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Sharon T. Phelan Thomas E. Nolan
Empiric therapy for women with pneumonia should be based on the specific patient profiles and the severity of their pneumonia. All patients with possible community-acquired pneumonia should have a chest radiograph to establish the diagnosis and the presence of complications.
Most patients with hypertension will require two or more antihypertensive medications to achieve optimal blood pressure control less than 140/90 or less than 130/80 mm Hg for patients with diabetes or kidney disease, respectively.
There is an increased use of cholesterol-lowering drugs, including the “statins,” a class of drugs that lower cholesterol by blocking a liver enzyme necessary to produce cholesterol, and they are very effective in reducing the risk of heart attacks and deaths.
Type 2 diabetes is frequently not diagnosed until complications appear, and approximately one-third of all people with diabetes may be undiagnosed: individuals at risk should be screened and a comprehensive plan of care initiated for those diagnosed with diabetes.
The sensitive thyroid-stimulating hormone (TSH) assay is the single best screening test for hyperthyroidism and hypothyroidism: in clinical hypothyroidism, the standard treatment is levothyroxine replacement, which must be tailored to the individual patient.
As health care providers for women, gynecologists are responsible for providing care that extends beyond diseases of the reproductive organs to include much of the general medical care of their patients. Broadening the spectrum of care requires adjustments in practice, with less emphasis placed on the surgical aspects of the specialty. Early diagnosis and treatment of medical illnesses can have a major impact on a woman’s health. Although timely referral is important for complex and advanced diseases, many conditions can be recognized and treated initially by gynecologists.
Respiratory problems are the most common reasons patients seek care from a physician, so gynecologists should be aware of their pathophysiology. Cardiovascular disease has a significant impact on overall morbidity and is the main cause of death in women. Cardiovascular disease is associated with cigarette smoking, hypertension, hypercholesterolemia, and diabetes mellitus. These conditions are responsive to screening, behavior modification, and control to lower risk factors. Thyroid disease is a major cause of morbidity for women. Because of the interaction of hormones and the overall effect on the endocrine system, thyroid disease can be of special significance in women. The gynecologist should provide screening and initial therapy for these conditions and assess the need for referral.