Ahead of the Curve

In the age of sub–specialization, Lexington Clinic’s OB/GYNs see the big picture of Women’s Health

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LEXINGTON The OB/GYN department at Lexington Clinic is always looking ahead. Collaboratively perceiving new ways to advance women’s health, three of its physicians, Tamara James, MD, Ramon Thomas, MD, and Tracy Arghavani, DO, each pursue what best suits them in availability and experience. Whether employing technologies like the da Vinci® surgical robot or InterStim®, or treating obscured pathologies like urge incontinence and HPV, they are pushing the boundaries of the traditional OB/GYN practice. Creating new services and finding the right physician to treat patients in need of these services, these physicians are both reaching out to a younger group of women and adapting to the needs of the aging baby boomers.

James, the department chair who began at Lexington Clinic in 2001, was joined by Thomas and Arghavani in January of 2014. Their collective strength benefits them and their patients. Each appreciates the economy of scale afforded them being part of Lexington Clinic’s multi-physician practice. As James says, “more physicians makes work and personal life more manageable.” The on-call duties are easier; they have access to Lexington Clinic’s powerful electronic health records system; and they are part of a multi-specialty group, which gives them internal consultants at their fingertips. James says that these things in sum help her live up to Lexington Clinic’s vision – to be “great people providing great healthcare” – because, “It makes it easier to focus on medicine and the patient.”

Utilizing the Power of Technology

Within the operating room, advances in technology are helping all three physicians as they serve their patients outside of the office. The da Vinci surgical robot has been an integral part of the practice for a number of years. James, one of a few hundred “proctors” who consults on the development of the robot, and her colleagues, utilize it primarily for resection and treatment of endometriosis, removal of fibroids, and hysterectomies, but potential applications are always emerging. Thomas, excited about those applications, says, “I plan to do more advanced procedures, both urological and pelvic floor defect procedures.”

Additionally, Thomas has developed a special niche within the department, providing the neurostimulator implant for urge incontinence. This “silent problem,” as he calls it, afflicts many aging women, but the implant can reduce the urge to urinate by 50 percent. Analogous to a pacemaker, the coin purse-sized neurostimulator is implanted in the upper buttock. The implant stabilizes the bladder and colon, helping patients who have experienced serious side effects from their incontinence medications. It also is effective for women who have developed fecal incontinence following birth lacerations.

Innovating to Meet the Needs of All Ages

The practice is encouraging pediatricians in the Lexington Clinic network to get their female patients into the OB/GYN. James says getting 13–15 year-olds in for a meet and greet is invaluable “because there may be some issues they do not want to talk about with their pediatrician, or some information they have not shared with their parents.” Her goal is to educate young women on what the gynecologist will be for them throughout their lives.

One way they are serving younger patients is through the provision of the HPV vaccine – now covering nine different viruses and further reducing incidences of cervical cancer. These advances empower James to promote this vaccine to other physicians, both for males and females, and encourage them to seek out the help of her and her colleagues when discussing the advantages of this vaccine with their young female patients.

Outside of the clinical setting, the Lexington Clinic physicians have participated in school outreach programs, which Thomas heads up in conjunction with Fayette County Public Schools. His primary focus is on minorities in healthcare, so he meets with underrepresented groups to “introduce more minorities to the breadth of possibilities in the healthcare profession, including physical therapy, dentistry, and pharmaceutical sales.”

But their work doesn’t focus solely on the younger patient population. James and Arghavani handle many of the common pathologies associated with the aging of women. They regularly deal with pelvic organ prolapse, which James notes is “a natural part of the aging process.” This is resolved by procedures such as vaginal hysterectomies, repair of the bladder, and suspension of the vaginal vault. And Thomas’s work with urge incontinence patients is another form of service to the older patient population.

The Future of the OB/GYN

Looking down the road, James sees most OB/GYNs becoming the primary care provider for their patients, as she has seen happen within her practice. She is at times a surgeon, a nutritionist, and a therapist.

“We have become the primary care providers for women age 15–45 and are now working to meet more than just their obstetric and gynecological needs. We are striving to focus on the entire health of the women we serve,” says James. “A woman’s gynecologist can be the gatekeeper for all aspects of a woman’s health, and that is what we, at Lexington Clinic, are trying to do.”