Posts Tagged ‘cancer prevention’

Hannah Peters plays vital role as doctor to the Rosies

posted on July 23, 2013

By Ginny McPartland, Heritage writer

Shipyard physician achieves brilliant postwar career as international reproductive biology expert

Hannah Peters, women's health physician in Kaiser Richmond World War II Shipyards. Photo courtesy of Susan and Tom Peters
Hannah Peters, women’s health physician in Kaiser Richmond World War II Shipyards. Photo courtesy of Susan and Tom Peters

Before 1943, nobody knew how well women shipyard workers would adapt to the grit and physicality of a man’s world of heavy industry.  In the midst of World War II, physician Hannah Peters tackled the job of unraveling that mystery without a play book.

She cared for female workers that poured into the Kaiser Richmond Shipyards. These women were pioneers, recruited to industry for the first time due to the war emergency.

Peters, German-born and trained in New York, had migrated to California in 1940 and set up an office in East Oakland. She found herself struggling to make ends meet and realized she needed to find a way to connect with patients who needed her.

When the United States entered the war in late 1941, Peters heard about Sidney Garfield, MD, who was developing a medical care program for Henry Kaiser’s shipyard workers in Richmond, Calif. She decided to leave private practice and join the staff of the Permanente Health Plan.

Shipyard women craved special attention

She quickly learned that the needs of women workers were abundant. They came from the South, the Midwest and the East Coast, and many had never seen a physician.

“I joined the medical department but it soon became clear to me that a gynecological department was necessary to take care of the special problems of the 23,000 women working in the yards,” Peters wrote in her memoir years later.

“A trained gynecologist was added to the staff and we established special programs to deal with the question of abnormal menstruation, pregnancy, venereal disease, sexual problems and to provide contraceptive services,” Peters wrote.

Kaiser Richmond Shipyard workers take special training to build their strength and stamina and adjust to heavy industrial work. Kaiser Permanente photo
Kaiser Richmond Shipyard workers take special training to build their strength and stamina and adjust to heavy industrial work. Kaiser Permanente photo

In seeing her patients, Peters noted many complaints about excessive menstrual bleeding that began when they started doing heavy work. Peters deduced that with a change in diet, to incorporate more carbohydrates for work energy, the women were worsening an already existing Vitamin B deficiency. She found shots of Vitamin B-complex solved the problem in most cases.

Peters also noticed that women lacked the stamina and strength to comfortably do their jobs. She arranged an activity program that had the Rosies (the term used to describe women war workers) climbing ladders and performing other tasks meant to strengthen their bodies to better handle their jobs.

Female workers screened for cancer

A believer in prenatal care and cancer prevention screening, Peters encouraged women to seek care often. She also urged women to come to the clinic to have pelvic and breast examinations every six months to screen for cancer of the ovaries, cervix, uterus and breast.

“In this way (conducting frequent physical examinations) we have demonstrated that extremely early cancer of the cervix can be consistently detected and not stumbled upon accidentally,” Peters and colleague Wilson Footer, MD,  wrote in their article “Gynecology in Industry,” published in the Permanente Foundation Medical Bulletin and elsewhere in 1945.

The physicians also distributed materials to educate workers on how to avoid venereal disease and unwanted pregnancy. In their study, Peters and Footer also looked at the question of  whether women should continue to work after they become pregnant.

In reviewing many cases of miscarriage among yard workers over a two-year period, they concluded that none of the terminations could be blamed on the work.

Shipyard experience opens up opportunities

“(Later in the war) another obstetrician (Dr. Robert W. King, a prince of a fellow) joined our group. He taught me obstetrics and gynecological surgery. . . I learned a great deal during the three years I was at Permanente . . . the years working with the shipyard women gave me experiences I could not have gotten in a life-time of private practice.

“The work with so many women of different backgrounds and coming from different cultures opened a new field for me: office gynecology,” she wrote.

Dr. Peters in her office at the Laboratory of Reproductive Biology in Copenhagen, Denmark, 1979. Photo courtesy of Susan and Tom Peters
Dr. Peters in her office at the Laboratory of Reproductive Biology in Copenhagen, Denmark, 1979. Photo courtesy of Susan and Tom Peters

After the war, Peters continued her work in women’s health, including family planning in India and elsewhere.  She distinguished herself over the decades as a prolific publisher of research about reproductive biology and cancer.

She founded the Laboratory of Reproductive Health in Copenhagen, Denmark, in 1959 and headed the lab until her retirement in 1980. Hannah Peters passed away in 2009 at the age of 97.

 

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Decades of health records fuel Kaiser Permanente research

posted on March 6, 2013

By Ginny McPartland, Heritage writer

Inside a Kaiser Permanente paper chart room before electronic health records. Kaiser Permanente Heritage photo

In a highly technological world, paper medical charts no longer show up in Kaiser Permanente doctors’ hands when they interact with today’s tech-savvy patients.  These collections of hand-written notes of our medical complaints, drug prescriptions, lab tests and more, are going the way of fax machines and typewriters.

They’ve been replaced by Kaiser Permanente’s award-winning electronic medical record system, Kaiser Permanente HealthConnect®, which brings patients much closer to their providers.1

But preserved paper patient records going back to World War II will continue to be a valuable asset for research, even as we trade in the old cumbersome model for the new.

Gary Friedman, MD, retired director of the Kaiser Permanente Division of Research in Oakland, Calif., says Kaiser Permanente’s medical records – whether the original hard copies or digital files– are valuable assets to allow groundbreaking research.

In a 1998 article in The Permanente Journal, Friedman wrote: “Our collection of manual charts going back over 50 years is a national treasure and must be preserved despite the storage and retrieval costs entailed.”

In his 2006 oral history, Friedman said the highly touted study on the value of sigmoidoscopy in preventing colon cancer relied on paper records going back to the 1970s.2

Former Northern California Division of Research Director Gary Friedman, MD, with patient, on the cover of the 1989 Kaiser Permanente Annual Report.

He added: “(In) a recent study I did on the early symptoms of ovarian cancer (we found) by going into the charts (paper records) we could get much more of what the physicians recorded in text about the symptoms these women were having . . .  Who knows what question might come up in the future (that could be answered) by looking at these charts that go back to the mid-1940s?”3

Kaiser Permanente’s early foray into digital world

Kaiser Permanente’s journey into electronic record keeping started around 1960 and took advantage of emerging computer technology. A desire to prevent chronic disease through pre-symptom screening supplied the motivation to automate routine tests and to compile anonymous patient data for population-based research.

Barbara Breen, a medical assistant at Kaiser Permanente Oakland Medical Center in the early 1970s, had her hands on paper charts as well as on the pioneering electronic medical records of the day. She often stood by as lunch-time relief to ensure the computer ran fluidly as it processed punch cards that coded the results of patient visits for Kaiser Permanente’s complete physical (multiphasic) examination.

She was on the cutting edge of computer technology of the time and was in awe. “I got to see all these brand new machines and they assigned me to the spirometer (to test lung capacity),” Breen recalled recently. “The patients filled out a medical questionnaire (health assessment) and had 90 minutes to go around to all the cubicles where they had the tests.”

Data collected by Breen and others in the multiphasic unit were fed into early computers that took up the basement at 3779 Piedmont Ave., just off of MacArthur Boulevard near Kaiser Permanente’s flagship medical center in Oakland, Calif.

Tracking members’ health over decades

Over the years, these records, now considered invaluable and precious, have been the basis for many Kaiser Permanente longitudinal research projects. Collection of detailed patient data from 1964 to 1972 was made possible by the pioneering computer work of Morris Collen, MD, largely funded by the federal government.

Barbara Breen, on the Kaiser Permanente staff for 30 years, had her hands on paper charts as well as early electronic health records.

Breen, who worked for Kaiser Permanente for 30 years mostly in the northern San Francisco Bay Area, recalls having the duty to retrieve charts for patients scheduled to come into the San Rafael facilities in the 1970s.

“I got a job down on Fourth Street, which was an old motel . . . General Medicine was downstairs and Internal Medicine was upstairs, and the garage next door is where all the charts were. And in those days, we didn’t have (access to) computers yet, so if you needed a chart ASAP you would order it by phone.

“The chart room didn’t always have an extra person to bring the chart over. So the medical assistant or other (staff person) went out, rain or shine, across the parking lot, into the remodeled garage and picked up your chart.”

Today, Kaiser Permanente medical centers are constructed without medical chart rooms, indicating a confidence that the electronic chart is here to stay. With KP HealthConnect® in place, patients get their routine test results much quicker, and they can discuss their care with their physicians via secure email and mobile devices.

For member convenience, patients who travel can have their medical data downloaded on to a memory stick to take wherever they go. For quality of care, physicians have access to patients’ medical information in any of Kaiser Permanente’s facilities nationwide, enabling better care and avoiding duplication of tests.

 

1 Kaiser Permanente has been awarded Stage 7 honors by the Health Information Management Systems Society Analytics for 36 of its hospitals. Stage 7 is the highest award in the category and recognizes environments in which paper charts are no longer used to deliver patient care. KP was also honored with the HIMSS Davis Award for excellence for 2011. The 2013 annual HIMSS conference is under way in New Orleans through Thursday, March 7.

2 Selby, JV, Friedman, GD, Quesenberry CP Jr, Weiss NS. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. New England Journal of Medicine 1992.

3 Kaiser Permanente patient charts going back to the 1940s are stored in a San Francisco Bay Area facility and are readily accessible to researchers.

Also see: “Screening for Better Health: Enter the Computer

http://bit.ly/XQvXJC

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