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Why it's Hard to Find Doctors Who Know their Way Around the Pelvic Floor

Posted Jan 15 2009 7:42pm

Last week I attended an eye-opening presentation at a top Los Angeles hospital given by one of the most knowledgeable pelvic floor physical therapists in the country. The goal of the presentation was to educate gynecologists affiliated with the hospital about pelvic floor musculoskeletal dysfunction (PFMD) and to show them how physical therapy can be a viable treatment option for PFMD patients. In attendance were male and female doctors both young and old. Wise to her audience, the PT was careful to back up all of her information with evidence-based research. She also did a wonderful job of balancing the info with interesting case studies and jaw-dropping images and diagrams of pelvic floor musculature. (In an upcoming post I plan to share highlights of the presentation.) The PT did a phenomenal job, and the presentation she delivered was fascinating. Equally as fascinating to me was what I learned that night about why so many doctors haven’t a clue about PFMD and the pain it causes. I now have a much better understanding of what PFMD patients are up against as they look to the medical community for answers and treatment.

In his introduction, the doctor who invited the PT to speak candidly admitted that he had not learned about pelvic floor musculoskeletal dysfunction (PFMD) in his medical training. What made the doctor’s statement even more remarkable was that he followed
it by saying that roughly one-third of his patients come to him with complaints that stem from PFMD. Later I learned that his statistic correlates with research that’s been done. So, in effect, one-third of the women who visit their gynecologists have some sort of PFMD issue, and yet, the subject matter is not one that is taught in med school. No wonder so many women have such a hard time getting a proper diagnosis!

As the PT spoke, I glanced around the room to take in the reaction of the audience. I fully expected them to be engrossed in the presentation. I was sure they were all having “A Ha!” moments. I couldn’t have been more wrong. One doctor sitting close to me was busy on his laptop, occasionally he would turn away from his computer screen to fiddle with his Blackberry. Another was busy in the back corner piling refreshments onto his plate. Others just stared blankly at the presentation screen. Finally, my gaze fell upon a small group of young women who were engrossed in the presentation and were looking on with interest. (It turns out these women were physical therapists.)

While I’m sure there were doctors in attendance who were interested and engaged in the presentation, the overall response of the group shocked me. After all, it wasn’t as if the PT was trying to sell them her personal brand of snake oil! She was giving them information on a health issue that impacts millions of women—maybe even answers that could help them treat their current patients who are in pain. And she was savvy enough to present the information in a language they understood—couched in one medical study after another. Every fact she threw out to them was backed up by research. Yet, I got the impression that many of the doctors in the room viewed the information as dubious.

I drove home utterly deflated. I’ve worked as a journalist for a decade and as a result I’ve become a bit of a cynic about the world at large. I think of myself as a positive-thinking cynic, but a cynic nonetheless. But going into that presentation, I had no doubt that the speaker was going to blow her audience away. That I was going to witness an en masse slapping of foreheads as the doctors grasped the gravity of the knowledge that was being shared with them. I was looking forward to a heady discussion after the presentation as the audience posed their pent-up questions.(Only one doctor asked a question. In his question, he implied that physical therapy was not a financial option for his patients and asked for a list of pharmaceutical alternatives.)

The next day I was scheduled to meet up with Dr. Noblett, the urogynocologist that I am collaborating with on a book about PFMD. I told Dr. N about what had happened at the presentation. I was looking for an explanation as to how, in the face of scientific proof, doctors could still doubt the very existence of PFMD and the pain it causes. After all, it’s not like it’s the Dark Ages; we’re in the throes of modern medicine—the PT wasn’t asking those doctors to take a leap of faith, she was merely making them aware of a medical diagnosis that had already been identified and researched.

After my rant, Dr. Noblett, who is one of the wisest, most thoughtful people I know, told me a story about two doctors who presented their theory that bacteria can cause stomach ulcers. They were laughed off the stage, she recounted. Now, their theory is widely accepted and antibiotics are a common treatment prescribed to patients suffering with ulcers. The doctors unveiled their theory, not in 1780 or 1880, but in the 1980s. So, even though medicine has come a long way, human nature remains pretty constant. It always takes time for new ideas in medicine to catch on, she explained, but if they’re backed by evidence, catch on they will. Dr. Noblett explained that her specialty, urogynocology, is a relatively new one. And it’s really the advent of this new medical specialty that has steered more attention to the musculature that supports the pelvic organs. And Dr. N made me realize that important strides have been made and are being made in the understanding of PFMD. On top of that, there are wonderful doctors and physical therapists who are driving the progress, and each year more are joining the cause.

Recently, I spoke to the PT who gave the presentation. I asked her if she was surprised by her audience’s response. She said it didn’t surprise her at all. This wasn’t the first time she’d given this talk to a group of doctors. She knew beforehand that she was up against a tough crowd. But, she said, if she only gets through to one, then it’s completely worth the trouble. Now, I have no doubt that with folks like this PT on the case, the medical community will for sure come around.

In the meantime, I’m hoping I can do my tiny part on this blog to help folks bypass the doctors who haven’t figured out their way around the pelvic floor and get to those that are pelvic floor pros. The post below this one is the beginning of a list I am putting together of docs that know what’s up when it comes to PFMD. As I continue on with my research for the book, I’ll be adding additional doctors. Also, check out the resources I’ve included in the post that can help you find a doc who’s down with PFMD in your area!

If you know of a doc that deserves a place on the list, please leave her/his name in the comment section and I’ll add her/him to the list!

Scroll down to see the list!
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