Dr. Luella Klein is a crisp, slender woman who spent the last year bringing "issues of concern to women" to a massively male organization most concerned with the health of American women.
As president of the American College of Obstetricians and Gynecologists, Klein, ACOG's first woman president, used task forces, conferences and speakers at the ACOG 33rd Annual Meeting ending here today to provoke open discussions of issues many of her colleagues had shied away from, including child abuse, rape, battered wives, teen pregnancy, sex education and birth control. Sometimes, she says, it was against the advice of her colleagues, as in, "Oh, you don't want to put that dirty stuff on the program."
"We as doctors," she says, "have been pretty good at crying out about smoking and drinking, and other kinds of problems, many of which are social rather than purely medical, and I think we're to the point now where we can ask patients if they have been battered or if they have been raped."
"Doctors," family violence expert Richard J. Gelles told the estimated 4,000 doctors and several thousand other health care professionals, "must stop being ostriches like the rest of society."
Gelles, who is one of two principal investigators on a government-sponsored domestic violence survey now getting under way, is a sociologist and anthropologist and dean of the College of Arts and Sciences at the University of New Hampshire. He is author of "Intimate Violence in Families."
Noting that pregnant women, especially when young, socially isolated and with no support system, are peculiarly vulnerable to victimization, Gelles challenged the doctors to "take your heads out of the sand . . . and ask the questions that make you uncomfortable. It is important not to ask, 'How did you get that injury?' but to ask instead, 'Does your husband hit you?' or, even better, 'When was the last time your husband hit you?' "
"We recommend," said Gelles, "that physicians recognize that one out of 22 women who come in their office are already victims. Moreover, they should know the hotline numbers or the shelters numbers and, above all, don't point the finger of blame at the victim. If I had a dollar for every time a physician has asked, 'What did you do it provoke him?' I'd retire."
"You must ask," reiterated Gelles, "you must help . . . If you're not willing to get involved as an ob-gyn, if you're not willing to see those injuries, then you have empowered that man to do it again."
Dr. Malcolm G. Freeman, founder and supervisor of the Rape Crisis Center at Grady Memorial Hospital in Atlanta, who participated with Gelles and child sexual abuse specialist Dr. Szanne M. Sgroi in a Luella Klein-inspired panel on "Violence in Women's Lives," added that "one of the things physicians can do is serve as a support system for the patient. She comes in feeling powerless, hopeless, overwhelmed by the situation. And another thing the physician can do is tell her 'you don't have to put up with that crap.' People need to understand that it is not normal to be beaten up and you can get out of it."
Other programs stimulated by Klein included:
* A session on contraception in response to a Gallup Poll commissioned by ACOG that showed that "three fourths of women believe the pill carries substantial health risks. Only 16 percent correctly stated that childbearing is more dangerous than taking the pill." ACOG officials, including Klein, were clearly startled at these poll results because, as Dr. David A. Grimes of the Centers for Disease Control stated: "Use of pills or an IUD is, on average, many times safer than delivering a child or smoking cigarettes or even water skiing. I am perplexed when young women who smoke tell me that they are afriad of the pill. Psychologists call this 'cognitive dissonance.' I call it 'muddled thinking.'"
* Dr. John T. Queenan, Georgetown University Medical Center's chairman of obstetrics and gynecology, described a model Georgetown program designed to make intended pregnances -- the safest subgroup of America's 3 million annual pregnancies -- even safer.
Under the Georgetown program couples who want to start (or add to) a family would have pre-pregnancy support sessions and pre-pregnancy tests to screen for potential problems, such as diabetes, tumors, cysts, polyps or blood problems, that might threaten a pregnancy, but might be easily treated beforehand. "The time of greatest sensitivity to malformations and damage to the embryo is the first eight weeks of life," said Queenan. "Waiting for the second missed period for an examination is just too late."
Klein, whose ACOG title is passing to Florida physician Dr. William T. Mixson Jr., plans to return to her practice at Grady Memorial Hospital and Emory University in Atlanta. Meanwhile, she concedes that "you can't just go out and change an organization, but it's important to speak up sometimes."
And as one of her official actions she named four women to ACOG's Hall of Fame, the first to be so honored. They are: Margaret Sanger, family planning leader and coiner of the phrase "birth control"; Dr. Virginia Apgar, whose five criteria for assessing the health of a newborn are now universally applied; Dr. Edith Potter, a pathologist; and Dr. Elizabeth Ramsey, a specialist in embryology.