A Reader and Author Respond to "Who Best Cares for the Postmenopausal Woman's Comprehensive Medical and Health Needs?"

L. Faith Birmingham, MD; Edward S. Linn, MD


October 04, 2007

To the Editor,

While the real-time mammography is a nice concept, that is a minute part of the care women past the age of 50 require and need. What was not addressed very well was how and who takes care of these women's multiple other medical conditions that actually make up the majority of their healthcare needs. Diabetes, cardiovascular disease, lipid disorders, osteoarthritis, hypertension, as well as mental health issues are a sampling of the disorders requiring care in these women.

I see large numbers of peri- and postmenopausal women in my practice (family practice but mostly internal medicine). Routine gynecologic care is a small part of their overall healthcare needs, and I provide that for them. I also manage all the other chronic medical conditions these women have. I find in the community I practice in, almost all gynecologists do not have the background or the desire to handle all the other medical problems these patients may have. It is the family practice physician or an internist willing to do routine gynecologic care that provides the best comprehensive care for these patients. One physician who can provide the great majority of their healthcare needs and can address multiple medical problems at one visit surely is preferable to sending the patient to multiple specialists to handle the nongynecologic-related heath issues of these women.[1]

L Faith Birmingham, MD
Raleigh, North Carolina


  1. Linn E. Who Best Cares for the Postmenopausal Woman's Comprehensive Medical and Health Needs? MedGenMed. 2007;9:19. Available at: Accessed September 24, 2007.


Author's Response to Letter From L. Faith Birmingham:

I appreciate Dr. Birmingham's concerns that were articulated in her Letter to the Editor regarding the video article she referenced. It is unfortunate that I gave the impression that comprehensive care for women centered on "real-time mammography" while ignoring the potentially complex medical needs of postmenopausal women. I agree with Dr. Birmingham about the importance of screening for and managing the multiple medical disorders that can occur in this age population.

The Centre for Women's Health at Rush North Shore Medical Center was developed to provide comprehensive healthcare to the most rapidly growing population of women in our community, those between 40 and 65 years of age. In order to accomplish this goal, a team of experts, in a variety of medical areas that directly impact this population, was recruited to provide care at the Centre. The services provided on site include wellness care with screening for the aforementioned medical conditions cited in Dr. Birmingham's letter as well as advanced diagnostic and therapeutic services such as mental health, gastroenterology, rheumatology, urogynecology, pelvic surgery, and breast and gynecologic oncology. Additionally, we are fortunate to work with a variety of primary care and specialty consultants, at our medical center, to provide additional needed services for our patients.

The example cited during the original video discussion with Dr. Lundberg[1] and cited in Dr. Birmingham's letter focused on the on-site mammography and osteoporosis screening programs. These services, which are often scheduled to occur in coordination with the annual wellness evaluations, offer same-day testing and results. This design is a product of research that was done to identify the services and philosophy of care that women identified as important to them, as we developed the Centre conceptually. Clearly, the Centre's patient satisfaction data have consistently supported the decision to offer screening services embracing this philosophy.

Our goal was to develop a women's health program that provides high-quality, comprehensive healthcare services to meet the needs of the population of women that we serve in our community. Rather than try to identify the ultimate "Renaissance" healthcare provider to meet this goal, we chose to develop the "Renaissance" Centre for Women's Health, offering intradisciplinary healthcare services in a patient-centric environment.

Edward S. Linn, MD
Chair, Department of Obstetrics and Gynecology
Director, Women's Health Services
Rush North Shore Medical Center
Skokie, Illinois


  1. Linn E. Who Best Cares for the Postmenopausal Woman's Comprehensive Medical and Health Needs? MedGenMed. 2007;9:19. Available at: Accessed September 24, 2007.




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