No Way to Treat a Lady

THE UNIVERSITY HEALTH SERIVCES (UHS) may not know how to treat its women patients, or at least that is what a lot of women health advocates have been arguing these days. But a lot of their main points have been lost in the shuffle of recent charges and counter charges.

What started six months ago as a face off between a women's advocacy committee and one particular UHS gynecologist have evolved into a mess of medical, ethical and statistical issues, none of them really useful to the average Harvard woman who is due for a checkup and getting nervous at the thought.

Unfortunately, the issue that both sides have focused on is easily the most abstruse. The women's initial complaint last April charged that D. Paul I Winig '62 had performed proportionally far too many Caesarian sections. The same letter cited a less quantifiable "consistent pattern" of complaints and discomfort about his practice generally.

Undergraduates might find a complaint against UHS focusing on pregnancy procedures somewhat remote. Both sides have exacerbated this problem by losing sight of the initial reason for emphasizing Caesarians that virtually all one on one patient doctor confrontations can be dismissed thy a defensive hospitals as clashes of personality, but statistics are harder to ignore. The Caesarian question then was intended primarily as a "hook" for other less quantifiable complaints. But UHS has had a simple reply to their statistics that they don't check out Dr. Warren E.C. Waeker responds in a wide variety of ways, which all point to some problems with the numbers. He has variously said the figures cover too short a timespan to be significant, that the better figures (obtained from Brigham and Women's Hospital records) show no scientifically significant pattern and that statistics are irrelevant any way.

The women's committee has responded in kind, challenging his analysis with an expert of their own choosing, and drawing competing information from nearby Beth Israel Hospital Neither group has managed to give much attention to the other matters mentioned in the complaint, so the question of Winig's overall competence remains untouched. As the committee has predicted, Waeker and his Brigham and Women's counterparts attribute such complaints to personality conflicts.

UHS GOT ANOTHER CHANCE to an real issues of care early this October, when a second woman filed a complaint against Winig--personally, not through the committee charging complicated and serious maltreatment. Because it concerns an individual, this case has rightly been conducted under a tighter cloak of secrecy than the first, but officials revealed last week that according to BWH, at least, that complaint has no grounds either. (The analogous review body at UHS has yet to turn in a decision).

This incident is not particularly damning for Winig, simply be cause his colleagues refuse to speculate on how common it is for a doctor to have three separate formal grievances leveled against him in a decade of practice. One UHS doctor notes that the complaints are so different that they hardly can be grouped together.

How then should a woman go about choosing whether to stick with UHS of go elsewhere for Undergraduates, a few unrelated factors further could the issue for one thing. UHS, like almost all college health services, has a bad reputation in general UHS patient advocate Amy Justice '82 blames the phenomenon largely on a magnitude word of mouth effect she cites a poll in which patients who rated UHS unfavorably consistently indicated they though others rated it unfavorably.

Dr. Murgaret S. McKenna '70, a former patient advocate who created the position and now works at McLain Hospital, has a more provocative suggestion doctors don't like to work at university clinics, she says, for the simple reason that the work is unchallenging compared to most full practices face it," she says, "students are boring. They get mono, they get colds. Once in a great while they get hepatitis. They're mostly in pretty good health, and if you want to hone your professional skills and keep abreast of the profession, you just won't want to work there Harvard has somewhat less trouble than most in attracting good physicians in recent years, McKenna adds because of the increasingly varied community it serves.

Other aspects of the Winig case though, are more troubling, and less easily written off as endemic to the system Reaction of UHS officials to the inquiry has ranged from the skeptical to the frankly paranoid with response to the women's committee sometimes released to the press first, and sometimes not at all.

Committee members points to an apparent discrepancy between initial reactions of BWH and UHS to the first complaint. Though rejecting, the argument that Winig's Caesarian sections were unwarranted BWH chief of gynecology and obstetrics Kenneth J Ryan this fall instituted a series of reforms in the department, including a requirement of prior consultation with the patient before a Caesarian section is performed. Committee members say that action points to some concern over the Winig situation a concern Wacker has maintained is not necessary. And to add a mysterious touch, copies of an anonymous letter to The Crimson made the rounds of several Med area offices last week, changing that the chairman of the women's committee was waging personal vendetta against Winig Experienced officials point out discrepancies in the letter which imply a man posing as a woman, or an interested party posing as someone. Unconnected: the suspicious is unavoidable that someone's stakes for protecting Winig are high.

SUBMITTING TO A medical examination by a doctor whose practices have been repeatedly challenged seems an action guaranteed to make a woman nervous. Nor is this an unreasonable reaction to the torrent of publicity. Women whose concerns are obstetric--who are primarily worried about how they will have their babies--now have several options which have been instituted in response to the complaint, notably the opportunity to be served by a BWH nurse-midwife. But for the woman with different and sometimes more complicated medical concerns, help does not appear to be on the way. Rather than let such discomfort grow further, the hospital and the women's committee must pursue their new found cooperation and, at last, settle the facts. Both sides owe the patients involved a real answer on Winig's competence not just a flurry of contracictory statistics.