Ten years ago when psychiatrist Karen Johnson first proposed creating a medical specialty in women's health, her colleagues found her idea eccentric.
But times -- and opinions -- have changed. This fall, a national conference of health professionals and social scientists will meet in Chicago to consider the best way to advance the idea.
"A lot of people ask me, 'But what about a specialty in men's health?' " the San Francisco physician says. "I tell them, 'We already have a specialty in men's health. It's called Medicine."
As the body of knowledge about the biomedical and social differences between men and women grows, many health care reformers are calling for changes in the delivery of women's health care. Some call for women to receive primary care from professionals trained in preventive women's health. Some say existing specialists could better incorporate into their practices new findings on women's health and treatments.
And others, like Dr. Johnson, think problems that occur frequently among women such as eating disorders and domestic violence illustrate the need for a new branch of medicine -- for women only.
"The current medical paradigm is based on experience and research with men. The assumption is that you can transfer that to women, but you cannot," she says.
"There are not only physical differences, but psycho-social differences as well. For a start, take sexual harassment: It can cause stress, anxiety, depression, heart palpitations. You can hardly talk to a woman who works who has not experienced it. But how many health care people recognize this enough to ask about it?"
During the past 10 years, nearly 1,100 hospital-sponsored women's health centers have sprung up around the country partly in response to women's lack of access to affordable health care and partly from frustration with what they see as fragmented health care.
"The typical adult woman finds herself having to visit at least two different kinds of physicians in two sites with a third site for
mammography," says Carol Weisman, a professor in health policy and management at the Johns Hopkins School of Hygiene and Public Health. "Men don't have to do that. Women have begun to realize that they don't get a good deal here."
In recent years, legislators such as Rep. Patricia Schroeder, D-Colo., physicians and researchers have pressured the government and the medical establishment to correct what they consider to be medicine's neglect of women's health issues. They have lobbied to include women in clinical trials. They have worked toward increased funding for research in such critical areas as breast cancer. They have pointed out the frequent failure of physicians and researchers to provide early diagnoses of women infected with HIV.
And they have called attention to areas of medical ignorance -- a study last week by the Centers for Disease Control, for instance, found that women with heart disease tend to be diagnosed at a later stage when their condition is less treatable.
The current system of delivering general health care to women relies upon internists and family practitioners. But studies show that women tend to see their gynecologists most frequently.
Many health care reformers believe women should see a primary care giver who treats common problems beyond those associated with the reproductive system. This health professional could also advise women on diet, exercise and preventing such lifestyle-related conditions as vaginal infections, osteoporosis and high blood pressure, says Cindy Pearson of the National Women's Health Network, a Washington advocacy group.
A recent national conference on the future of obstetrics and gynecology recommended that advanced practice nurses and family physicians provide more help with normal pregnancies, simple gynecologic problems and preventive health care, says Edward Wallach, professor and chairman of the department of obstetrics and gynecology at Johns Hopkins Hospital.
It is a suggestion that appeals to a lot of patients, too.
When 20-year-old Alicia Taylor recalls the Baltimore inner city clinic she visited while she was pregnant, she remembers being rushed through prenatal examinations by a series of physicians. Now in the care of Dottie Atkins, a nurse practitioner at University Hospital, Ms. Taylor not only receives regular gynecological checkups but also advice about her general health. And she feels free to discuss the joys and stresses of life with her 2-year-old daughter.
"Dottie takes care of everything I need," Ms. Taylor says. "I can talk to her and tell her what's going on. I think you get to know a nurse practitioner better than a physician. They take a lot more time with you."