCP) is a healthcare generalist trained to view the whole person, from screenings for things like depression and certain cancers, to physical exams and continued management of chronic conditions. Think of her as your own personal Nancy Drew—sleuthing for answers and connecting the dots as she builds the big, overall picture of your health.
“Pediatricians, family medicine physicians (FP), and internal medicine (IM) physicians are all considered primary care,” says Megan Schmitt, MD, an obstetrician and gynecologist at Park Nicollet Health Services Women’s Center.
Pediatricians specialize in treating patients from birth to the age of 18, IM provides services for adults 18 years and older, and FP oversees the entire age spectrum.
“Whether it’s through your OB or your PCP, the most important thing is that a patient sees a healthcare provider annually to screen for mental illness and cancers, provide protective immunizations, and discuss healthy lifestyle changes and recommendations.”
- Dr. Megan Schmitt / Park Nicollet Health Services
“The transition from pediatrics to adult care typically occurs between the ages of 18 to 21,” adds Cally Scherber, MD, a pediatrician at Southdale Pediatrics. “The exact timing of this transition varies between patients, but the right time usually depends on factors like overall medical history and social or family circumstances.”
With the parents’ aid, the pediatrician primes adolescent patients to own their healthcare needs, encouraging question-asking to develop a one-to-one rapport. “We try to make this transition as seamless and tailored to the patient’s needs as possible,” says Scherber.
While some young adults move on to a general internist, women usually opt for a gynecologist as they cope with hormonal changes, menstrual cycles and abnormalities, and birth control decisions.
And this is usually where the switch just … clicks. And sticks.
What Counts is Comprehensive Care
Since an OB/GYN is trained to cover both, the medical specialties of obstetrics (“ob”) and gynecology (“gyn”) are presented as a shared unit. But it’s important to note that some doctors choose to practice one or the other: Obstetricians act like the first responders for mamas-to-be, while gynecologists specialize in reproductive health unrelated to pregnancy.
Holistically speaking, “the emphasis on full understanding of the anatomic, physiologic, and pathologic issues of the reproductive system make OB/GYNs uniquely qualified to handle issues of sexual health and STDs in adolescents, childbirth and its ramifications in younger women, and hormonal issues in older women,” says Melvin Ashford, MD, an obstetrician and gynecologist at Minnesota Women’s Care.
But women-focused care isn’t where the line neatly starts and stops. It is, instead, where the line starts to curve and intersect with the curved line of primary care—creating a sort of Venn diagram that mashes up the two practices.
Take birth control, for example: though it’s usually synonymous with an OB/GYN visit, she isn’t the only doc writing the prescriptions or diagnosing reproductive issues. “A primary care physician can provide birth control, and initiate evaluations of abnormal uterine bleeding and postmenopausal bleeding,” says Schmitt.
And well-woman visits—oft-thought as strictly OB/GYN turf, given the nature of breast and pelvic exams—can be facilitated by a primary care doctor as well.
“From there, a PCP can even start the evaluation for more complex problems like painful periods or trouble getting pregnant,” says Amy Elliott, MD, a family medicine physician at Allina Health Faribault. “The physician can discuss the plan of care with the patient, and recommend an OB/GYN when needed.”
Given that they’re low-risk, OB/GYNs usually make a point of addressing their patients’ needs to a broader extent—most have a hand in navigating and administering routine primary care services.
“We can help patients update their immunizations and choose the right screening tests for diabetes, high blood pressure, colon cancer, and mammograms,” says Ron Gourneau, MD, an obstetrician and gynecologist at Allina Health Mercy Women’s Clinic. “We are focused on facilitating women’s access to the right care at the right time in their lives, caring for the whole person: in mind, body and spirit.” If what a patient presents with is treatable, it’s fair to say that most feel comfortable executing on that treatment.
So if both practices boast a wide-ranging approach to wellness, is it really necessary to have both on speed dial?
The Exception
It’s true, “many women are uncertain where the best place is to start for both primary care and for evaluation of specific concerns,” says Schmitt. “The goal, regardless if a patient starts by seeing primary care or OB/GYN, is that comprehensive medical, family, and reproductive histories are obtained.”
Here’s the deal: whether it’s one or the other, continuity is key. If you’re a generally healthy person and feel like your doc gives you the 360-medical overview you need, you’re probably fine. Just make a point of letting her know that she’s the only doc you see on a routine basis.
That means staying on top of your requisite screenings and phoning your doc when unsettling symptoms strike. Experts agree that the ultimate end-goal of doctor-patient relationships is in achieving overall wellness—not chasing issues after they reach the surface.
“All providers hope to foster a relationship where women feel comfortable sharing their stories so we can help to facilitate an empowering way to confront any issues they may have,” says Elliott.
“All providers hope to foster a relationship where ... we can help to facilitate an empowering way to confront any issues [women] may have.”
- Dr. Amy Elliott / Allina Health
Still, if a woman has other medical problems or a strong family history of disease, then the situation may call for both, adds Gourneau. “We [OB/GYNs] would defer to PCP in cases of acute illnesses and other long-term medical issues, like diabetes and hypertension.” If the issue is out of her hands, she can help coordinate more advanced care and refer you to the appropriate specialist, like a surgeon, cardiologist, or psychiatrist.
The either-or mentality, however, really shouldn’t be a one and done decision—it should be considered on a case-by-case basis, says Ashford.
“Particular hormones can have an impact on the general health of a woman,” he says. “Women should have both an OB/GYN and a PCP caring for them for optimum results.”
flowers
Well-Woman Recommendations
The American College of Obstetricians and Gynecologists (ACOG) has recommended dividing a woman’s life cycle into four intervals—ages 13–18, 19–39, 40–64, and older than 65—in order to best organize the approach to primary and preventive health care.
Ages 13-18:
Vaccines for HPV and the one-time dose of Tdap, and/or the discussion of birth control options takes place.
Ages 19-39:
Pap smear testing begins at age 21 for most healthy women. Sexually transmitted infection testing and discussion regarding genetic testing is also important at this age.
Ages 40-64:
Mammogram screening usually begins around age 40. Cholesterol levels should be checked every 5 years starting at age 45. Colon cancer screening usually begins around age 50.
Ages 65+:
Screening for osteoporosis usually will begin around age 65. The test most commonly used is called a DEXA scan.
