Clinic Specializes in Maladies of Women

Patsy Swords was breaking up a marriage of 17 years. The day had been bad, no question. But she reluctantly kept a longstanding medical appointment. During the exam, all of her rage and frustration spilled out.

Walking out of the doctor’s office, Swords resolved to stop seeking medical care--as long as “insensitive male doctors” wielded the stethoscope.

“He was rough,” Swords said. “He wasn’t a bit sensitive--he’d never been that way before. I was crying. He didn’t care. He made absolutely no effort to calm me. I was so angry. I walked out and didn’t go to a doctor for a decade.”

Recently, Swords sought a mammogram--an X-ray of the breast. Calcium deposits turned up, and Swords sought further care from Dr. Janet Schwartz at the Center for Women’s Medicine in Mission Valley.

The center was opened in January. It’s one of only a few in the United States but is part of a growing trend--medical centers staffed entirely by women, with the caveat that only women be patients.

Doctors who staff such centers say some women are tired of conventional medical care. They don’t believe male doctors spend enough time, especially with breast exams. Failing to take the time, such doctors are sometimes guilty, they say, of overlooking small lumps that could be malignant.

When larger lumps are detected later, it is often too late. Recovery can be costly and painful, more so than necessary. Some doctors believe a mastectomy (removal of the breast) wouldn’t be necessary if small lumps were detected earlier.

“We spend a minimum of 10 minutes on every breast exam,” Schwartz said. “We spend time teaching, showing the woman how to examine her own breast, doing as much educating as possible. Some doctors spend as little as two minutes, and that just isn’t enough.”

Of course, not all doctors agree that “conventional” medicine isn’t doing its job.

“Women are generally well-cared-for wherever they go,” said Dr. John Berger, immediate past president of the San Diego County Medical Society. Berger is a family practitioner in Hillcrest.

“I see nothing wrong with specializing in women’s problems, or for that matter, men’s problems,” he said. “If it’s a special area you want to deal with, fine. But I do feel women are well-cared-for--I repeat, well-cared-for--with conventional medicine.”

In regard to “women’s” doctors taking more time with breast exams, Berger said, “It’s important to take time with all exams. By and large, most doctors are very conscientious about (breast exams), as they are with anything else. Teaching is a very important part. Some of us are better about that than others.”

Schwartz, a 40-year-old medical veteran, formerly worked as a family doctor in rural Marin County. Female patients often told her she should think about specializing in women’s medicine. She “fought it for a while,” given that her grounding--her focus--had been the entire family, not just women.

“I was one of five women out of 130 students in medical school,” she said. “It was such a battle to prove yourself in a man’s world. I felt I was a doctor who happened to be a woman--rather than a woman’s doctor. That’s how I chose to look at myself.”

Finally, she took her patients’ advice when it became clear--in her words--that some women “just weren’t having their needs met” by “conventional” doctors.

“Sixty percent of women today work outside the home,” she said. “Many have families and seem to be trying, desperately at times, to juggle a career in between raising a family. They need a convenient, one-stop-if-possible medical outlet, one that addresses as many of their health concerns as possible. That’s what we hope to be.”

And that’s the kind of doctor Schwartz is trying to be. The center has plans to expand, not only in doctors (at the moment, Schwartz is it) but also in outlets. A second is planned for August in La Jolla, a third in North County and a fourth in South Bay. About half a dozen centers for women’s medicine, with roughly similar philosophies, operate nationwide. More are due shortly, according to a spokesman for the American Hospital Assn. in Chicago.

Schwartz said a second doctor who specializes in obstetrics-gynecology and endocrinology is due “within a month.” A radiologist works part time, and in the not-too-distant future, a clinical psychologist will be added.

“Let’s say a woman comes in with abdominal pain,” Schwartz said. “We determine she has an ulcer. She can also have a pap smear (an exam to determine cancer of the cervix) and a mammogram. If the ulcer is stress-related, as most are, we can have the psychologist intervene.

“We believe any number of problems are particular to women. That’s one reason we think such a center is necessary. Migraines, for instance, are more common among women. Many other problems have particular effects on women--fatigue-depression syndrome; osteoporosis (bone disease); skin problems, particularly varicosities; the heart condition of mitral valve prolapse, which is commonly associated with chest pains in women. Lupus is more common among women.

“We believe that just focusing on women gives us more power in taking a good, hard look at problems like these. If a woman needs gynecological care but is concerned about nutrition, weight loss and stress, we believe we can serve those needs. If we have to refer somebody elsewhere, we will.”

The Center for Women’s Medicine--currently the only one in San Diego County--treats girls just reaching puberty as well as women in their 70s and 80s.

Part of the plan involves appearance. The offices are done up in soft, subtle shades of mauve and peach. A deliberate attempt to counter harsh medical settings, and approaches, is constantly, strikingly evident.

On the other hand, efforts to educate patients with books and videos are hardly new or unique to women’s medicine. Taking more time may be, although many “conventional” doctors, male or female, would bristle at such a charge. Nevertheless, Schwartz’s offices do offer a more personal and less cluttered look than many in conventional medicine.

“I had been to a lot of regular doctors,” said Mary Harrison, 44, a patient. “A lot of them seemed really impersonal. It’s like you’re not a person, you’re a number. They don’t have much time to talk to you. Over there (at the center), they just took more time. Enough time that I was satisfied.”