Building a Reputation

When we embark on a career, we cannot predict the path that we will take or the successes and obstacles along the way. However, it’s gratifying to find a special issue that gives us an opportunity to shape our profession.

In 1997, I joined the board of our local affiliate of the American Heart Association. In addition to raising money for cardiovascular research every year, the board advocated for other important health issues. First, it lobbied for increasing the number of smoking cessation ads to encourage smokers to quit and for instituting laws to prohibit smoking in public. The board also worked on plans for a healthy eating program to be taught in elementary through high school.

A third issue particularly interested me: making women more aware of their risk of cardiovascular disease, as an astonishing percentage of women thought that only their spouses were at risk. Women need to be proactive by keeping track of their blood pressure and cholesterol numbers at the very least.

While researching for a lecture I was to give in downtown Rochester about the history of women and heart disease, I discovered a disturbing fact: Women were rarely included in clinical trials.

The information I present here stems from research I did at the time. Prior to 1986, large clinical trials funded by the National Institutes of Health (NIH) included few women. The unofficial view was that the disease presents similarly in both genders and therefore the research conclusions could be applied to both men and women. This was a faulty assumption and a bit shocking because at this point it should have been widely recognized that gender is a factor in disease.

What made this even more disturbing was that heart disease was the primary cause of death for women over age 50, resulting in 500,000 deaths annually. Yet so many of the studies disregarded the fact that physiological differences (such as hormone levels) between the genders affected the presentation and treatment of the disease. Presentation differences were made obvious in one study that showed that chest pain is not specific as an indicator of heart disease in women. This type of information can save thousands of lives.

My Fueled Passion

Learning about the history of women and heart disease helped fuel my passion for improving women’s access to excellent cardiac care and for educating women to be proactive about their health. Since that pivotal period in the 1990s, we have made great progress in our understanding of how the symptoms and pathophysiology of heart attacks present in women.

I saw many women who took the initiative to see me because their complaints about symptoms were not taken seriously by their physicians. Often complaints about chest pain were attributed to stress or other non-cardiac possibilities because the physicians erroneously believed that young women did not get heart disease.

I realized that I could make an important public contribution by educating women about heart disease and chronicling their symptoms and concerns to address the gaps in knowledge.

My growing expertise in the field meant that journalists sought me out every February during heart month. I used that platform to educate everyone, and women in particular, about the risks for heart disease and the symptoms of a heart attack.

My reputation as a cardiologist who advocated for women’s health was a factor in my growing practice. Many female patients told me that other doctors, typically male, dismissed their symptoms as anxiety, stress, or musculoskeletal issues. Therefore, their symptoms were never investigated, and their cardiac issues were left untreated.

Many patients were appreciative that I didn’t label them as hypochondriacs and instead took their complaints seriously. Even if physicians did not say it aloud, the women felt that they were not being taken seriously. Although I provided the same health advice for my male patients, I also found that women often had more gaps in their knowledge either because they believed that they were not at risk for heart disease or because they spent most of their energy caring for others.

Women are, by nature, caregivers for their spouses, children, parents, extended family, and even close friends. Many times, I had conversations with women who needed cardiac procedures or surgery but who didn’t want to take the time to take care of themselves. They saw themselves as care providers, not care receivers. I spent much time persuading them that taking care of themselves would allow them to take care of others in their lives. It is interesting that many women think it is selfish to take care of themselves first. Due to the persistence of legislators on both sides of the aisle, physicians gradually became better equipped to care for their female cardiac patients.

I have passed on my knowledge and learned from others by participating in the Women in Cardiology (WIC) chapter of the ACC now for several years. WIC works hard to encourage young women in high school to study science and math and to encourage female residents to consider cardiology as a career choice.

Toward a Rich Career

So, like many doctors and other professionals, I put my career on a different path than I had originally envisioned. But I believe that most things happen for a reason. My career as a healthcare provider became all the more rewarding with my knowing that I, along with so many other women physicians in cardiology as well as other specialties, improved the lives of many women by increasing their access to quality healthcare.

I encourage young professionals reading this to start their careers with enthusiasm and flexibility. There will be opportunities along the way, and they may seem scary at first because they involve some risk. If it sounds exciting and challenging, take the risk so that you, too, will be rewarded with a rich and fulfilling career.

Do not be afraid to stand on women’s shoulders — not just my shoulders but those of the many other courageous pioneering women cardiologists who have helped pave the way for the next generation of inspirational women.

Adapted from The Heart of the Story: My Improbably Journey as a Cardiologist by Joan L. Thomas, MD, CPE, FACC.