Women-Centered Care: Redefining Primary Health for Every Stage of Life

Podcast Transcript

Dr. James K. Stoller:

Hello and welcome to MedEd Thread, a Cleveland Clinic Education podcast that explores the latest innovations in medical education and amplifies the tremendous work of our educators across the enterprise.

Dr. Tony Tizzano: 

Hello, welcome to today's episode of MedEd Thread, an education podcast exploring education around women's unique healthcare needs and preventative measures. I'm your host, Dr. Tony Tizzano, director of Student and Learner Health here at Cleveland Clinic in Cleveland, Ohio. Today, I'm very pleased to have Dr. Laura Lipold, Medical Director of Primary Care Women's Health at Cleveland Clinic here to join us. Laura, welcome to today's podcast.

Dr. Laura Lipold:

Yeah, thank you for having me.

Dr. Tony Tizzano:

To get started, if you would please tell us a little bit about yourself, your educational background, what brought you to Cleveland, and your role here at Cleveland Clinic.

Dr. Laura Lipold:

Thank you for the question. So I, I'm not a Clevelander originally. I grew up in New York and I did my medical school training in New York. I ended up at Case Western Reserve University for training through the match, and I stayed on for a one-year fellowship in women's health. My primary care training is family medicine, so I'm a family medicine trained physician, and I completed a one-year fellowship. And right after fellowship training, I joined Cleveland Clinic and I've been here ever since. This is my 24th year here.

Dr. Tony Tizzano:

Excellent. And in that extra year of fellowship, what did that entail?

Dr. Laura Lipold:

That's a really good question because there are different structured women's health fellowship programs across the US. And the way I like to frame it is that there are basically two avenues. You can have a fellowship-trained program where, like myself, I chose one that gave me more opportunity around procedural training in addition to enhancing my clinical women's health skills with the intention of still coming out of that, being a primary care physician with enhanced women's health skills and doing some women's health procedures, basically short of surgery and delivering babies. The other avenue in the US is really gonna be for somebody who comes out of a primary care residency program that feels like they really didn't get all of the women's health clinical skills and really want to develop that more to the level of maybe consultative women's health care type of practice that they would pursue post-training.

I'll give an example. So the program that I completed at Case Western Reserve University Hospitals, there was a research opportunity. I rotated with a lot of women's health specialists, but I also had a pretty good skill base already with performing pelvic examinations, doing some procedures. I delivered over a hundred babies. So I had a lot of that skill set, but I really wanted to hone in on my more advanced GYN skills in addition to the other clinical opportunities, again, with the idea that I would come out, I would still be a primary care physician and I would just have enhanced women's health skills. We have here at Cleveland Clinic, a fellowship program that it's a two-year program, and most of the fellows go on, they're really in that day-to-day primary care physicians, but they're really women's health consultants. So they're really providing more complex, higher level women's healthcare, for example, complex osteoporosis management, complex hormone therapy management, etc.

Dr. Tony Tizzano:

Yeah, those are all great points. You know, I think sometimes listeners might think, "Gee, we're all human. I mean, how many differences are there?" You know, how would you speak to that? How would you say, "Well, wait a minute. You take care of men, you take care of women." I mean, how different can they possibly be?

Dr. Laura Lipold:

Right. And I think that we're still learning the answer to that question. Right? And I think around shortly before the time that I decided on a fellowship in the nineties, there was that aha moment that we had understanding that women were not well represented in research studies. Right? That was the big aha moment at that point. And there was a real commitment moving forward to making sure that we were doing more gender-based research. And I think with that, we're also understanding that, you know what? There's been a lot of, you know, we hear about structured racism, but there's been structured sexism. And we also know that as a result of our differences in terms of our hormonal milieu, that that is influencing diseases that are not necessarily unique to women, I.E. occur in both men and women, but may present differently, may have different prognosis, and may have different response to treatment.

Dr. Tony Tizzano:

And perhaps even if they present the same way, for example, chest pain, if you went in with the exact chest pain suggestive of a, an MI for a man and a woman, the likelihood that you get admitted to a cardiology service would be higher for a man than it would be for a woman.

Dr. Laura Lipold:

Absolutely.

Dr. Tony Tizzano:

And why is that?

Dr. Laura Lipold:

Right. Right. Why is that?

Dr. Tony Tizzano:

Is that implicit bias, or what do you think that-

Dr. Laura Lipold:

Right. You know, and I feel like that is kind of along the lines of the conversations that we're also having around maternal and infant mortality. I'm gonna kind of parallel a little bit with some of the structured racism, right? Why do minority women have such higher rates in terms of maternal mortality and infant mortality? Why do we see that? And I, I think there's that kind of parallel in terms of structured sexism and racism in medicine that we're probably historically seeing the impact of.

Dr. Tony Tizzano:

You have a heading down a path that maybe not be our exactly our topic, but that you mention it, so where do you begin to influence students in their education to these disparities and, and have them believe it?

Dr. Laura Lipold:

Right.

Dr. Tony Tizzano:

Is that part of what your fellowship did? Or I, I have a feeling that you already were on this path before you got to fellowship-

Dr. Laura Lipold:

Uh-

Dr. Tony Tizzano:

... when you told me a hundred deliveries.

Dr. Laura Lipold:

I have to tell you that I have learned a lot over the past couple of decades around historically the structured sexism and racism. I, I feel like my eyes have been open to things that even, you know, I probably had participated in that I didn't even realize. So there's a lot that I think we've learned in terms of historically how we've practiced and how we need to think differently. And I think a lot of it comes down to trust with the patient and really having some good communication skills. I think what we're seeing in the world of infant and maternal health is that what seems to be very successful is really community health workers being able to connect with patients in their communities and help to be that bridge of trust between patients and between the healthcare providers. Because in some instances, understandably, that trust has been really broken down. And I think really starting to address that trust issue is probably first and foremost.

Dr. Tony Tizzano:

Yeah, that is spot on. We're gonna be doing a podcast in the future looking at some of these programs and acronym. Everything you're saying is really resonating with me.

Dr. Laura Lipold:

Ah.

Dr. Tony Tizzano:

So along these lines, you mentioned earlier the concept of a women-centered medical home.

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

What does that mean?

Dr. Laura Lipold:

Right. Uh, the way I like to think about it is that, you know what? You have a trusted primary source of healthcare that will be your go-to when it comes to navigating the healthcare system. I also like to think of it as you can be confident that wherever you choose to have your medical home, you will get the same access to high quality women's healthcare. We're not there yet, but that for me is really aspirational for what that really means altogether. So kind of maybe giving you an example of what that would look like, so if you have a primary care physician and you access your primary care physician, you know, nowadays virtually or in the office, you can have those conversations about making sure that you are number one, up to date on your important preventive women's healthcare services.

You can talk about concerns that you have and what would be appropriate next steps in terms of, you know, helping you with diagnosis or treatment. And the primary care physician team may be able to manage that or may have some conversation with you about seeing specialists or other sub-specialists too as well. And then I also like to think when we're talking, you know, very importantly about women's healthcare is that, you know, making sure also that you have, especially nowadays access to reproductive healthcare. And I feel like the woman's medical home should be an important place where, you know what? It doesn't matter how old you are as a female, you know, it doesn't matter if you are 13, 12-

Dr. Tony Tizzano:

Sure.

Dr. Laura Lipold:

... 53, you know, you need to make sure that your reproductive healthcare needs are being met.

Dr. Tony Tizzano:

I like to think that there's also a gatekeeper component to this.

Dr. Laura Lipold:

Yep.

Dr. Tony Tizzano:

And I know I look at myself and I think, okay-

Dr. Laura Lipold:

Right.

Dr. Tony Tizzano:

... I know the very woman-specific things for screening, but treatment is a whole other ballgame.

Dr. Laura Lipold:

Right.

Dr. Laura Lipold:

That kind of points me in the direction of, you know, the American College of Obstetrics and Gynecology suggests that the general OBGYN should be and serve as-Mm-hmm.

Dr. Tony Tizzano:

... the primary care physician for women.

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

And of course they have modules here and there, but make no mistake, at least during my training, it was not part and parcel of what was looked at-

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

... focused upon, and then tested on in no way, shape, or form. And I think the most glaring thing that I think about is depression.

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

You know, we see women postpartum.

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

Postpartum depression's not at all uncommon, but then you get evaluated, you might start treatment, and then that next visit comes a couple of months later and you continue the script. But then now it's the next annual exam, they're still on the antidepressant. There's been no inventory done.

Dr. Laura Lipold:

Mm-hmm. Mm-hmm.

Dr. Tony Tizzano:

And I sometimes wondered, is that a reasonable thing to think that in today's 21st century, that the OBGYN is really focused enough on the primary care extended beyond screening? Or is it time to say, hey look, let's work collaboratively, hand-in-hand with our internists and primary care doctors?

Dr. Laura Lipold:

Right. You hit on a couple of points here. So I think it does come down to training and experience and top of licensed care is another way to look at it too, as well. And it all depends. Certainly when we think about primary care services, there's probably gonna be different types of providers that may contribute to that. And so for an individual who is maybe right in the midst of their reproductive life phase where they're starting families or having children, they're seeing their obstetrician on a regular basis, that obstetrician is in a really good position to make sure that that individual is up-to-date on some of those preventive screening services. And is certainly well-trained in terms of breast health and cervical health, right? But correct. Probably the traditional obstetrical gynecology program, you know, they're probably not gonna be trained on hypertension management that's beyond the peri and postpartum time period.

They're probably not gonna have a lot of training around recurrent major depressive disorders, generalized anxiety disorders, et cetera. And those tend to be more of the bread and butter training for primary care physicians. So they may play a role, but they certainly, I don't think can do it exclusively alone by themselves. But kind of getting to the point, there are probably are really truly gonna be different primary care healthcare needs across a female's lifespan. And a primary care trained physician really does transitions of care really well. They really help to support that in a very positive way. So I can give you the example of a family medicine trained physician. So you know, they can help to support that individual during childhood. And then as they start to transition over to adolescence, they can help to support that, making sure that they're, you know, giving appropriate counseling about the normal changes that are happening, making sure that vaccinations, importantly HPV vaccination is up-to-date altogether.

And there may be an opportunity to, in terms of sexual health, to start to, you know, talk about sexual health and then maybe addressing reproductive healthcare needs during adolescence, and then helping them make that really important transition to adulthood. And I think we've under-recognized the importance of helping to support our patients that are moving from a pediatric model of healthcare to an adult model of healthcare. So, you know, we know legally the day you turn 18, all of a sudden, you know, you're according to the law an adult. But you know (laughs)-

Dr. Tony Tizzano:

Right. Right.

Dr. Laura Lipold:

... not everybody really is feeling truly autonomous as an adult. And there are a lot of ways that we can help to kind of support these transitions. I think nowadays we're doing a little bit of a better job with that. And then, you know, transitioning, alright, you've got, now you're moving over into, you may be into your twenties and thirties and starting to think about having a family or not having a family. Right? And so how can we kind of help you to address those needs that you need? Okay, maybe it's now time to see an obstetrician, or let's have those great conversations about all of the options we have around reproductive healthcare, et cetera. And then there's of course a transition into peri and post-menopause.

Dr. Tony Tizzano:

When you look at sexual health-

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

... in the adolescent-

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

... and you know, from the time of puberty on, and actually even before then-

Dr. Laura Lipold:

Yeah. Mm-hmm.

Dr. Tony Tizzano:

Sex education in the household, because it doesn't exist in our schools.

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

So let's all agree on that.

Dr. Laura Lipold:

Correct.

Dr. Tony Tizzano:

I think I can say that with confidence, and yet we're sexually active beings, but there's not good information.

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

There's an attempt at times at information, but there's not always a good source.

Dr. Laura Lipold:

Mm-hmm. Correct.

Dr. Tony Tizzano:

People are uncomfortable, they don't know what to do with it. And quite honestly, for the OB-GYN, that younger group is outside of our grasp.

Dr. Laura Lipold:

Right.

Dr. Tony Tizzano:

You know, we don't see them unless they have a problem.

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

If something comes up, a painful period, something this or that.

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

And of course, now we don't worry about a pap smear until they're 21-

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

... and so forth.

Dr. Laura Lipold:

Right.

Dr. Tony Tizzano:

So we don't even really get to weigh in on vaccination.

Dr. Laura Lipold:

Right, right.

Dr. Tony Tizzano:

So there is an opportunity in primary care that is just, and in pediatrics-

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

... that is just ripe and it's just a matter of gaining a comfort zone, and not to even mention all the issues around the LGBTQ plus community, which has to happen sooner than high school.

Dr. Laura Lipold:

Absolutely. I'm, I'm glad that you brought that up too as well because I, if I can just kind of mention, I-

Dr. Tony Tizzano:

Please.

Dr. Laura Lipold:

... know that the big buzzwords were women's healthcare, gender-based care back when I started in this fellowship. But clearly we need to think about language that's more inclusive. And I, I did struggle with my title, right? So, you know, Medical Director of Primary Care Women's Health. Well, that may now be seen as inclusive, but again, how do we acknowledge the gender-based, you know, I'm trying to advocate for more gender-based equitable healthcare. And so we sometimes use women's plus to try to (laughs) relay that we're more inclusive all together. But it is certainly something I think that we need to continually think about how we can be inclusive. And you're right, these conversations need to start early on so that we are supporting individuals very early on.

Dr. Tony Tizzano:

Yeah. And I sometimes think that, you know, our students may carry the torch in this area, especially with in terms of less implicit bias-

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

... more able to reach out around DEI-

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

... than those of us who are more seasoned. And I'm having to work at it to know that I'm more inclusive in the office. So I think it's an excellent point.

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

So with regards to the ages of patients seen, is there a difference between an internist and a family medicine or family practice physician?

Dr. Laura Lipold:

There would be. So the family medicine trained primary care physician is the traditional womb to tomb. And still nowadays they do have obstetrics as part of their training. So they're really providing full-spectrum care altogether. Internal medicine is, I think we typically think of it as adults. I do have some internal medicine colleagues that may see patients down to an adolescent age, again, depending on their experience and their comfort level. But more traditionally, adults, meaning 18 and above. And that is their training. And then, and just kind of getting back to the training piece altogether, those are the two main tracks in terms of how somebody would become a primary care physician in the United States. And internal medicine, what's nice about that is if you're considering a career in a specialty field, you're gonna wanna do your categorical internal medicine training and then move on from that.

But some elect to not do that and to continue in primary care. The ACGME requirements to graduate from an internal medicine accredited program actually removed needing to complete or document PAP examinations or pelvic examinations, and-

Dr. Tony Tizzano:

Interesting.

Dr. Laura Lipold:

So it is interesting. So you certainly understand from the one side of it, if you aspire to be a cardiologist, you don't need that skill. However, if you want to be a primary care physician, arguably you need that skill. So I think the response of some programs have been that they're really looking at trying to develop more primary care tracks. So if individuals know early on that they're probably gonna be on track to become a primary care physician and not a specialist, that they're really gonna try to go out of their way to give them that experience and help them to develop that skill set.

Dr. Tony Tizzano:

Yeah. It's intriguing, and I know this is a little bit off-topic, but you know, as an OBGYN, I look at the woman who comes to my office urgently because she was just seen in the emergency room for pelvic pain.

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

And I always tell 'em, "I'll see you in the next morning." You can just call, they can come in at 7:30, I'll be there. And they had pain, they got an ultrasound, wasn't so sure what they saw in ultrasound so they got a CAT scan, and CAT scan left something to be desired so they got an MRI. We call it the trifecta. So they come to see me and I'm talking with them and I say, "You know, you've probably already examined, but I'd like to examine you again." "Oh, no I wasn't, I didn't have a pelvic exam." Guess what? No cervical motion tenderness. I can just about tell you for sure, there's nothing wrong with the tubes, uterus, or ovaries.

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

It may be diverticulitis, maybe something else. But instead, we've got three mega imaging techniques. So we've sometimes lost our hands-on physical examination. And I think that to your point, having some of these basics, having this fundamental basis of knowledge is probably still important for most of us.

Dr. Laura Lipold:

And to your point, look at that service to that individual, right? And look at the cost to the healthcare system.

Dr. Tony Tizzano:

You're preaching to the choir there. I agree with you a hundred percent.

Dr. Laura Lipold:

Yeah.

Dr. Tony Tizzano:

So what do you think about from the payer's standpoint, this needing to have a referral from the primary care physician for some of the specialty work, which sometimes I can't make referral to?

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

I've gotta bounce it back to you, and then-

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

Is that, do you think a good thing? Do you think sometimes, maybe sometimes not? What's your thought?

Dr. Laura Lipold:

Right. And I think you're right. I think there are a couple of different ways to angle that altogether. I mean, the, the benefit of the primary care physician playing the role of gatekeeper and needing to place that order or that referral for specialty or subspecialty care, doing that first initial assessment of the patient and just really kind of better understanding patient expectations, right? So if it is a condition that the primary care physician can easily address, then you know, if they have that relationship, they can really take care of it right there on the spot. But if it is something that probably does warrant specialty care, it is also an opportunity for the primary care physician to help the patient understand what you can reasonably expect from the specialist, right? So I've had some patients walk in, you know, "I've got severe back pain, I need to see an orthopedic surgeon." Well, there's a lot of education that can go into that visit right then and there if a consultation is indeed ordered in terms of what probably more appropriate next steps will look like when they see the specialist.

Dr. Tony Tizzano:

And I always think for myself, I'd like to have a captain of the ship.

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

And that's usually not gonna be my specialist. I usually need an internist or a primary care physician saying, "Hey, I'm going to wrap my arms around all of this. I wonder if we shouldn't be doing something here or there, like, okay, your, your lipids look good, but not if you have heart disease. We need to have 'em be even lower." Oh, you know, I thought just because it said, well, yeah, it's good for a normal person but not for someone with heart disease.

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

Or if you have someone who needs weight management, or you have someone who is heading towards their reproductive years but has some issues.

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

Maybe they have diabetes, and how can you get them tuned up and ready? You know, things that we would see them at the time of pregnancy, but you could have already taken a long ways towards having success. You know, how does someone know to choose that?

Dr. Laura Lipold:

Very well said. So these are the conversations I have all the time with my patients, especially the ones that have maybe perplexing conditions, so things that they're maybe seeing multiple specialists and they're still trying to get, you know, a sense in terms of what might be potentially causing or contributing to their symptoms. And I often find in that circumstance, we have that conversation in terms of what next steps seem to be appropriate and what they should look like. And then we have those regular visits in between the specialty care visits so we can, okay, let's regroup, let's see what's happened. You know, let me answer any questions that you have that maybe weren't addressed by the specialist or maybe you don't understand.

We can review imaging. Oh, by the way, there was something, a little something on that imaging that we also need to follow up on per se, or a little something off with that blood test we need to follow up onto as well. And then we can just really, again, kind of help them along that journey and support them, but also really say, "Eh, you know what? This seems to be a little bit duplicative in terms of a recommendation. We could probably nix that one consult. You probably don't need that." But yeah, to your point, really being an important, so to say, quarterback of everything.

Dr. Tony Tizzano:

So you're done with your family, you now have an IUD in, or perhaps you've had a sterilization and now you're headed into those other years. You know, when do you sit back and think, okay, is there a time when I need to shift back to seeing my primary care doc more because I might begin to develop problems that are perhaps maybe age associated that your expertise begins to rise to the surface and be better? 'Cause it sounds to me like one size doesn't fit all.

Dr. Laura Lipold:

Right.

Dr. Tony Tizzano:

But there's some times, and it's as long as you know what you don't know, you're okay.

Dr. Laura Lipold:

Right.

Dr. Tony Tizzano:

And know when to punt.

Dr. Laura Lipold:

So I, I would have to say a lot of us have conversations about this, and I feel that we are probably moving towards earlier and more regular involvement with primary care. And again, thinking about trying to collaborate in terms of helping to manage patients with chronic diseases. I'll give you an example. So currently, the Comprehensive Maternal Care program through the Ohio Department of Medicaid, one of their metrics that they are using is a primary care visit within 12 weeks of delivery.

Dr. Tony Tizzano:

Ah.

Dr. Laura Lipold:

So that's kind of a, you know, kind of a newer thing.

Dr. Tony Tizzano:

I like it.

Dr. Laura Lipold:

We always think about the importance of postpartum OB visit, but they're recognizing the importance of getting them back to the primary care physician pretty quickly as well. Again, kind of recognizing that, you know what? Get that touch base. Make sure that you have an opportunity if there is anything that your primary care physician needs to be addressing that your OB has not addressed or you know, can't address. The other thing I think about, and I usually tell patients at this point, so what about the purely truly healthy individual has come to the end of having babies, maybe is in their thirties, right? So, or hitting 40, but they still decided that they're gonna continue, they have a really good relationship with their obstetrician, they're going to continue with their obstetrician gynecologist for now to get their cervical cancer screens and they're gonna kind of check in with them still once a year. They're gonna continue to do that.

I don't get in the way of that. I know I, I'm not really, I'm like, okay, that's fine. That's, you know, if that's something you want to continue to do, but I offer a timeline in terms of when they probably need to start to return to me. And I think about when things start to kick in. So per guidelines, there are definitely regular screens that we need to be thinking about doing at the age of 40. You know, if you haven't had your lipid screen or your fasting glucose, et cetera. We've now lowered the age for colorectal cancer screening to the age of 45. So I'm definitely kind of working in there, you know what? We should probably start to see each other for your annual with me in your forties on a pretty regular basis. So that's a way that I kind of approach it in that general sense too as well.

Dr. Tony Tizzano:

Sure. And you know, I think there's other areas of oversight like osteoporosis. I mean-

Dr. Laura Lipold:

Yes.

Dr. Tony Tizzano:

... historically how often you would see a young woman, they come in, they want birth control, what do they get? They get a birth control pill. And less is better-

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

... so they get these low dose pills, but then we start to realize that if they're under a 30 or 35 mic pill, they're probably not going to achieve their optimal bone mass by the age of 26.

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

Or, but maybe they don't, maybe they use an IUD or something else makes a difference.

Dr. Laura Lipold:

Mm-hmm. Mm-hmm.

Dr. Tony Tizzano:

Those are things that we didn't even think about-

Dr. Laura Lipold:

Mm-hmm. Mm-hmm. In terms of bone health. Right. Right.

Dr. Tony Tizzano:

... a decade ago.

Dr. Laura Lipold:

Absolutely.

Dr. Tony Tizzano:

We didn't think about it.

Dr. Laura Lipold:

Right.

Dr. Tony Tizzano:

We just thought, "Lower dose better, gotta be less estrogen."

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

Better off. Laura, you've given us so much to consider. That said, what do you see lying on the horizon for primary care and women's health?

Dr. Laura Lipold:

I will say what I see as aspirational, what I think is really important is that we are thinking about our healthcare delivery system to be more accessible. And I wanna make sure that traditionally marginalized individuals, that we can be able to reach out to them in a way that they will access the care and they will get the same high quality healthcare that non-marginalized individuals get. The ask of us is going to be to be thinking very creatively. The traditional come into a doctor's office may not always work. And so I think we need to think very creatively about it, but it is very important that we think about that and that we are reaching out to marginalized individuals.

I think also the future, to answer your question, is gonna be, I think around personalized healthcare. So the field of medical genetics is exploding, and I think we're really gonna be in a position quite soon where we are gonna be able to leverage our understanding of genes to truly understand an individual's risk for disease, one example being cancer. And then as a result of that, we can provide very tailored, personalized approaches to prevention and treatment. So I think that's really gonna be huge in the future altogether.

Dr. Tony Tizzano:

Yeah, I agree. Do you think there's a place when we just, I was just thinking as you were talking, within our education? For an organization like the size of ours, that there might be an opportunity to have obstetrician gynecologists and primary care have maybe twice a year grand rounds together on topics where there's this intersection that maybe we can do better?

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

Maybe you can do better? Women, I think are much more tuned into their health to begin with.

Dr. Laura Lipold:

Mm-hmm.

Dr. Tony Tizzano:

And sometimes we count on that. And I always tell my wife, I said, "Behind every healthy man is a woman with a stick poking him." You know, get this done, get that done. But we could coalesce some of our training that I think the conversation might be interesting.

Dr. Laura Lipold:

I agree. Well said. Yes.

Dr. Tony Tizzano:

Is there anything that I haven't asked or that you think we should discuss and is important for our audience to know?

Dr. Laura Lipold:

Certainly, I agree with the comments that you've made, and I would say that we are really just starting to scratch the surface in terms of, as you had said, this really better, less siloed, more collaborative approach in terms of treating individuals. And I would agree that, you know, how that would translate into interdisciplinary collaborative healthcare around specific disease states also is one of the future aspects too as well.

Dr. Tony Tizzano:

Once a year is a place to start.

Dr. Laura Lipold:

Yep.

Dr. Tony Tizzano:

We might have to talk about that. Well, Laura, thank you so much. This has been a wonderfully insightful podcast. To our listeners, if you'd like to suggest a medical education topic to us or comment on an episode, please email us at education@ccf.org. Thank you very much for joining, and we look forward to seeing you on our next podcast. Have a wonderful day.

This concludes this episode of MedEd Thread, a Cleveland Clinic Education podcast. Be sure to subscribe to hear new episodes via iTunes, Google Play, Stitcher, Spotify, or wherever you get your podcasts. Until next time. Thanks for listening to MedEd Thread, and please join us again soon.