I often joke that this year, I work in a field called called “gynechiatry”—a mix of gynecology and psychiatry. It’s normal for patients to share intimate, often anxiety-provoking parts of their lives with their OB-GYNs, including details they don’t even tell their closest friends and family members.
Yet I’ve never had as many patients cry to me in routine visits as I have these past eight months. The confluence of COVID-19, the Black Lives Matter movement, and one of the worst fire seasons on the West Coast has had an immeasurable toll on our mental, emotional, and physical health, and the exam room is a safe space to release.
As painful and unfair as 2020 has been for so many of us, it’s also forced an inflection point where we’re reexamining the systems that make the U.S. especially vulnerable.
What doctors and patients are dealing with
When COVID-19 cases first surged, healthcare providers came to work and accepted the potential risks without understanding their full implications. We showed up for our patients despite our own fears because there was no alternative, and it’s what we’re trained to do: take care of people, no matter the circumstances.
In those early days, I was using one N95 mask that I had fortunately stored in my office desk the year prior. I was asked to make it last for the foreseeable future. I left my house every day, kissing my kids goodbye (while also struggling to find childcare, like so many millions of parents all over the country), worked all day in the clinic and hospital, and then, once home, started the intricate routine of decontaminating myself in the garage, hoping not to have brought something home that could kill me or my family.
At first, we didn’t know anything about COVID-19 and pregnancy, other than pregnant people were considered immunocompromised and needed to be protected. When a mother-to-be looked at me with heightened anxiety, pushing for answers, it was stressful to not have them. What information we did have came out of tiny observational studies from China and New York, where not nearly enough data was available to analyze. With this rapidly spreading and deadly virus, the go-to response quickly became, “We just aren’t sure yet,” which is always unsettling to hear.
As if COVID-19 wasn’t enough, almost all of my Black patients (and especially those planning for sons) expressed a palpable fear about bringing children into this world. What does it mean to celebrate the joy of your baby boy and simultaneously know that he too could one day be calling out your name under the weight of a police officer’s knee? I am not Black, and there is no way I could come close to giving adequate weight or words to this issue, and knowing that, I continue trying to educate myself and advocate for equity in patient care every single day. It’s my role as my patients’ doctor to rise up to this need, plain and simple.
In this unique storm of stressors, no one medical specialty is working alone—this is a team sport. Psychiatrists are inundated with patients and OB-GYNs are helping to bridge the gap by providing more temporizing mental healthcare than ever before. Given our role as combined specialist/primary care providers, and our training in prescribing medications for issues like perinatal depression, we’re often the ones patients first go to when they need psychiatric prescriptions, especially if they don’t have a primary care provider or mental health specialist. While OB-GYNs will never take the place of our much-needed psychiatry colleagues, we can be a stepping stone to that specialized care and help shine light on the dire need for improved access to mental healthcare in this country.
The other elephant in the room
With Supreme Court Justice Ruth Bader Ginsburg’s passing and the confirmation of Judge Amy Coney Barrett as her replacement, the very existence of the Affordable Care Act is under fire. My patients know this, and they're scared. This law has drastically increased the number of U.S. women who can obtain and keep health insurance and absolutely improves the quality of care for millions of Americans. It was only about 10 years ago that pregnancy was a “pre-existing condition” that precluded people from getting health insurance.
Due to rapidly evolving health policies and changes in the Supreme Court, there’s a very real possibility that many women’s health services—like breastfeeding support and counseling, contraception, prenatal vitamins, screening for sexually transmitted infections, breast cancer and cervical cancer screening—will no longer be covered as they are now.
A patient recently asked me to change out her IUD several months earlier than planned because she was nervous that once it was actually due for replacement, she would not be able to afford the $800-$1,000 that it could (and very recently did) cost to insert. She is not alone in her concern. There are millions of Americans for whom essential hormonal treatment like this would not be economically possible.
The future of women’s healthcare as we know it
2020 has been a nightmare stress test with hit after hit, but I do see some opportunity. I see patients better equipped to advocate for their care—many of them have no choice. I see the healthcare system and patients alike rapidly adjusting to virtual care and telehealth as opportunities for increased access. This gives me hope that we’ll be able to build more infrastructure and more solutions in the years to come. And I see an abundance of high-quality healthcare products that are making access to care easier than ever before. Through my work as a medical advisor at Modern Fertility to increased employer support for family planning and Walmart’s recent investment in women’s healthcare—there is positive change happening despite the cluster that is 2020.
As I tell my patients with a smirk when they ask how I’m doing, “I’m 2020-good,” but more than that, I have faith that we’re on the right track to the radical changes we’ve all been waiting for. Because we’ve reached a tipping point, and the only way forward is up.
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