A Specialist’s Perspective on Cardiovascular Disease in Women: C Noel Bairey Merz, MD

Q: Why do you think some women’s health issues, like breast cancer, get more attention than heart disease?

I don’t know that we have the answer. Bikini medicine—medicine that focuses on reproductive organs—is still a problem. There is a tradition coming from the health care system that women’s health is defined only by their reproductive organs.

Both health care providers and women are part of the larger society that sees the world through gendered lenses. While we all have the best of intentions, it’s difficult to ignore our biases.

More recently, I think the attention comes from the types of breast cancer campaigns, such as NFL players wearing pink. Breasts and breast cancer have been sexualized. We don’t like to talk about graphic sex, but we like to have our little innuendoes.

Q: Could you suggest opportunities for improved communication among physicians (PCPs, OB/GYNs, and cardiologists)?

We have a lot of opportunities. Women rarely see cardiologists, even when they have heart attacks. If a man has a heart attack, most are seen by a cardiologist. Women are also not being seen for prevention.

OB/GYNs are surgically trained—as in, they are focused on surgical reproductive issues—and do not have the same training as general physicians when it comes to cardiovascular disease prevention such as chronic hypertension, cholesterol, and diabetes management.

Advanced practice providers (eg, nurse practitioners and physician’s assistants) are trained to follow protocol so they are proficient at chronic care management, but are unfortunately not typically present in OB/GYN offices. One potential solution would be to have NPs and PAs available right in the offices.

Q: What has changed in your own practice as a result of the WHA survey?

For many years, we did not routinely weigh women in my practice. We asked about their diet and exercise, but we did not weigh them unless they asked to be weighed.

But now, due to electronic health records and new technology, including patient exam tables and chairs equipped with scales, a patient is weighed regardless of whether or not they want to be.


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