Focusing on Women's Health Care

ddressing the medical needs of women is fast becoming a top priority at the University of Miami. To that end, the School of Medicine recently recruited Leo B. Twiggs, M.D., as the new associate dean for women's health. The former chairman of the Department of Obstetrics and Gynecology at the University of Minnesota, Dr. Twiggs will coordinate all women's health services across the University's medical departments under an umbrella project known as the Women's Health Institute. Dr. Twiggs recently discussed his vision of women's health services at the medical center with Lisa Sedelnik, director of publications at the School of Medicine.

LS From a historical perspective, what changed in the medical profession for it to take a closer look at women's health care?
LT The change occurred with the paradigm shift from the disease model of medical care (caring for a person and their specific disease) to a broader concept of health care. With the scientification of medicine and the various scientific advancements made in the 20th century, the medical profession began to reevaluate this disease model concept. This broader concept of health care involves taking care of the whole being by examining a person's physical and mental functioning, as well as the environment in which he or she lives and works. It also encompasses other aspects of health care such as prevention, the environment, the social relationships with the family (or lack thereof), and related psychological relationships.

LS With such a visible affirmation of the school's new commitment to women's health, first by naming you as the associate dean for women's health, what is your vision for this new directive at the medical center?
LT The idea is to create a virtual institute, which over time, will allow us to tap into a multidisciplinary group of experts and specialists, not just from the medical school, hospital and clinics, but from the entire University and its community. More specifically, the Women's Health Institute will integrate all women's health programs at the University of Miami/
Jackson Memorial Medical Center under one system. This system will allow us to create a network of resources and services for our patients across all medical disciplines. It will help us build comprehensive clinics where women can get treated or find valuable information about a number of ailments that specifically affect them. The institute also will facilitate the research and education missions of the school and hospital by providing a recognizable administrative identity.

LS From an informational standpoint, the concept of women's health, especially in terms of providing comprehensive services under one umbrella, is new. How will you successfully market this idea internally?
LT Once we build a group of interested faculty members, we will invite individuals to participate in a multidisciplinary advisory group. This group will meet on a regular basis and determine where the opportunities for research and clinical care are and how to pool together our resources to meet these opportunities. We also will work closely with Jackson Memorial Hospital and the Public Health Trust, under Ira Clark's leadership, to further develop the clinical outreach sites. The University of Miami Medical Group is looking carefully at community outreach sites and their related community networks, and we will continue to work together to develop that further. Part of the institute's mission is to provide education to these community sites so that we can increase the standard of care for women needing our services.

LS You've been instrumental in raising significant amounts of money for a cancer center chair at the University of Minnesota. Do you plan to implement similar fundraising projects here?
LT We not only raised money for a cancer center chair in Minnesota, but we were successful at the medical school level in focusing the upcoming campaign to include a significant women's health component. That's already happening here. A number of philanthropic organizations at the University of Miami/Sylvester Comprehensive Cancer Center, such as the Papanicolaou Corps for Cancer Research and the Women's Cancer Association of the University, have already been successful in raising money. These organizations may also help us raise funds for the institute, as well as other things. We don't want the institute to compete with our other programs. Our mission is to create a center that is inclusionary, not exclusionary. We want to facilitate interaction, interdisciplinary care, and fundraising. That is our goal.

LS How will the creation of such an institute have a significant impact on the delivery of health care to patients?
LT The School of Medicine and Jackson Memorial Hospital have long made it a part of their mission to deliver quality care to the community. The community supports us with its tax dollars, so it's imperative that we deliver care to our taxpayers. For many in the community, though, going to a big hospital may be inconvenient, if not impossible. So in response, we want to build a community network to the underserved that facilitates access to such clinics. Also, we will work diligently to elevate the standard of care at these sites so that patients receive top quality health care.

LS Supplemental psychosocial treatment has proven to increase the well-being of many patients, including women. Will this type of treatment play an important role in the Women's Health Institute?
LT The medical center and the University have taken a lead in the psychosocial aspects of women's health under the leadership of Dr. Carl Eisdorfer in the Department of Psychiatry and Behavioral Sciences and Dr. Carlos Sandoval of the Courtelis Center for Research and Treatment in Psychosocial Oncology. When you look at what is happening in this area, there is a lot of excitement and rightfully so. There is already a critical mass at the University in women's health. My role will be to facilitate the interaction. That's another reason why I am here. If we can facilitate interaction across disciplines and across the University, then we should be able to define a system that will be nationally recognized for its excellence in research and education of health care professionals.

LS Coming from Minnesota, you are going to find South Florida a more ethnically diverse community. How will the Women's Health Institute address the needs of this population?
LT The fact that South Florida is such an ethnically diverse place is one of the great opportunities about my new position. Miami is at a hemispheric crossroads, and the people coming and going here make it an exciting place in many aspects. It also is a place where organizations and funding institutions want to develop their mission and goals. More research studies and clinical trials need to be conducted so that we can figure out what is happening with underserved care as well as with ethnically diverse populations. Our job is to act as a funding catalyst for such communities.

LS How will women's health be integrated into the curriculum?
LT It already is being integrated. The medical school has taken a lead in making women's health part of its core curriculum. In fact, the new curriculum, which Mark O'Connell, M.D., senior associate dean for medical education, is developing, is expected to be implemented in August 2001 and will have a women's health component to it. Many people have already come to the conclusion that including women's health topics in the classroom is the right thing to do, and they are moving forward with it. Hopefully, I will be able to facilitate that across different disciplines--medicine, psychiatry, family practice, pediatrics, adolescent medicine, OB/GYN, and others. The concept of women's health is here to stay and we want to support it as best we can and have the University of Miami recognized for its leadership in this area.