Class of ’70 | The clock is ticking. Your doctor has exactly seven minutes to examine you, and now you’re wondering if the symptom that nagged you all night is worth asking about after all.
Dr. Marie Savard Nu’70 GrNu’72 M’76 sympathizes. As an internist, author, and ABC Medical News contributor, she’s used to dispensing prescriptions and advice [“Fruits and Fate,” Sept|Oct 2005]. But she has also worn the pink paper gown and knows that women have a tendency to lose their voices in the examining room.
With that in mind, she has written Ask Dr. Marie: Straight Talk and Reassuring Answers to Your Most Private Questions (The Globe Pequot Press). Savard, who also serves as a Penn Trustee, says her intention was to entertain and inform in a format that’s more like having a conversation with your girlfriend. Given her specialty in women’s health (drsavard.com), she decided to focus her book on issues “below the belt.” Savard talked about those topics and more in a recent interview with Gazette writer Susan Frith:
Why did you seek to write a book of straight talk? What do you think women are missing in their doctor-patient relationships?
The bottom line is that women don’t feel listened to. They don’t feel heard when they leave their doctor’s office—often because they feel rushed, or they feel embarrassed to ask questions. And doctors can tend to be inflexible in the way they handle things. Some, for example, have a one-size-fits-all regimen for prescribing hormones. Women, I have found, want more than just all the information. They want to be much more involved in decision-making.
You write about women’s bodies and concerns across a lifetime. Can you touch upon some highlights?
It’s incredibly important for women to understand what’s happening in their bodies and how the body changes long before puberty starts. Increasingly, teenagers are getting pregnant, and they don’t even think about oral sex as sex. They need to learn about oral cancer that can be caused by the human papillomavirus. There are no moral values in the book: Here’s the information, here are the consequences of these actions, and here’s how to protect yourself.
I also talk about pregnancy and infertility and how important it is to make sure you are fully evaluated. Patients are going to different doctors and they may have overlooked a simple thyroid problem.
Finally, I talk about what happens at menopause and how we should view it and help women make more informed and balanced decisions.
Many people have had the experience of wanting to ask their doctor another question, but they see the hand on the doorknob and hesitate. Any advice?
First, know that you are important. These things are important to talk about—whether it’s painful sex or hormone issues or the HPV (human papillomavirus) vaccine. Try to do it in an office visit where you’ve scheduled enough time. Don’t say you’re coming in for a cold and have a laundry list of other questions. Come with your streamlined agenda and give it to your doctor at the beginning of the visit so he or she can prioritize. Bring someone with you—a health buddy who can take notes. You should request and keep copies of every health report and test result. That information is rightfully yours and you’re in the best position to see that every doctor who treats you has a look.
The HPV vaccine that’s now available is offered to girls as young as nine. What do you say to parents who don’t want their daughters vaccinated for fear that it will encourage them to be sexually active before their time?
This vaccine protects young girls from cancer when it is given before they are sexually active—and that is inevitable at some point (and too often sooner than [their parents] might hope). Nobody is saying it prevents all STDs, so it isn’t logical to assume girls will suddenly take increased risks once they’ve been vaccinated. Besides, many mothers may not even talk to their daughters [depending on their age] about what shots they’re getting at a checkup. It isn’t like the girls are going to make the connection.
What was your own introduction to sex education like? How would you compare it to today?
In my day, fear of pregnancy was everything and sexually transmitted infections weren’t even on our radar. I remember the head nurse [in nursing school] saying that you might get pregnant from a toilet seat! I wasn’t even sexually active yet, but all the nursing students went to the same doctor—who gave out birth-control pills without a pelvic exam—because we didn’t want to be examined. We were young, afraid, and had no idea why an exam might even be important. And a strange doctor touching us? Yikes, no.
Today, women have access to so much more information, but what seems to be missing for girls today is a sense of vulnerability. Or maybe self-esteem. When I hear about girls hooking up, I can’t help but wonder if women are still trying to please the males—even when it comes to doing something that risks their sexual health.
What kinds of things are people most reluctant to talk about with their doctors?
After an interview with Diane Sawyer, I heard from a lot of 50-something women who, because they had lost a spouse through death or divorce, wondered if they would ever be in another sexual relationship again. “I thought it was too late,” one woman said, almost implying that everything dries up after menopause and doesn’t work. I think women have been misinformed about estrogen replacement. A little topical cream down below can make a huge difference, and yet not have any side effects.
Everybody has been so against hormones because of one study—that was time-flawed—linking them to cancer and discounting the feelings of women who are suffering from menopause and benefiting from hormones. But if it’s erectile dysfunction, it’s handled a different way.
Although your book doesn’t address the current health-care debate, do you have any thoughts on how the system could be reformed?
The notion of who’s paying the bill, and is it public or private, is only one small piece. My passion is reforming how we view health in general and to develop and create a system where health is valued and nurtured.
Obviously we have this extraordinary amount of technology. There was an article in The New York Times about statins and how poor people can’t afford this drug. What was not said is that we know what will prevent 80 percent of strokes, diabetes, and heart attacks as well as 50 percent of cancers. It’s a “lifestyle pill” of eating well, getting exercise, lowering stress, getting our vitamin D, et cetera … It works more powerfully than anything else and it doesn’t cost anything.
Yes, we do need a kind of catastrophic umbrella coverage for everyone, but I’m in favor of setting up programs that reward and reimburse for good health practices.