For straight-up down-there medical problems--a yeast infection, say, or a positive at-home pregnancy test-- there's no question you should call on your obstetrician/gynecologist (OBGYN) for care. But what if you have a nasty cough, or need a flu shot? If you're like many women, you'll also turn to your OBGYN. In fact, research shows nearly half of all OBGYNs consider themselves primary care physicians (PCP). But could women give themselves short shrift by cutting out the traditional gatekeeper of their overall health?
Not necessarily, according to Rabiya Suleman, MD, an OBGYN at Overland Park Regional Medical Center in Kansas. "A lot of women don't have a primary care physician until they develop multiple medical issues, she says. "For someone who's otherwise healthy, that's generally okay. OBGYNS are trained to address basic things like blood pressure, high cholesterol and thyroid status. Dr. Suleman notes that OBGYNs also help with women's health issues that crop up at the far end of the reproductive cycle, such as changes that come with menopause along with other health risks that increase with age.
In fact, the American Congress of Obstetricians and Gynecologists (ACOG) has established recommendations for what OBGYNs should offer at yearly "well-woman" exams, based on age and risk factors. These include screenings, laboratory and other tests, and evaluation and counseling. Suleman says her practice sees patients for well-woman exams on a yearly basis. During that time we address blood pressure, smoking status, exercise and diet. We usually will offer a yearly set of labs to check thyroid, cholesterol, hemoglobin and blood sugar.
When to see a PCP or specialist
Women also can get certain key vaccinations at their OBGYN's office. This isn't new, but ACOG released updated guidelines for offering immunizations to women as a way to boost lagging vaccination rates among adults. "In our office we do flu shots, the Tdap vaccine and the HPV vaccine," says Suleman. "We don't offer hepatitis B or pneumococcal vaccines, though. For those, a woman would need to see a PCP."
She also would need to see a primary care doctor, internist or specialist for any beyond-basic care she might need for a problem uncovered by her OBGYN. "If your cholesterol is high, I can start you on dietary measures, but I'll also set you up with another doctor, she says. If I see a strange mole on your skin, I can say it looks irregular, but I'm not going to do a biopsy. I'll refer you to a dermatologist. And even though screening for post-partum depression is an important focus for us, when it comes to treating depression of any type there's only so far we might go. I may try a few rounds of medication, but if that doesn't work I'll send a woman with depression to a psychiatrist. In many ways, she says, "we're like a sieve, or screening tool for specialists."
The bottom line, according to Suleman, is if you have a chronic condition such as diabetes or lupus or some other long-standing illness, you absolutely should regularly see an internist or family practice doctor. "It's always a good idea to have a PCP," she says. But if you don't have one, seeing your OBGYN is better than seeing no doctor at all. And, as for that positive home pregnancy test — or, at the other end of the spectrum, unbearable hot flashes? That's when your OBGYN should be at the top of your list for calls to make.