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A doctor talks about: Gynecologist or internist?

A doctor talks about

Gynecologist or internist?

Many of my patients who have passed their childbearing years ask whether they need to see both a gynecologist and an internist for routine health care. There’s no single correct answer, but here’s what I tell my patients.

Many women begin their adult health care with a gynecologist/obstetrician who performs periodic physicals as well as breast and gynecologic exams. Others get routine breast exams and gynecologic care from an internist or a primary care clinician instead. This makes most sense when a woman has a health condition that requires expertise in internal medicine and has already established a relationship with an internist. On the other hand, a woman whose medical concerns or risks are mainly gynecologic may want to see her gynecologist for all her care. Other factors can also enter into this decision — insurance coverage, for example, because not all insurers will pay for routine visits to different providers.

What matters most for a healthy woman after her childbearing years is not whether she is followed by a gynecologist or an internist, but whether she receives all recommended physical and mental health evaluations, laboratory tests, immunizations, and screenings in a timely fashion. These include occasional measures of blood pressure, weight, and height; appropriate physical, breast, and gynecologic examinations; and conversations with a clinician about general well-being — giving special attention to depression, excessive alcohol consumption, smoking, and osteoporosis.

Most gynecologists and internists are capable of performing these assessments in healthy women. But as we age, we may become more concerned about conditions such as heart disease or colon cancer that fall into the primary care clinician or internist’s area of expertise. A woman with any such medical condition — high blood pressure, for example — should be followed regularly by a clinician who is trained to treat and monitor that condition. For women who are past menopause, not using hormone therapy, and free of other gynecologic problems, it’s probably more important to see an internist than a gynecologist.

If you’d like your internist or primary care clinician to take care of your routine gynecologic care, ask whether she or he does this regularly. Most internists can perform routine breast and pelvic exams as well as Pap tests. But you’ll also want to make sure that you’ll have access to a gynecologist, in case your Pap test becomes abnormal or you develop a gynecologic condition outside the expertise of your primary care doctor. Most often, in such circumstances, a referral can easily be arranged. If you’re relying on your gynecologist for routine care, be sure she or he is comfortable in that role.

The important thing is to have a trusting relationship with a physician you like and who knows you. That kind of relationship, with either a gynecologist or a primary care clinician, is immensely helpful when unexpected health difficulties crop up. However you decide to arrange your care, be sure to get all the health assessments and counseling appropriate for your age and risk profile.

Last updated:	August 21, 2006