Women’s health care in the Hudson Valley lags in quality

Despite the establishment of large healthcare networks in the Hudson Valley over the past five years, the quality of the gynecological care here doesn’t measure up to that available in big cities.

I recently sought treatment for uterine fibroids and received false and misleading information from three area gynecologists, one of whom is the director of his large practice’s gynecological division and onetime chairman of its board of directors. . He told me that because my uterus was so large my only option was abdominal surgery with a disfiguring vertical incision, rather than a much more subtle bikini-line incision.

It felt like a return to an earlier era, when women with fibroids basically had two options: do nothing or have open surgery. But given the Hudson Valley’s proximity to New York City, a major medical center, I expected more.

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Even more upsetting, though, was the discovery that this medical practice, one of the largest in the Hudson Valley, doesn’t offer the standard diagnostic test for fibroids, a pelvic MRI. Nor could I find a facility in the area that does. Three other large medical providers, including one that specializes in radiology, told me they don’t offer the test. I couldn’t even find a local facility that was familiar with the test.

That raises the question, are surgeons here operating on women with fibroids without first doing this critical test, which pinpoints fibroids’ size and location and helps doctors determine the best treatment? Are they, in a sense, going in blind?

I contacted several top administrators at the practice, but none could explain why it doesn’t offer fibroid-mapping MRIs or how its gynecologists are able to operate accurately without them.

“Having up-to-date, cutting-edge diagnostics is just as important as having surgeons who have the training, skills, and resources to perform procedures,” says Dr. Jim Greenberg, chief of gynecology at Brigham and Women’s Faulkner Hospital in Boston and a specialist in minimally invasive procedures.

Hysterectomy is the second most common surgery for women after Cesarean section. As many as 70 to 80 percent of women develop fibroids by age 50, and each year about 600,000 women undergo a hysterectomy, with up to half due to a fibroid diagnosis. Sixty percent of these hysterectomies are performed through a large abdominal incision, although the operation carries a higher risk of complications, more pain, and a longer hospital stay and recovery period than less-invasive procedures.

A 2015 study in the American Journal of Obstetrics and Gynecology found that many hysterectomies are unnecessary and 40 percent of women who had a hysterectomy weren’t offered alternatives.

“In smaller communities, as new medical technologies come forward, even though they may not have the people to do them, there should be more resources available for people to understand what all the options are,” Dr. Greenberg says.

I sought second opinions from two other doctors in the same practice, since it accepts my insurance. One told me that gynecologists no longer perform morcellation (a technique that allows enlarged uteruses to be removed laparoscopically by dissecting the tissue before removal) because of concerns about spreading potentially cancerous tissue. But a technique called in-bag morcellation that addresses those concerns by collecting tissue in a bag before removal has been used successfully for years.

The third gynecologist I saw also recommended abdominal surgery and told me the only way to know whether any of my fibroids could be removed laparoscopically was to open me up. A pelvic MRI can provide this information.

 

I did research online and discovered Acessa, a minimally invasive technique approved by the Food and Drug Administration in 2012 that has been shown to significantly reduce uterine size. Acessa targets fibroids through radiofrequency thermal ablation, which uses heat waves to destroy tissue. Patients are typically released from the hospital the same day as the procedure and can return to normal activity within a few days.

When I mentioned Acessa to the doctor who had made the comment about morcellation, she first confused it with another, completely different procedure that her office offers, and then admitted she had never heard of it.

No doctors or hospitals in the region offer Acessa, according to the device’s manufacturer, Acessa Health, and I couldn’t find a doctor here trained in or knowledgeable about in-bag morcellation.

After getting a pelvic MRI at a New York City hospital, I discovered that the minimally invasive options I had researched weren’t the best solution for me. I found a surgeon in the Bronx who routinely performs hysterectomies with bikini incisions on uteruses the same size as mine.

My surgery is scheduled for November 12. I feel confident this is a good choice for me, but only because I did my own research and consulted three gynecologists outside the Hudson Valley. Gynecology patients here should be able to count on their doctors to provide the information and referrals they need.

 

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