While visiting family in the US earlier this year, my mother-in-law showed me an article in the Washington Post titled “Many women use an OBGYN as their main doctor – should they?” The article discussed the findings of a large study that revealed that women who saw their primary care physicians for routine gynaecologic visits were more likely to receive comprehensive care addressing various aspects of health, such as mental health issues, metabolic and circulatory conditions, respiratory, digestive and skin diseases.
Like some of my patients, mom-in-law was surprised that I did “G-Y-N stuff” as a primary care doctor. I told her women’s health was an essential part of our training in family medicine. Women’s Health encompasses a wide spectrum of health issues affecting women at all stages of their lives. The family physician plays an important role in providing preventive care and managing a variety of clinical problems including gynaecological conditions. Family doctors are well-placed to carry out routine gynaecological examinations for their patients, such as the Pap smear test for cervical cancer, HPV test, pelvic examinations, and screening tests for sexually transmitted infections where necessary. Routine breast examination and breast cancer screening with mammogram in the recommended age or risk group is also performed by family doctors, often when a patient visits for a gynae check-up or a Well-Woman visit.
The American Congress of Obstetricians and Gynaecologists (ACOG) states that “the annual health assessment (Well-Woman visit) is a fundamental part of medical care and is valuable in promoting prevention practices, recognizing risk factors for disease, identifying medical problems, and establishing the clinician-patient relationship.”
Many gynaecological problems can be evaluated, diagnosed and treated by their family doctors. A diagnosis can often be made after a thorough history of the complaint is taken and a physical examination performed. If necessary, laboratory tests may be ordered and these are done in-house in our clinic. Ultrasound scans, mammograms or other radiological examinations can also be arranged by the doctor if needed. In cases that are more complicated, the family doctor may refer the patient to a gynaecologist for further evaluation.
Women of child-bearing age can see their family doctors for preconception counseling, family planning and contraception. At IMC we have doctors who perform intra-uterine contraceptive device (IUCD) insertions and subdermal contraceptive implant insertions. Pregnant women can see their family doctors for common ailments during pregnancy. Our family doctors also perform postnatal checks and manage breastfeeding problems and other postpartum issues. Managing the menopause and osteoporosis screening are other aspects of women’s health that family doctors look after. Cardiovascular health screening is another major aspect of health – your family doctor will be interested in assessing and managing lifestyle factors, weight, blood pressure, and screen for diabetes and dyslipidaemia. Screening for depression and other mental health issues is relevant at any stage of a woman’s life. Immunizations according to recommended schedules in adulthood should also be discussed with your family doctor at routine health visits.
Family physicians have a working insight of all the many specialties, both physical and psychological – screening for diseases and problem-solving are therefore tailored to each unique individual. Every woman’s health needs should be well-served by her family doctor.
By Dr June Tan Sheren
MBBS (Singapore), M Med (Family Med) (Singapore)