Although the roles of gynecologist and interventional radiologist seem like two unrelated specialties when treating uterine fibroids, researchers have found the opposite to be true. Working together as a team has resulted in a win-win situation for doctors—and most importantly—for patients.
“One of the challenges if you’re a specialist in gynecology or radiology is that you really only have one tool,” said Dr. Christopher Tarnay, Clinical Professor of Obstetrics & Gynecology and Urology at UCLA School of Medicine, Chief of the Division of Female Pelvic Medicine and Reconstructive Surgery, and Co-Director of the Comprehensive Fibroid Treatment Program at UCLA in Los Angeles, Calif. “You tend to only offer the tools you have available to that patient. If you’re a gynecologist, you have medications or surgery. If you’re an interventional radiologist, you’ll offer the things you have in your tool belt like uterine fibroid embolization (UFE).”
Currently a reality of our healthcare system, this prevalent gap between specialties could be doing patients more harm than good. Without full disclosure of all fibroid treatment options, a woman may potentially undergo a procedure that doesn’t align with what she wants or needs.
“Patients are increasingly opting for less invasive therapies compared to the past, when hysterectomy was considered the mainstay of treatment,” said Dr. Neil Resnick, Chief of the Division of Interventional Radiology at NYC Health + Hospitals/Harlem and Assistant Clinical Professor of Radiology at Columbia University Medical Center in New York City. “Patients see tremendous benefits when gynecologists and radiologists collaborate strongly. All patients requiring invasive fibroid treatment are evaluated by both specialties at my institution. Our patients may choose from the entire spectrum of anti-fibroid therapies. We have found that comprehensive care is optimal for addressing women’s health needs.”
But this collaboration hasn’t always come easy. Gynecologists may disagree with practicing in a collaborative manner for fear of losing patients—instead the opposite has been observed. “My colleagues found over time they did not lose all of their patients,” Dr. Resnick discussed referencing his institution’s collaborative environment. “And [patients] who returned to them after UFE were very satisfied with the results and pleased with the referral they made.”
To investigate how a cooperative referral relationship affected patient and doctor experience, a team of experts led by R. K. Zurawin at Baylor College of Medicine in Houston, Texas, tracked the course of fibroid treatment among 226 women. Of these women, 138 were referred to an interventional radiologist by a gynecologist and 88 were self-referred.
The results, published in the Journal of Minimally Invasive Gynecology1, revealed that 62 percent of the women were candidates for UFE and 38 percent had the procedure done during the study. Those who didn’t undergo UFE returned to the referring gynecologist for further care.
In terms of patient satisfaction—whether women underwent UFE or another treatment—70 percent of those self-referred and 92 percent of those gynecologist-referred reported being satisfied with their original gynecologist and were referred back to their doctor.
A reported 8 percent of gynecologist-referred women were dissatisfied and switched to another doctor mainly because of “the gynecologist’s failure to fully disclose treatment options or offer desired minimally invasive procedures.”
From a business perspective, collaboration with an interventional radiologist was seen to improve “patient flow to a gynecologist practice.” Including self-referred women who were sent to in-network gynecologists as new patients, researchers saw a 119 percent return rate on the original 138 women referred to a radiologist by their gynecologist.
It was concluded that establishing a “trusting, collaborative, long-term, noncompetitive” relationship between specialties not only expanded business but also was seen to meet patient needs for full disclosure of all treatment options and improve overall care.
A significant part of developing this noncompetitive relationship between doctors is recognizing the limits of each specialty and respecting these boundaries. “Gynecologists and radiologists each have different strengths to bring to the table for women with symptomatic fibroids,” Dr. Resnick emphasized.
“Interventional radiologists play an important role,” Dr. Tarnay agreed. “But a patient who has a fibroid really needs to first see a gynecologist who can offer a pelvic exam and evaluate all symptoms. This was the nidus for developing a comprehensive program at UCLA. The more you can collaborate and learn about other options—the better.” In Dr. Tarnay’s research published in the Journal of Therapeutic Ultrasound2, an integrated approach at his facility was shown to increase the use of less invasive options over hysterectomy. “Our study supports the feasibility of a combined approach and likely facilitates the increased use of less invasive options over hysterectomy for fibroid treatment.”
With so many treatment options available, how can a woman with fibroids ensure she’s receiving comprehensive care?
Both doctors commented on the importance of working with specialists who candidly pool together their knowledge and expertise. This openness can provide a clearer picture of a woman’s condition and how to effectively treat it. If this isn’t a woman’s experience, she should feel secure in her choice to look elsewhere.
“A patient should feel free to seek out a gynecologist who is collaborative about patient care and understands the value of UFE,” Dr. Resnick stressed. “Alternatively, she may set up an appointment directly to see an interventional radiologist to discuss if she may be an appropriate candidate for the procedure. However, it is highly valuable and, in fact, necessary that she also be evaluated by a gynecologist, who can ensure her care is complete.”
“Explaining all of the information with balance is the intent of collaboration,” Dr. Tarnay explained. “Ultimately, it’s about putting the patient’s best interests first.”
ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer and Photographer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering within her community.
ABOUT THE DOCTOR Christopher Tarnay is a Clinical Professor of Obstetrics & Gynecology and Urology at UCLA School of Medicine, Chief of the Division of Female Pelvic Medicine and Reconstructive Surgery, and Co-Director of the Comprehensive Fibroid Treatment Program at UCLA. Dr. Tarnay incorporates the latest advances in minimally invasive surgery emphasizing the importance of uterine and fertility preservation. Named a Super Doctor of Southern California Los Angeles, Dr. Tarnay is American Board Certified in Obstetrics & Gynecology and Female Pelvic Medicine and Reconstructive Surgery.
ABOUT THE DOCTOR Neil J. Resnick is Chief of the Division of Interventional Radiology at NYC Health + Hospitals/Harlem and Assistant Clinical Professor of Radiology at Columbia University Medical Center in New York City. Through his research and diverse experience in Interventional and Diagnostic Radiology, Dr. Resnick strives to improve the field of Interventional Radiology with the goal of providing patients with the best care possible.
Zurawin, R. K., Fischer, J. H., & Amir, L. (2010). The effect of a gynecologist-interventional radiologist relationship on selection of treatment modality for the patient with uterine myoma. Journal of Minimally Invasive Gynecology, 17(2):214-221. doi: 10.1016/j.jmig.2009.12.015
2. Tan, N., McClure, T. D., Tarnay, C., Johnson, M.T., Lu, D.S., & Raman, S.S. (2014). Women seeking second opinion for symptomatic uterine leiomyoma: role of comprehensive fibroid center. Journal of Therapeutic Ultrasound, 15(2):3. doi: 10.1186/2050-5736-2-3