Editors' Comments

A Tribute to Women
Tom Janisse, Editor-in-Chief

You are holding the first of two Women's Health issues; the second will be published in the Fall. There was such a large response to our call for articles that the Editorial Team decided to publish the best articles in two successive issues. As you read these research studies, programs, initiatives, and systems innovations, and view the paintings, photographs and other visuals, you will learn much that is transferable to all of your patients. We are privileged as an organization to have women so prominent and successful in the fields of clinical medicine, research and leadership to be able to present such exemplary knowledge, practice, and wisdom. This will be of great benefit to ourselves, our members, and our communities both local and national. Congratulations to the women we feature and to the women we serve.

Women's Health Center
The concept of "Women's Health" as a realizable future alternative to conventional health care for women exists only by understanding several key components and by achieving a new perspective. Primarily, enhanced care for women will not be achieved by erecting a new building to house a Women's Health Center. Neither will it be achieved through an institutional icon; through advances in technology; through tertiary services; through expanded well-analyzed data sets; through singular or insular treatment approaches delivered by an impersonal scientist; or through advancements in traditional medical science. Clinicians will, however, be more sensitive to women and will exhibit enhanced communication and relationship skills.

In our process to describe the future, we must first ask women what they want and listen to them, before we mistakenly build a future on the basis of our current assumptions about them from a biomedical model. What women have suggested so far in focus groups of members, in meetings of clinicians, and in the recent literature looks and sounds alternative. A spectrum of approaches and activities are necessary from convenience to holism. Focus first on common needs and concerns. Deliver services close to home, in one place. Don't make a woman drive all over town to each specialist's office. Care should be multidisciplinary and delivered or coordinated as much as possible at one visit in a women's health module. For example, just as two surgeons from different departments arrange their time to perform an operation and look into the belly together, two specialists could arrange a visit to look into a woman's health concern together. In a variation of this scenario, some would even prefer a group setting with other women to socialize and exchange stories and advice. And it is important to remember that women's health begins when they are young girls. Compartmentalizing their care within department boundaries is artificial and better serves providers of care than recipients.

Kaiser Permanente has been developing the "capability" of delivering advanced women's health care for several years. This capabilitya connected set of activities and competenciesresides in our integrated system and in people and processes. It represents a women's health "center" that exists in many sites; through many services; in many relationships; and in the attitudes, perspectives, and interpersonal skills of many clinicians and ancillary providers. This will be a center "without walls" as exemplified by the personal health knowledge a registering medical assistant will have by accessing a woman's electronic medical record in any facility.

The woman, as individual, will be "the center" of her health care. The center will not be a structure into which she seeks service. It will be a primary care center rather than a tertiary care center. A primary care doctor and team will lead the coordination of her care. She will not receive expert medical advice at the end of a long string of visits that have ignored psychological, social, behavioral, familial, or environmental factors. These will be assessed initially as "emotional vital signs" and be taken with the physical vital signs.

When clinicians recommend that geriatric women go to the local health club for exercise, we will recognize their loss of dizziness, improved balance, less painful knees, and normalizing blood sugar as advanced health care practice rather than an off-handed suggestion about which medical science doesn't concern itself. We will recognize that the social encounter she had with several other elderly women was one of the most potent components in improving her physiology, because she learned that others have similar maladies and that they have overcome them with simple methods they taught her. As well, she will be versed in self-care through easily available education, materials, printed and electronic resources that are readily accessible, carefully researched, and reader-friendly.

Clinicians will consider alternative options and will recognize cultural diversity and preferences. Similarly, quick referral by her primary care physician to an acupuncturist for relief of chronic nasal congestion, or to a massage therapist for lumbar strain, or to a naturopath for an herbal tea to help her sleep will become common practice and be recognized as advances in women's health care.

As we continue to develop the women's health center capability as a program, and it becomes increasingly recognized, the women in our preferred market segments will stay with our system, and others will join us. Because these women make many of the health care decisions for their family, we gain their husbands and children as members. These women will influence other women with whom they are friends, in their neighborhoods, in their churches, in their gatherings, and in their workplaces. Women will also influence their husbands, fathers and sons to appreciate a more holistic, balanced approach to their treatment.

In this discovery and creation process, impersonal medical care will become personal health care.

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