An empowered woman’s guide to better health [PODCAST]

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“It is well known that men and women have different communication styles, and learning how to effectively communicate with each other is important. This is one of the main focuses of our book, which aims to give women the knowledge and tools to ask the right questions during their encounters with physicians.

I’ve performed thousands of hip and knee replacements throughout my career, and I’ve never had a woman patient ask me what the implants are made of. I’ve had many male patients ask me this question, which always surprised me because I would think, ‘Why do you care? What does it matter to you what alloys are used in the implant?’ But the difference is that I can answer that question very specifically and concretely. When a patient feels that I can answer their questions and that I know my stuff, they are more likely to trust me and feel comfortable with me as their doctor.

Women, on the other hand, are more likely to ask questions about how long they will be in pain after surgery. This is a question that I cannot answer specifically because everyone’s recovery journey is different. I can give a general idea of how most patients recover in terms of their pain, but I cannot be more specific.

Another important topic to discuss is the use of online health information. Both men and women often go online to look for information about their health, but there are pitfalls to be aware of. One of the main issues is that people often come to their clinical encounters with a self-diagnosis that may or may not be accurate. It is our job as health care professionals to uncover the truth and provide accurate information. Cancer is a common example where patients may think they have a certain condition, but in reality, it may be something else entirely. It is important for us to be thorough and provide reliable information to our patients.”

Mary O’Connor is an orthopedic surgeon.

She shares her story and discusses her book, Taking Care of You: The Empowered Woman’s Guide to Better Health.

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show, we have Mary O’Connor. She’s an orthopedic surgeon, and she’s the co-author of the book Taking Care of You: The Empowered Woman’s Guide to Better Health, and there’s an excerpt from that book on KevinMD. Mary, welcome to the show.

Mary O’Connor: Hi, Kevin. Delighted to be with you and your listeners today.

Kevin Pho: So we’ll talk about your book and excerpt in a little bit, but first off, just briefly share your story and journey to where you are today.

Mary O’Connor: Well, Kevin, I’m an orthopedic surgeon. I did my training at Mayo Clinic Rochester and went on staff at Mayo Clinic Florida, where I was for years chair of the orthopedic department there. I had lots of leadership roles at Mayo. I love Mayo, and I feel I carry my Mayo Clinic values with me, particularly that the needs of the patient come first.

I retired from Mayo in 2015, and I went to Yale, recruited to lead the development of an integrated musculoskeletal center. Then, about a year and a half ago, I had the opportunity to co-found a virtual medical company that focuses on integrated musculoskeletal care, called Vori Health, V-O-R-I. And so now I’m flexing my entrepreneurial skills and developing those, and having a good time working on transforming the delivery of care in this entrepreneurial space.

Along the way, I wrote this book with my co-author, who’s a medical anthropologist, focused on empowering women as patients to be able to receive better health care and have a more satisfying experience as a patient with their health care team.

Kevin Pho: Now, as you reflect on your career, it sounds like you’ve had many leadership roles. For those clinicians and physicians who are interested in stepping into that physician leadership space, what kind of advice do you have for them?

Mary O’Connor: That’s a great question, and I would say some of that advice depends on the location in which the physician is. For example, if you’re in an academic system and you aspire to leadership, that typically means becoming the chair of a department, and in order to become the chair of a department in an academic center, you need your academic credentials. So my advice to a young person in that scenario is: Publish. You’ve got to get your CV going.

I’m a full professor at Mayo Clinic, professor emerita now since I’m retired, and past professor of orthopedics and rehabilitation at Yale School of Medicine. So you need to build up your academic work in order to get your promotions, because if you want to aspire to leadership in an academic setting, you almost always need to be a full professor.

Now, if you’re not in an academic setting, then that’s not so important, right? And in general, focusing on work that will drive quality improvement, value, and delivering clinical care in a better way are always essential skills toward advancing as a physician leader in any health care setting. I also would encourage people to go get their master’s degree. If I were younger, I probably would go and get my MBA.

Kevin Pho: Do you feel that’s a key step if they want to pursue physician leadership or pursue something entrepreneurial like you are?

Mary O’Connor: I think it’s a key step to pursue those activities in the sense that it will allow you to be a candidate for opportunities. Otherwise, if an MBA is something that a group is looking for, or a physician MBA, right, then you’re just not even considered. You don’t even make the first cut toward the interview process if you don’t meet the inclusion criteria, essentially.

Kevin Pho: All right, so let’s talk about your book. It’s titled Taking Care of You: The Empowered Woman’s Guide to Better Health. Now, before talking about the book, tell me about the events leading up to you co-authoring that.

Mary O’Connor: Yeah, you know, Kevin, I’ve been a minority in my profession forever, right? Orthopedic surgery unfortunately has the lowest percentage of women of any surgical subspecialty, a fact that I’m disappointed to report, and I have spent my entire career working to build more diversity in the orthopedic profession. So that would mean that oftentimes I would see women patients who felt, basically, that their orthopedic surgeon didn’t listen to them, didn’t take their complaints seriously, minimized their degree of pain, and that they didn’t have a good experience, or weren’t offered the same kinds of therapies or treatments, and in general had disparate care.

Kevin Pho: Now, what would be an example of that? Tell us a story that would really illustrate that point.

Mary O’Connor: Well, the story is that the female patient comes in with knee pain and significant knee osteoarthritis, but she’s also overweight or obese, and maybe she has diabetes. She comes in because she saw an orthopedic surgeon, a male orthopedic surgeon, a year ago who told her, “Go lose weight, and then come back to see me.”

So that is part of the challenge, and this is not an uncommon scenario, right? I’m totally aligned that we want our patients to not be obese at the time; ideally, right, they’re at a healthier weight at the time of surgery. But one of the things that we need to think about in terms of how we approach these patients is that telling them to go lose weight is one thing, and helping support them to do it is another.

Now, I do not see that as the sole responsibility of the orthopedic surgeon, right? But it’s the surgeon taking that step to refer the patient to a weight loss center, or encouraging them and saying, “Listen, I know your knee hurts. You have severe arthritis. I do think that knee replacement surgery would help you, but let’s get you healthier first. I’m going to refer you to the center to help you lose weight, to partner with you. Let me see you in six months and see how you’re progressing.” Now I’m giving that patient more of a sense of hope, and a sense that I am not abandoning them, as opposed to the message of “Call me after you’ve lost weight,” which the patient often interprets as “I’m dismissed.” So this is a different thought process in terms of how we want to partner with patients on their journey.

So anyway, I would see lots of women who felt that they didn’t have a good experience with their male orthopedic surgeon. And again, beauty is in the eye of the beholder, right? The experience is in the eye of the beholder, the patient. And so I don’t say that to criticize my colleagues. I believe that almost 99 percent of my colleagues are out there trying to do a good job with patients. However, could we have better communication skills? Probably. Could we listen better? Almost always, including me.

So the idea of this book came about to give women a resource to empower them to advocate more effectively for their own health. The book has three sections. The first section really focuses on accessing the health care system. The second section, which is the majority of the book, has 55 chapters on common clinical conditions. We avoided clinical conditions like pregnancy and fertility, because there are already lots of books out there for women like that.

And we templated the clinical condition chapters in a standard way, so that the first thing would be explaining what the condition is. Can it be prevented? How is it treated? Why does it matter to women? Then questions to ask your health care team about the condition, and then my favorite part, which is pearls of wisdom from the contributors. We had 111 women contributors writing these clinical chapters, all experts in the field, mostly, almost all, physicians, but not exclusively. And then the final section of the book is called “Taking Care of You,” which is where we focus on activities and important aspects for women to embrace to improve their overall health and wellness, like sleep, nutrition, mindfulness, etc.

Kevin Pho: So tell us some of the main pieces of advice that you can give to women on how they can empower themselves as they navigate our health care system. Without, of course, giving away all your chapters, what are some main pieces of advice?

Mary O’Connor: Well, the first piece of advice I would give any patient is that they need to find a doctor that they’re comfortable with, that they feel they can trust, who is putting their needs first, and who listens to them.

Kevin Pho: Now, what kinds of questions can they ask themselves, or ask that physician, in order to get that comfort level? So when you say find a doctor who you’re most comfortable with, what are some specific criteria that you would recommend?

Mary O’Connor: So this is all about feeling and not so much about data, right? Because trust is a feeling. And so in that encounter, is there eye contact? Is the physician listening to the patient, whether that’s a woman or a man? But, right, we find that this communication difference is established. We know that women and men have different styles of communication, and so learning how we can communicate more effectively on both sides is important, which is, again, part of the purpose of this book: to give women the knowledge of questions to ask that physician in the encounter.

And I’ll share a short story. I’ve done, I mean, I don’t know, thousands of hip and knee replacements in my career, and I’ve never, ever had one woman patient ask me what the hip or knee replacement was actually made of, like, what are the metals? And I’ve had plenty of men ask me this question, which I always found astonishing, because in the back of my head I’m thinking, “What are you, like a metallurgist or something? What do you care? What does it matter to you what alloys are used to make this implant?”

But the difference is that I can answer that question very specifically and concretely. Now that patient then feels, “Oh, Dr. O’Connor, she can answer my question. She knows her stuff. I’m comfortable with her. I can trust her. She’s an expert.”

The question that women will ask more commonly is, “How long will I be in pain after my surgery?” That is a question that I cannot answer so concretely, right? I mean, I can say, “Well, in general, here’s how most patients recover in terms of their pain, and we’re going to support you through this journey, but everyone has a different journey.” So I can answer the question, but I can’t answer it as specifically as I can the question that male patients would ask me. And I’m very much stereotyping and generalizing right now, but these are communication style differences.

Kevin Pho: Now, in your excerpt on KevinMD, you talk about online health information, and both men and women, of course, go online to look for health information. So talk about some of the pitfalls and the advice you have for people who go online looking for health information.

Mary O’Connor: So that’s another great question, Kevin, because you and I know that there’s a tremendous amount of information out there, and almost always, for people who use the internet, Google is their first responder, right? Because people will go and search for their symptoms or search for a condition that they think they have.

Because the essential point for all of us as health care clinicians to remember is that almost all patients come to this clinical encounter with a self-diagnosis. All patients have an idea of what’s wrong with them that may or may not be true, and it’s our job to try to make sure we uncover that, because oftentimes they’re fearful of a diagnosis that is, of course, completely not there.

And cancer is the most common thing. Patients would come in to me, they’ve got hip pain, and maybe it’s arthritis, and we’re having a conversation. And then I would always try to ask, “And how does this align with what you were thinking when you came into the office today?” Because, and I’ll say this, most patients are thinking about, or have, basically, a self-diagnosis. They’ve thought in their head, “Here’s what I think is wrong with me.” How does that align with what we’ve talked about? And in that conversation, you can then elicit, “Well, I was actually worried that it could be cancer, because I have a history of cancer,” or “My sister has breast cancer,” or there’s something in the back of their head that’s saying, “This is really bad.” And if I don’t address that, they’re going to walk out of the office thinking, “Well, I know Dr. O’Connor told me it’s arthritis, but I’m really still worried that it’s cancer and she’s missing it.”

So we have to recognize that people will self-diagnose, and that is, I would say, even more heightened now that people can go online and use Google as their first responder and gather all this information with which they can align their symptoms. OK? You can go align your symptoms with all kinds of things out there that are totally off the charts in terms of clinical relevance.

Kevin Pho: Now, how do you advise patients to filter that information, and how to interpret that information that they come across on Google?

Mary O’Connor: Yeah, that’s another great question. So the first advice I give patients is: Please go to what I would consider a reputable website, right? Mayo Clinic, Cleveland Clinic, I mean, a well-known health care institution where the content is peer-reviewed and vetted by experts. So that’s the first piece of advice, because there are a lot of, I’ll call them, unconventional treatments out there. And I’m actually a person who is very open to considering kind of unconventional things, but at the same time, the patient or consumer has to recognize that they’re unconventional. They may not be tested. They may not be, quote, “proven.” And they have to filter that into the context of the decision-making process. That’s my first advice: Please go to what we would consider a reputable source, where the content is peer-reviewed.

Kevin Pho: We’re talking to Mary O’Connor. She is the co-author of the book Taking Care of You: The Empowered Woman’s Guide to Better Health. Mary, what are some of your take-home messages that you want to leave with the KevinMD audience?

Mary O’Connor: Let’s be aware of and sensitive to the health inequities that we have in this country, and it’s not just women. It’s individuals of color. It’s people in rural America. I chair a national nonprofit, multi-stakeholder coalition called Movement Is Life. We actually have our national meeting coming up next week, but we’ll have one the following year, and we would love for people to join us, because we collectively need to address this.

So this book, our book, Taking Care of You, was basically born out of my passion for health equity. This focuses on women. We also pull in any data that we can on women of color. But I want to highlight that we sometimes think of health disparities as being isolated to the inner cities and communities of color, but there are huge disparities that occur in rural America as well. So this is something that we all have to be aware of to solve.

And I’m hopeful that this book will help at least women empower themselves to be better partners in their health care journey and better advocates for their health. And actually, men can use the book too, to think of the right questions to ask their doctors and to learn about the conditions, although we specifically did include content focused on disparities affecting women.

Kevin Pho: Mary, thank you so much for sharing your time and insight, and thanks again for being on the show.

Mary O’Connor: My pleasure, Kevin. Thank you so much.

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