Dr. Pellò, how has women’s overall approach to their health changed in recent years?
Dr. Laura Pellò
What might be the main reasons for this change?
Everybody, not just women, is changing their approach to what we call today “health”. Health is seen as a global form of wellbeing, where medical sciences are only a contribution, and where life style, nutrition and psychological wellbeing are other important contributions.
There are many reasons for this new holistic approach: a much wider diffusion of information, much closer interpersonal communications, and the inputs via the media.
Medical and paramedical personnel have also changed their approach to their profession, and even their training is much more responsive to a global view of patients.
You have been successfully working in several countries and are now practicing in Brussels: have you noticed many differences in women’s attitude to their health across countries? Can you provide some examples or anecdotes?
Every day I continue to be confronted with great differences in the attitude of women to their health, depending on their culture and traditions and also increasingly on the generation to which they belong, but certainly the most evident differences I have noticed are related to women’s country of origin.
I do not believe in stereotypes, however I remarked some common traits in behaviour among women coming from different geographical zones; for example my patients from North Europe seem less emotional than the ones from Southern Europe, ladies from Eastern Europe tend to follow my advice and the prescribed therapies more diligently, maybe because they have been used to respect “authority” in their country of origin and they attribute authority to competent professionals.
Another difference resides in generations: amongst the younger generations I remarked that women belonging to generations 80s/90s are more self-confident in relation to their body and their health, therefore it’s easier to have a dialogue and to be on the same wavelength with them.
Nationality and age are not the only elements that affect the attitude to health; culture and the relationship between the generations are also important factor. The dialogue between mothers and daughters, between teachers and pupils, often also between friends and colleagues, become important elements of change in attitude.
In this context, Brussels offers a great variety of experiences, which are also opportunities to challenge and re-orient my own way of practicing gynaecology.
Have men also changed their attitude to women’s health in your opinion?
Yes, I would certainly say that men have also become more sensitive and caring about the health of women. They are more and more frequently involved, in a direct way, with the wellbeing of their partners, especially in the case of pregnancy, but also when serious problems arise, for example sterility or in the case of oncology related problems.
At the same time, I believe that even my male colleagues are today much more attentive than a few years ago to the wider sphere of wellbeing of their patients.
How has women’s approach to their health modified their attitude to their gynaecological well-being? Is it a mind-shift or?
Today, in their relationship with a trusted gynaecologist, women address practically all their health problems. To a certain extent, a gynaecologist is seen as the medical doctor in charge of the overall wellbeing of a woman, almost as a general practitioner.
In the past, women used to see a gynaecologist only in the case of a pregnancy or of serious pathologies. For other problems, there was more reluctance to open up to a gynaecologist. For instance women had a widespread idea that after menopause there was no longer a reason for check-ups. Moreover, the quasi totality of male gynaecologists meant that women would not discuss their more delicate, complex or intimate health problems.
How has women’s relationship with their gynaecologist evolved? Do you see female patients of all ages?
Indeed that relationship has changed because women have changed and because we, doctors, have changed too.
I have started to work as a gynaecologist about thirty years ago. At the start of my activity, I would normally deal only with pregnancies, deliveries, fibroids, cancers, endocrinology related problems and birth control. The typical age of my patients ranged from eighteen to sixty years.
Today I see women of all ages: from young girls of twelve, who wish to be reassured about their periods, to eighty year old ladies, who want to continue preventive care against cancer or against osteoporosis. All this could also be explained by the fact that today women have much longer lives, that contraception starts very early, and that the importance of preventive care is clearly understood.
I would however like to point out once more that Brussels is a privileged place of observation. Belgium, in fact, has in my view a public health system of very high quality, together with easy access to medical assistance and relatively low costs. Clearly, in such conditions, patients are led to consult doctors more easily and regularly. This is not always the case in other countries, including many other European countries.
In your experience do patients talk about sex and sex issues to their trusted gynaecologist or is this a topic for a psychologist?
If so, how have women changed their attitude towards sex and their femininity?
Sex and sexuality are still taboos, at least in my experience: it is very seldom that patients consult me about any sexual problems.
It may happen that patients - during a consultation about contraception methods or menopause – mention sexual problems, but it’s mostly up to me to sense that behind their pathology there might be a latent sexual issue.
I believe that women still consider sex/sexuality as a topic to face with psychologists or a psychotherapist.
What are the main focus areas for a gynaecologist nowadays? How do you see the future evolution of the gynaecology?
The main challenges which Gynaecology faces today are the treatment of sterility and the prevention and treatment of gynaecological cancers (especially the most aggressive forms of breast and ovarian cancer). It is in this context that I can see both continuity and evolution in my profession, without however losing sight of the overall vision of women, and of the global approach I was referring to before, regarding the multiplicity of problems that need to be faced in the wellbeing of women.
Dr. Pellò, I have heard that (breast) cancer is increasing in the western countries, is it true?
Recent statistics - available just for western countries - show that one woman in eight is affected by breast cancer in the course of her life. The latest figures from Italy (1), for example, show 48,000 cases of primary breast cancer in 2013.
This pathology is however quite vast with a large variety of cellular typologies. We know today that genes and receptors play a fundamental role both in the development and in the treatment of these forms of disease, and that it will soon be possible to build a “personalised” therapy for each patient. By "personalised” medicine we mean a specific medical approach that proposes the customization of healthcare tailored to the individual patient and to the genetic information of their disease. This medical model includes all the aspects of healthcare, such as the pharmacological and surgical ones, prevention and follow-up. Personalised medicine is a modern reality, which will soon be widespread and widely accessible. Women are today well informed and strongly motivated in their relationship with preventive care.
The statistical increase – globally - in the incidence of all types of gynaecological cancers should be read in the context of an earlier diagnosis and of a more effective preventive screening. The survival rate, five years after first diagnosis, is estimated today at 87%. Moreover, an early diagnosis allows a more conservative type of surgical intervention.
Laura, what has inspired you to become a doctor and a gynaecologist? Tell us about your career.
What do you like most about your profession and why?
Once I made up my mind to become a physician, it was obvious to me that I should become a gynaecologist. My grandmother and great grandmother were midwives.I was also involved, from an early age, with women's movements in a social and political dimension, so I could not have taken a different orientation in my medical profession.
In my career I can distinguish three phases so far:
- The hospital and surgery phase at the beginning, where the relationship with women patients was very brief or non-existent
- The second phase, in which I consolidated my competencies and I had the opportunity to teach at the university, was a very pleasant period
- The third phase has been very difficult to accept because at first it seemed to me that clinical consultation was a boring and routine job … but now I have patients of various nationalities, “entire families” (grandmother, mother, daughter, aunt, sister-in-law, daughter-in-law), groups of friends or colleagues, patients whom I have treated for over twenty years and whom I have seen growing up and getting older: it’s fabulous and very enjoyable.
Together with my patients I have developed professionally too, thanks also to the excellent team work enabled by the hospital in which I practice.
In terms of career, is it still harder for a female doctor (than a male) to progress through the professional ranks of doctors in a hospital? Are the hospital boards still a man’s domain?
I think that this form of (negative) discrimination has now become much less pronounced. The number of female doctors is constantly increasing and women's representation in medical boards has reached relatively high levels, which put them at the same level, practically, with men. As for combining a difficult job (and indeed the medical profession is difficult) with a family life, women in medicine face the same difficulties as many other modern women.
What would you recommend to a young female doctor who wants to become a gynaecologist?
I advise the young generations of practitioners to be strongly motivated to face the hardship of a very long training, and they are generally very well trained.
I would recommend that they develop that subtle capacity for empathy that would distinguish them from their male colleagues: that "special touch" that makes them feel closer to fellow women. I think that this sense of female feeling, irrespective of the area they choose, for instance Obstetrics or Oncology, will make them go that extra mile that makes them good and successful professionals.
What advice about health would you like to give to our readership?
I would advise them to listen carefully to their doctor, and to build with him/her a relationship of mutual trust, avoiding the Internet, blogs, and social media (as sources of medical advice).
To conclude, I would also recommend to readers to take good quality and regular preventive care!
Laura Pellò obtained her degree in General Medicine at the University of Milan (IT) in 1981. She then moved to the University of Oxford (UK) for her postgraduate studies in Obstetrics and Gynaecology. After a few years as a lecturer at the University of Leuven (BE), she has been practising as a gynaecologist in Brussels for more than twenty years. She has also been consultant for the World Health Organisation.
Dr Pellò is married with two children.
Dr. Laura PELLÒ
CHIREC Hospitals, Clinique du Parc Leopold
Rue Froissart, 38
Any views and opinions presented in this article are solely those of the author and do not necessarily reflect those of Chirec, nor do they constitute a legally binding agreement.