13- FINDING THE RIGHT DOCTOR
By our best estimate, there are about 15 million women with incontinence or prolapse in the United States. If each one of them sought medical care for this problem, the 30,000 gynecologists practicing today would not have enough time to evaluate and care for them all. And, most gynecologists (and urologists) have not been properly trained to care for these women. It was only about 20 years ago that several gynecologists and urologists began focusing on helping women with incontinence and prolapse and created a sub-specialty field called urogynecology. As a result of the efforts of these doctors, there has been great progress in the evaluation and treatment of these problems.
With new developments, and with the likely increase in the number of women having incontinence and prolapse as the baby boom generation ages, the number of doctors trained to treat incontinence and prolapse will likely also increase. In recognition of this growing need, The American Board of Obstetrics and Gynecology and the American Board of Urology have just joined forces to accredit a new subspecialty fellowship called Female Pelvic Medicine and Reconstructive Surgery. Three years of fellowship training in womens incontinence and prolapse will be necessary for certification. As of 2002, about 15 hospitals have accredited training programs in this new specialty, with more to be added each year. The establishment of this new fellowship validates the concept that urogynecology is now a priority for womens healthcare.
Hopefully, the topic of womens incontinence and prolapse will enter the publics awareness, and women will begin to discuss this disease instead of suffering in silence. We hope word will spread to women that there are good medical solutions to incontinence and prolapse. It is important to find a doctor who has the training and experience necessary to provide the best care currently available.
ARE ALL PRIMARY CARE DOCTORS TRAINED TO TREAT INCONTINENCE?
Unfortunately, the answer is no. Most family doctors or internists receive very little training about womens incontinence. And, since many women and their doctors find incontinence a difficult subject to discuss, the patient and the doctor avoid initiating a discussion. This is the main reason that the National Institute of Health felt it necessary to publish federal practice guidelines for all U.S. physicians instructing them about the evaluation and treatment of incontinence. If you have a problem with incontinence, we urge you to bring it up with your doctor. If you are in a managed care plan, you may need to ask for a referral to a gynecologist, urologist or urogynecologist in order to receive the proper care.
ARE ALL GYNECOLOGISTS TRAINED TO TREAT INCONTINENCE?
Most gynecologists have received some training in womens incontinence and prolapse during their residency. However, residency programs vary with regard to the expertise of the teaching faculty, and some programs spend very little time training the residents to properly evaluate and treat incontinence. Therefore, the amount of training and the level of interest of gynecologists vary greatly.
Obstetrician/Gynecologists, especially those recently trained, spend a fair amount of time doing obstetrics and primary care for women. While women enjoy access to a doctor they know well, providing a broad range of primary care, obstetrical and gynecological services gives the doctor less time to learn and maintain specialized surgical skills.
For these reasons, if you have incontinence or prolapse, it is probably best to find a doctor who has a special interest in these areas and who has taken the time to get extra training. If a physician is actively engaged in treating the complex problems of incontinence and prolapse, he or she will likely read urogynecology subspecialty medical journals, newsletter updates about current therapy and research, and attend urogynecology conferences. Most gynecologists with an interest in female incontinence belong to the American Urogynecology Association (AUGS). It is important that you try to find a doctor who has the special training and expertise in incontinence and prolapse.
Recently the fields of urogynecology and laparoscopy have intersected. Much of pelvic reconstructive surgery can now be accomplished with laparoscopic techniques performed by experienced laparoscopic surgeons. Many of the gynecologists with interest and expertise in laparoscopic surgery belong to the American Association of Gynecologic Laparoscopists (AAGL). If you think you have a problem that may be amenable to laparoscopic surgical repair, consider finding a physician who has the interest and expertise in both areas. Looking through the member lists of AUGS and AAGL may help start that search.
ARE ALL UROLOGISTS TRAINED TO TREAT INCONTINENCE IN WOMEN?
In general, most urologists spend the majority of their time dealing with male urological problems such as prostate trouble because that is a more common occurrence than female incontinence. Urologists with no particular interest in female incontinence are often inadequately prepared to treat prolapse and incontinence comprehensively. Vaginal surgery, bladder repairs, hysterectomies, and rectal repairs are not routinely included in urology surgical training programs. Those surgical techniques belong to the gynecologist. However, some urology residency programs do teach these skills, so if you are being treated by a urologist, ask if they can provide comprehensive care.
WHAT IS A UROGYNECOLOGIST?
Since most gynecologists have incomplete training in care for women with incontinence and prolapse, a new sub-specialty was formed to focus on female urology and pelvic surgery. Because the field combines urology (problems with the bladder, kidneys, etc) and gynecology (medical specialists in the female reproductive system), the new field is called urogynecology. A urogynecologist is a doctor who completes the full training in gynecology and then gets further training in the evaluation and treatment of female incontinence and pelvic prolapse.
In addition, there are many gynecologists and urologists with interest in the problems of female incontinence and prolapse. These doctors spend considerable time learning about those problems and gain the needed expertise for the proper evaluation and treatment of bladder and prolapse problems. Additionally, a gynecologist and a urologist may team up to work together or consult with one another for difficult problems. Colorectal surgeons are consulted when there are problems with anal incontinence. This multidisciplinary approach works extremely well.
The American Urogynecology Association in conjunction with The American Urologic Association promotes the education of gynecologists and urologists in the treatment of women with incontinence and prolapse. AUGS, as it is also called, has about 700 members who have shown such an interest. If you contact the American Urogynecology Association, they can give you names of members in your area. Some university medical centers have departments of urogynecology whose staff members teach and see patients. Your family doctor or internist may also be able to recommend a physician with special expertise in this field.
HOW DO YOU CHOOSE A DOCTOR FOR YOUR BLADDER OR PROLAPSE PROBLEMS?
Experience counts, and in medicine it counts a great deal. This is where you need to be your own advocate by asking lots of questions. Here are some questions we think are worth asking the doctor:
|Do you often treat women with incontinence or prolapse?
|How much extra training in treating female incontinence and prolapse have you received?
|Do you work as part of a team with other gynecologists, urologists and colorectal surgeons?
|What other tests are available to evaluate my specific condition?
|Do you regularly offer UDS/ urodynamics?
|What are the alternatives to the treatment you are recommending for me?
|How many of these surgeries have you done? What is your success rate?
|Are you recommending this surgery because it is what you usually do? Is it the best choice for my particular needs? Do you perform it several times a month?
|Is laparoscopic surgery reasonable for the condition that I have?
|Are you trained in laparoscopic procedures, and do you perform them frequently?
We suggest you read the parts of this book that relate to your particular situation carefully. Write down any questions you may have and take them with you when you visit your doctor again. Look for a gynecologist, a urogynecologist, or both a gynecologist and urologist working together in order to find a satisfactory solution to your problem. Ask if both your urologist and gynecologist have experience treating your particular problem.
SHOULD YOU GET A SECOND OPINION?
We think getting a second opinion is an excellent idea, especially if surgery has been recommended to you. Very few things in medicine are black or white, and there are often differences of opinion. Dont worry about hurting your doctors feelings. The vast majority of physicians are very comfortable about their patients seeking another consultation. Most of them would likely do the same thing for themselves or their family members. If you are facing surgery, you will have piece of mind if youve done all your homework and have sought the best care possible.
For the patients in our practice who get a second opinion, we ask them to call and talk to us about the results of that consultation. This allows us to answer any new questions and respond to any suggestions the other physician has offered. If we disagree with the recommendations, then we can explain why. We never feel offended if a patient wants a second opinion. Remember, this is your body and your health. Do not be afraid to get another opinion.
WHO SHOULD YOU CONSULT FOR A SECOND OPINION?
Seeking a second opinion sometimes seems awkward. Heres how we recommend you go about doing it:
First, tell your gynecologist that you want another opinion. Just be upfront and tell him or her you want another professionals thoughts about your case. Your doctor will likely appreciate your honesty and may be able to provide you with the name of a gynecologist, urologist, or urogynecologist who is well respected. Another alternative is for you to call a nearby university-based medical center to see if they have a urogynecology department. Also, your family doctor or internist may know gynecologists or urologists in the community who are knowledgeable about urogynecology.
If you find a physician for a second opinion without your doctors help, consider notifying your doctor of the name of this second physician. That will give him or her an opportunity to voice any concerns about the recommendations you have been given. This need not dissuade you from seeking care from another doctor, but you will at least be aware of any differences of opinion.
HOW CAN YOU BE SURE TO GET GOOD CARE?
In this book, our aim is to educate you about problems with incontinence and prolapse and to present state-of-the-art information regarding a range of solutions. We want to help foster a healthy doctor-patient partnership - something we believe is vital to good care. It is in your best interest to be educated about the health-care decisions you make. If you need more information, seek it out, get a second opinion. Ask all the questions you need until you understand and are comfortable with the answers. Seek out information about possible alternatives. When it comes time to make decisions, you will feel confident and secure about your choice.
American Association of Gynecologic Laparoscopists
13021 East Florence Ave
Santa Fe Springs, CA, 90670-4505
Toll-free (800) 554-2245
Fax (562) 946-0073
American Urogynecologic Society
2025 M Street NW, Suite 800
Washington, D.C., 20036
Phone (202) 367-1167
Fax (202) 367-2167
Edited Excerpts from our book
The Incontinence Solution
By William H. Parker, MD, Amy E. Rosenman, MD, and Rachel Parker
||Order The Incontinence Solution directly from Amazon.com.
Previous Chapter |
Next Chapter |
Table Of Contents