After decades of ignoring the differences between men and women, some hospitals are smartening up and offering programs specifically tailored to the health issues of women our age. Here, the top spots for treatment—and, if these facilities are too distant, advice on finding the best programs near you
Heart Disease: Cedars-Sinai Medical Center, Los Angeles
After her own research documented problematic gender differences in the symptoms and outcomes of heart disease, cardiologist C. Noel Bairey Merz, MD, founded the Women’s Heart Center at Cedars-Sinai Medical Center, the largest nonprofit hospital in the western U.S. Last year, the WHC also opened an Advanced Preventive Women’s Clinic for women with menopause symptoms who have or who are at risk of heart disease.
The goal for both the clinic and the heart center is to quickly translate state-of-the-art science to women’s care. For example, the Women’s Ischemic Syndrome Evaluation study, led by Bairey Merz, found that women who have an abnormal stress test and chest pain but no serious artery plaques are nonetheless prone to heart attacks. Though women in that category are usually assured by their doctors that all is well, at Cedars-Sinai these patients are now given a coronary angiogram to further investigate their condition.
What to look for closer to home Check out the government’s Web site, hospitalcompare.hhs.gov, to find institutions meeting widely accepted standards for heart care (such as giving most heart attack patients angioplasty within 90 minutes of ER arrival). Look for a place that employs cardiologists dedicated to treating women, sponsors conferences on women’s heart health, and maybe even underwrites gender-based research, says New York cardiology specialist Nieca Goldberg.
Bone Health: NewYork-Presbyterian Hospital, New York
Women with clear evidence of osteoporosis are generally treated with drugs. But experts can disagree on how to handle patients who show signs of bone thinning that hasn’t reached a critical stage—a category that includes many postmenopausal women. That’s why personalized care is offered at the Toni Stabile Osteoporosis Center at Columbia University’s NewYork-Presbyterian. With 10 researcher-physicians on salary, “We have the luxury of scheduling 60-minute appointments for new patients, with 30-minute follow-ups,” says director Ethel Siris, MD.
Because the doctors are aware of or, in some cases, have conducted the latest women’s bone research, they understand the nuances involved in interpreting the bone density tests performed by the center’s four DXA machines. (The center also has an experimental imager called the high-resolution pQCT.) “We evaluate the full DXA report hot off the printer, not just the summary,” Siris says, so the physicians can detect any (rare) machine errors that don’t make sense. The data, combined with other risk factors, helps them decide whether a woman needs medication.
What to look for closer to home Because the doctor’s judgment plays a key role in making the right treatment decisions, you want a facility with a dedicated bone health program. Inquire, too, if the technicians who conduct the DXA scans are certified by the International Society for Clinical Densitometry. “Problems in the positioning and quality of measurements—which affect treatment decisions—are more likely with someone who doesn’t do these scans regularly,” says Subhash Kukreja, MD, codirector of the bone health program at the University of Illinois Medical Center.
Fibroids: Georgetown University Hospital, Washington, D.C.
Uterine fibroid embolization (UFE) is typically the treatment of choice for dealing with debilitating fibroids (noncancerous uterine tumors), which disproportionately affect women in their forties. During the procedure, tiny beads are inserted into the uterine artery to cut off blood flow; the fibroids shrink, and the patient gets relief without having to undergo a hysterectomy. Probably no hospital is more adept at the procedure than the Georgetown University Hospital, a pioneer in the method since 1997. James Spies, MD, chair of the department of radiology, says the hospital’s high success rate stems not only from its long experience (2,500-plus women have undergone the procedure there so far), but also from the hospital’s commitment to continuing research; Spies and his colleagues have published more than 80 studies.
Recently, for instance, after testing various types of beads for effectiveness, the hospital banned all but the top-scoring two. Georgetown also keeps a close eye on patient comfort. “We start pain management while women are still in the procedure room, so it’s seamless,” Spies says. If a woman is not a candidate for UFE, another option, surgical removal of the fibroids, is done at Georgetown with state-of-the-art equipment, and can often be done laparoscopically, which performs the job with less pain than usual.
What to look for closer to home Find physicians who perform UFE at the Society of Interventional Radiology Web site, sirweb.org. Ask how many procedures they’ve performed and what the outcomes were, Spies suggests. Then inquire into their hospital’s pain management approach. “Hospitals have different cultures about this, and it absolutely affects your experience during and after a procedure,” says Elvira Lang, MD, associate professor of radiology at Harvard Medical School.
Breast Cancer: Northside Hospital, Atlanta
Top academic teaching hospitals don’t have a lock on great women’s programs, especially when it comes to breast cancer. Many community hospitals perform well in this area, and foremost among them is Northside Hospital in Atlanta, which diagnoses over one thousand cases a year—more than half in women ages 40 to 59. Northside’s Breast Care Program has the latest equipment (digital mammography, computer assisted detection and stereotactic biopsy machines—where views from two angles are fed to a computer to calculate a lump’s exact location). Northside’s breast program has a staff of over 50 physicians, and the hospital’s five-year average survival rates for breast cancer exceed the national average.
Another special feature of Northside is the intense support it offers to women with breast cancer. “As soon as the doctor tells a woman she has the disease—before she has time to Google—I call to wrap my arms around her,” says Susan Casella, RN, head nurse navigator. Additional support comes from the hospital’s Network of Hope, which connects new patients with women who’ve successfully completed treatment. “We match women for age, careers, family situation and the like, so each patient feels that her mentor understands all she’s going through,” explains Patti Owen, RN, director of oncology services. After treatment, women can opt to join a survivors support group.
What to look for closer to home A new National Accreditation Program for Breast Centers puts a stamp of approval on programs meeting rigorous criteria—from care (such as the quality of the pathology department) to caring (such as having a survivors program). The ranks of accredited programs are small but growing. (Northside is currently being evaluated.) Find accredited centers at accreditedbreastcenters.org. Then call to ask what special support they offer for women over 40.
Depression: Hospital of the University of Pennsylvania, Philadelphia
It’s a fledgling program but psychiatrist C. Neill Epperson, MD, has big plans for her newly created Penn Center for Women’s Behavioral Wellness, one of a handful of female-centric outpatient mental health programs in the U.S. Although the center sees women of various ages, there’s a special emphasis on the menopausal years, when previously healthy women have a two-fold increase in risk for depression. “Psychiatrists don’t always consider the hormonal component, but at our center we recognize that sometimes treating mood disorders with hormone therapy rather than antidepressants makes the difference,” she says.
Epperson and her team also understand that menopause can worsen the condition of women with a history of mental troubles. “Someone with bipolar disorder can be thrown way off when she experiences the night sweats and sleep disruption typical of menopause, even if her condition was under control before,” Epperson says. Making it easy for patients to find them, the center’s three psychiatrists and one psychologist have extra offices in the hospital’s ob-gyn department. They are also reaching out to hospital cardiologists, since untreated depression in the postmenopausal years substantially increases a woman’s five-year risk of fatal heart attack.
What to look for closer to home: You’ll have to do some sleuthing to find out if a mental health program
understands the role of changing hormones, says Peter Schmidt, MD, chief of the section on behavioral endocrinology at the National Institute of Mental Health, which has an excellent menopause and mental health clinic. “A psychiatrist should discuss not only your behavioral issues, but also your medical and gynecological histories,” he says. Ask, too, about the lines of communication between the psychiatrist and your other caregivers. “In midlife too many symptoms overlap, so medical care really needs to be coordinated across your health care providers,” Schmidt says.
Sources: American Heart Association; National Osteoporosis Foundation; Society of Interventional Radiology; AAGL; Association for Health Care Journalists; David Winchester, MD; Nieca Goldberg, MD; Jennifer Mieres, MD; Elvira Lang, MD; John Nestler, MD; Subhash Kukreja, MD; Nelson Watts, MD; Judy Kneece, RN; Constance Lehman, MD; Carolyn Kaelin, MD; Peter Schmidt, MD; Nanette Santoro, MD; Bernard Harlow, PhD; Wulf Utian, MD, PhD.