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HCP Editorial November 2002
What’s a Person to do?
Linda Dominguez, NP
 A meno-something age patient addressed this plaintive question to me last week. Her eyes were bright and snapping as she sat perched on the edge of the exam table, “I mean really what am I to do? I want to take good care of my health, I really do, but every time I think I have my plan mapped out, I turn on the news and wham I’m back to step one.”
Nearly everyday the menopausal health care consumer is bombarded with the latest study, the newest treatment, and doubt is cast upon traditional technologies. In the past few weeks these women have been advised by the popular press that hormone treatments are deadly, a pap smear at her age is not cost-effective, a colonscopy is an overhyped test, her mammogram is of questionable value, a self-breast exam is a waste of her time, and furthermore, her health care provider is probably not helping much by performing a clinical breast exam. Not to mention that she also fears the air bag in her car, the water from the tap, genetically engineered taco shells, and a myriad of other day-to-day dangers that seem to lurk around every corner!
“On any given day I don’t know if chocolate is good or bad for me. Is a glass of red wine OK or not? And, for heaven’s sake, what is the deal about caffeine? Can I drink it or not?” And the often-heard query “Is natural better for me and what does natural really mean?” To Soy or Not to Soy. That is the question.
Where do women turn for clarification regarding this out-of-focus health care picture? She turns to you. And you and I are often caught short without a quick response. A most egregious recent example is how the WHI report was launched without opportunity for key organizations to evaluate the data. Clinicians were left to grapple with scraps of information that were pared down to sound bites. The media frenzy was unprecedented. The networks were guaranteed an audience that would be sitting on the edge of their seat. After all, the meno-something age woman is the news networks main demographic. Katie, Connie, and Barbara edged us out as they took on the role of the understanding health advocate.
Back on the firing line, the very next day, we were seeing patients and we felt as bewildered as they were. Where were we to look for guidance? We needed answers and we needed them quickly. It is noteworthy that the Nurse Practitioner’s in Women’s Health (NPWH) was the first organization to post online and publish a clear and succinct evaluation and response that could be utilized by practicing clinicians and the public. Other women’s health organizations have now weighed in and today, as I type, NIH hearings regarding the WHI findings are being held in Washington, DC.
Contrary to the media hype, our patients are treated as individuals and we recognize that they have unique and changing needs. The truth is we do not employ a “one size fits all” approach as has been suggested. Weighing the risk verses the benefits is not empty rhetoric but an avenue for honest dialogue. We recognize that it is critically important to explore what her expectations are and what the treatment can really accomplish. What heartens me is that I know that over the years we have walked the walk and talked the talked with our patients. We have been their true allies and advocates and that will hold us in good stead as we make our way through the currant morass.
As caring clinicians and advocates, we continue to try to keep abreast of the latest research and make sense of it in a context of what we once understood. What is so difficult is that there are rarely clear-cut indisputable answers.
So, stay tuned, the news isn’t over yet…
Linda Dominguez, NP
Albuquerque, New Mexico
Chair-elect, NPWH
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