Physician heal thy profession: trailblazing fibroid docs shifting treatment paradigm

By Holly Bridges and Zal Press

In its 2014 roadmap for the future, the Canadian Medical Association declared “its readiness to take a leadership position in confronting the hard choices required to make health care work better for Canadians”.

Part of the solution, promised the CMA, was its framework for transformation that included:

  • Building a culture of patient-centred care
  • Enhancing patient access along the continuum of care
  • Recruiting more health care providers trained in high tech medicine

Things that are changing in caring for FibroidsWhile the CMA has a long way to go before all 72,000 of its members adopt patient-centred care to reduce wait times and fast-track better outcomes, there are pockets of practitioners who are demonstrating real leadership.

The recent Uterine Fibroid Collaborative Forum in Toronto, which saw both patients and physicians come together for the first time, offered a glimpse of this new patient-centred paradigm.

Some trailblazing Canadian gynaecologists who are on the front lines of treating women with fibroids surrendered a precious Saturday (from a workweek that is often 80 to 100 hours) to update patients on new treatment options.

Many of the gynaecologists who attended, such as Dr. Nicholas Leyland, Dr. Grace Liu, Dr. Ally Murji and even a young medical student, are true visionaries at the forefront of change. These surgeons are improving the lives of Canadian women yet often at their own financial peril (gynaecologists who practice minimally invasive gynaecology actually lose money because newer high tech alternatives pay half what a hysterectomy pays yet take twice or three times as long).

Dr. Nicholas Leyland, MD, Ob-Gyn, a long-time champion for women’s health and currently a Professor and Chair Department of Obstetrics and Gynaecology at the Michael G. DeGroote School of Medicine McMaster University, spoke of a politicized health care system.

“I can tell you that women’s’ health is just not on the radar,” said Dr. Leyland. “It’s not even part of the conversation and you can look at the quality of life data and the impact on the quality of women’s lives and it is at least as significant as the disorders that they have chosen to prioritize so ask yourself ‘Why is that?’”

A system, Dr. Leyland said, that has prioritized cancer, cardiac care, diagnostic imaging, joint replacement and sight replacement and neglected the needs of women with debilitating fibroids.

A study by the Johns Hopkins Bloomberg School of Public Health on the quality of life burden facing women afflicted with pelvic pain and Heavy Menstrual Bleeding (HMB) found that women who suffer from serious, sometimes life-threatening HMB have the same quality of life and level of function as heart attack and stroke victims entering rehabilitation.

We have to think of a different way to influence changeYet these women are not off work in treatment, or in hospital. They are working full-time, running kids to soccer, doing groceries, etc, all while struggling against the exhaustion and crippling pain that are the signposts of this condition.

Dr. Leyland and other gynaecologists who specialize in less invasive, less risky and less painful treatment options (everything from medication to keyhole surgery), are working hard to make these options the gold standard for women.

  • They have released new guidelines for the treatment of uterine fibroids which, for the first time, include non-surgical, medical management treatment options. The new guidelines can be found on the Society of Obstetricians and Gynaecologists website.
  • They are training new gynaecologists to perform less invasive surgeries.
  • They have developed an index called “technicity,” a system to monitor how many Canadian hospitals are performing less invasive hysterectomies (keyhole surgery versus open surgery).
  • And, they have formed a new society called the Society of Minimally Invasive Gynaecology.

So while their work is helping women with fibroids, there is still much work to do.

As Dr. Leyland suggested:

  • More gynaecologists need to adopt patient-centred care and follow these new fibroid treatment guidelines, which recommend hysterectomy as a last, not first, resort.
  • More patients need to understand the options contained in the guidelines.
  • Women need to pressure politicians to make women’s health a priority.

While the CMA has a big challenge ahead of it, dynamic leadership can be found in specialty practice that emulates the commitment to transformation the CMA roadmap heralds.