Friday, August 13, 2010

How Medicine Needs Critical Thinking Derived from Investigating Sex Differences

Medical education begins as a reductionistic endeavor. The 'one size fits all' aide in mastery of concepts and principles. The reality of clinical care is that one size does not fit all. Not one for every human; one for every man; one for every woman.  The impact of clinical exposure is that clinicians gain a video-library in their head of symptoms. From the first textbook description on angina - we meet patients with exertional jaw pain ("I get tired while eating'); to neck pain ("it feels like someone is strangling me') to fatigue, tachycardia, nausea and pressure. So we explode our differential diagnosis with these real-life manifestations of disease. In the ideal, we then can use (or design studies to find) data and evidence on how best to proceed in diagnosis; treatment; outcomes and prevention of complications. The binary evaluation of information by sex - men/women, affords an opportunity to practice how to consider uniqueness in patient specific ways.
       Clinical reasoning implications from evaluating sex differences is seen in evaluation of the literature (what applies to whom and when?); in tuning your ears for how people present to you with symptoms ('classic chest pain' vs fatigue); deciding on treatment (what is best for whom); avoiding complications and adverse effects and investigate unanswered question in science as well as discovering new ways to delivery better care and improve outcomes.
     Show me the data! - the Institute of Medicine functions as an evidence based body that evaluates various topics and is a terrific resource. Congress authorizes the IOM to explore issues; they convene a panel of experts who deliberate for several years; these experts then report on all available evidence on a topic. In showing the impact of sex and health, the 2001 report entitled Exploring the Biological Contributions to Human Health: Does Sex Matter? responded with a yes, it does.
So, what do we mean by sex and gender health disparities?
              Sex and Gender Health Disparities - evaluation of the unequal burdens of disease in morbidity ( dysfunction) and mortality (death) that result in unequal health outcomes.SGHD can occur amongst women ( e.g cardiac disease) or amongst men(osteoporosis)
And in sex/ gender medicine - we tend to focus on the context (not just a disease located within a patient) which is in concert with the the definition of comprehensive girls/women's health
              Comprehensive Women's Healthcare- patient centered, whole patient care that includes the lifespan ( womb to tomb) and non-reproductive and reproductive healthcare within the context of her life and world. This comprehensive approach is useful for all patients, but Women's health is often framed as reproductive health only care -yet the reproductive span is shorter than non-reproductive.
This very cool graphic is from Dr Sarah Hean in her article Learning theories and interprofessional education: a user's guide. Source Learning in Health & Social Care. 8(4):250-262, December 2009.