Women’s Health in Hawai‘i: The Doctors and Specialists You Want on Your Team
Let’s be honest—we don’t always understand who we should see when it comes to medical care. From internists vs. geriatricians to ophthalmologists vs. optometrists, we asked the experts about the specialists women may want to add to their team.
IT’S NOT JUST FOR THEIR OWN WELL-BEING. Women often also take on the responsibilities of caring for keiki, spouses, parents and other relatives. But they don’t have to do it alone. Today, you can build a team of physicians to help tend to everything from pregnancy to infant immunizations, hormone-related hair loss to the complexities of medications and moods for seniors.
PEDIATRICIAN OR FAMILY PHYSICIAN
AVERAGE WAIT TIME: 1 Week for New Patients
Before your child is born, you’ll likely be asked to select a doctor for your little one. There are two specialties that focus on keiki’s general health—pediatricians and family physicians. Which one is the right fit for you?
Pediatricians treat patients from birth to around 18. Their duties include vaccinations, treating illnesses, preventing diseases and monitoring the growth and well-being of their patients. They collaborate with parents, offer nutritional guidance and track growth milestones at annual checkups. Some pediatricians, such as Dr. Yolanda Wu at Kapi‘olani Medical Center for Women and Children, even offer in-office dental screenings and fluoride varnishes.
Wait times for a first appointment can vary depending on the office; the time of year is also a factor. “Usually the wait [for first-time patients] is about one week for checkups,” Wu says. “During the summertime, there is a higher demand and it can be up to one month.”
When a young adult decides to graduate to another primary care physician, the person can continue to seek primary medical care through an internist or family medicine practitioner. “If a patient has an uncommon genetic condition in their family that their parents’ doctor is familiar with, it might be advantageous to have the same physician, or if the patient already has a relationship and feels comfortable with that doctor from seeing them,” says Wu. “But keep in mind that once a patient is 18 and able to consent for themselves, the doctor may not disclose any medical information to the family without the consent of the patient.”
Dr. Vincent Au is a family practice physician at Kaiser Permanente. Unlike other primary physician specialities, family practice means Au cares for people through all stages of life, from newborn keiki to kūpuna. Family medicine deals with a spectrum of medical issues, from acute illnesses such as infections and lacerations, to chronic diseases, including diabetes and hypertension.
Because these physicians treat people of all ages, patients have the option of staying with the same doctors their entire lives. “We provide counseling for stress, family issues, mental health and care of our seniors, too,” says Au, who, like Wu at Kapi‘olani, points to the potential benefits of an entire family being treated by a single doctor who has knowledge of the ‘ohana’s medical history, especially families with a history of hereditary diseases.
Practicing family medicine for 21 years, Au assists in coordinating care with all other subspecialists. “When members visit a physician for their illness, they not only receive care from their provider but may also receive care from the medical assistant, nurse, pharmacist, physical therapist and many others—not just the person they came to see,” Au says.
Family medicine has a range of subspecialties, such as sports medicine, weight management and occupational medicine. Au says most new patients can schedule appointments within a few weeks.
SEE ALSO: HONOLULU Magazine’s 2018 Top Doctors in Hawai‘i
AVERAGE WAIT TIME: 2 Weeks to 4 Months for New Patients
Kids who go to a pediatrician may continue their care as an adult with an internal medicine doctor. Dr. Todd China, an internist at Straub Medical Center, thinks of internists as the first line of defense in health. “Most specialists require a referral from us, so in a sense we’re like the ‘gatekeepers’ helping to decide when that referral is medically necessary,” he says. Internal medicine doctors focus on the care of adults and are trained to diagnose and treat diseases of every organ system. Internists also address advance care planning and perform age-appropriate cancer screenings and vaccinations.
Dr. Andrew Dang at Straub Mililani Family Health Center has been practicing internal medicine for 27 years. Equipped to see anyone 18 and older, Dang describes himself much like the head coach of a football team, “treating patients [himself] but also utilizing other specialists to give them the best possible care.”
Because internists treat a broad range of illnesses and conditions, they may also choose an area of specialized expertise, such as endocrinology, gastroenterology or hematology. Common conditions internists treat include hypertension, high cholesterol, asthma and emphysema, diabetes and acute illnesses such as infections, colds and flu.
Referred to as the “doctor’s doctor,” internists are often called by other physicians to consult on diagnostic problems. “I feel doctors do work more in tandem now as medicine is advancing so rapidly that it is hard to keep up with everything. So specialists are consulted more often to give the patient the best, most up-to-date treatment,” Dang says.
Although internists are trained to treat adults of all ages, Dang says that once a patient reaches 80, he or she will usually see both an internist and a geriatrician, as a team. “As a patient’s medical profile gets more complex, it is impossible for a doctor alone to manage effectively all the aspects of their care,” he says. “Many patients have needs like social services, behavioral modification, specific one-on-one education about their diseases and medication.”
Internists such as China refer patients to geriatricians for difficult problems involving dementia, insomnia or hallucinations. However, geriatricians do not assume primary care, so internists are still needed for all general medical concerns. Wait times for new patients can vary anywhere from two weeks to four months, depending on the doctor.
AVERAGE WAIT TIME: 3 Months for New Patients
Once you are older than 60, you may want to meet with a geriatrician. These doctors deal with the physiological and psychosocial changes that come with aging, including the complex interactions between multiple medical issues and medications. For instance, these physicians might study how one’s medicine for high cholesterol interacts with medicine for Alzheimer’s, or how vitamin deficiencies can affect a patient’s mood.
Dr. Jeremy Chun, a geriatrician, says he takes a “holistic approach by evaluating how well a person is performing their daily activities at home.”
He and other geriatricians look at multiple factors, including diet, social support and medication. Geriatricians start off certified in either internal or family medicine, but have worked intensively with older adults to become board certified in geriatric medicine.
Chun manages health problems including dementia, gait impairment, osteoporosis and polypharmacy (the simultaneous use of multiple medicines, which is common among seniors). Chun, along with The Queen’s Medical Center Geriatric Services team, provides care through clinics, the hospital and short-term rehab centers, as well as house calls for homebound patients.
“Many people think that the field of geriatrics is depressing because older adults develop multiple chronic medical conditions that cannot be cured,” says Chun. “However, geriatricians have one of the highest job satisfaction rates among all the medical specialties. The foundation of geriatrics involves listening to a person’s story and building meaningful relationships, which is extremely rewarding.”
These physicians also stress a team approach, working collaboratively with other care providers such as physical therapists, social workers, nutritionists and geriatric psychiatrists. Although not all older adults may require a geriatrician, people usually start seeing one at 65; typically, Chun’s patients are in their 70s to 90s.
The wait time for a first appointment is around three months. According to Chun, many geriatric training programs around the country are having difficulty filling their positions. “Unfortunately, at a time when our population is rapidly aging, we have a significant shortage of geriatricians,” says Chun.
AVERAGE WAIT TIME: 3 to 4 Months for New Patients
Women should start getting pap smears to screen for cervical cancer at 21, which is when most start seeking an OB-GYN. But Dr. Eileen Ogasawara-Chun, who has been practicing medicine at Kaiser Permanente for 18 years, encourages women to start seeing an OB-GYN before they become sexually active. The wait time for a first annual exam is usually three to four months, according to Ogasawara-Chun. Because some women may have anxiety about seeing an OB-GYN, Dr. Stephen Lin at Kapi‘olani tells patients that they can have a phone conversation with the physician even before the first appointment.
A gynecologist specializes in women’s reproductive health while obstetricians primarily care for women who are pregnant. Many doctors specialize in both—we call them OB-GYNs, who focus mainly on preventive medicine. “I see women with menstrual problems, pelvic problems, female infections, infertility, regular health maintenance and abnormal Paps. I also counsel and provide birth control,” Ogasawara-Chun says.
“I have women in their 80s that still see us regularly,” she says, “but most women stop coming in when they stop having Pap smears done, around age 65.”
Says Lin: “One of the best things about being an OB-GYN is that you get the privilege of caring for a patient throughout her life. I am now delivering babies from women that
Although OB-GYNs care for women through the years, Ogasawara-Chun recommends that women also choose a primary care physician, such as an internal or family medicine provider. “Medicine has definitely become a team sport. I now am in touch with many of our patients’ former physicians as we continue their care here in Hawai‘i,” she says.
AVERAGE WAIT TIME: 2 Weeks for New Patients
Many people only visit dermatologists if they have acne, eczema or other skin problems. But this medical specialty also deals with other issues such as hair loss, something that is more common in women as they age.
Dr. Miki Garcia of The Queen’s Medical Center has treated common medical conditions including acne, eczema, warts and rashes during her 12 years in practice. She also performs cosmetic procedures, including Botox, fillers, laser treatments, microneedling and chemical peels. Dermatologists can also diagnose skin cancers and other issues and disorders including scars, dermatitis (inflammation of the skin) and hair loss.
“Hair loss in women can be very distressing since our hair is part of our identity,” says Garcia. “The most common cause [for hair loss] as we get older is related to a decrease in estrogen, and it can also be hereditary.” Depending on the cause, Garcia usually treats hair loss with topical or injected steroid medications or oral contraceptives.
Wait time for a regular appointment is around two weeks, Garcia says. “Because we are specialists, we sometimes need a referral from a primary care physician. Otherwise, we see many people on short notice and as soon as possible.”
Garcia’s patients are of all ages, ranging from infants to the elderly. “There is no specific age when we recommend seeing a dermatologist, but we recommend that if someone has a lot of moles or a family history of skin cancer to have a screening,” Garcia says.
Patients with a history of skin cancer visit Garcia for skin checks as often as once every three to 12 months. For other problems, such as chronic sun exposure or a suppressed immune system, she recommends that patients take preventive care and come in at least once a year. Her most important preventive tip for patients? Use sunscreen. “At least SPF 30, broad spectrum and water resistant up to 80 minutes to prevent skin cancer and aging,” she says.
SEE ALSO: This Hawai‘i Doctor is Helping to Change the Rules for Your Medical Care
AVERAGE WAIT TIME: Varies Depending on Time of Year
IN Hawai‘i, allergists have become a regular part of the medical roster for many families.
The physicians treat conditions such as asthma, eczema, sinusitis, hives and hypersensitivities to food, venom and drugs. Dr. Abigail Harada, who has been practicing allergy and immunology at The Queen’s Medical Center for 10 years, offers serum IgE testing, pulmonary function testing, allergen immunotherapy and monoclonal antibody therapy.
Harada says that people may face a long wait to get a first appointment in Hawai‘i. “We live in a unique environment because we are exposed to nonallergic triggers like pollution from vog and unpredictable weather changes, which affect about a third of my patients,” she says. “Therefore, there are many people who are seeking specialty medical attention for their symptoms.” Harada also says that the wait time can vary depending on the year, with summer and winter usually being busy times.
Harada’s patients are of all ages and see her anytime from annually to every two to four weeks, depending on the severity of their conditions. Many patients take a proactive approach, trying to avoid allergy symptoms altogether. “I have been asked by many families to evaluate for pet allergies before a new pet is brought into the home or to assess for pollen allergy before the outdoor landscape is modified around the home,” she says.
OPHTHALMOLOGIST OR OPTOMETRIST
AVERAGE WAIT TIME: 3 Weeks for New Patients
An optometrist is an eye doctor with a doctor of optometry degree. Ophthalmologists are M.D.s (doctors of medicine) or D.O.s (doctors of osteopathic medicine), similar to primary care physicians. Both are trained to perform vision tests and write prescriptions; however, ophthalmologists are also licensed to perform eye surgery.
When choosing between an ophthalmologist and optometrist, Dr. Julie Nishimura says there is no quick and easy answer. “If a person is experiencing a new vision problem and is not already under the care of an eye care professional, I would advise seeking guidance from his or her primary physician. This is because some symptoms are suggestive of sight-threatening eye disease or even a neurological condition. Other symptoms suggest that the problem could be managed by an optometrist.”
Nishimura, an ophthalmologist at Kaiser Permanente Honolulu Medical Office, provides medical and surgical eye care for people of all ages. She starts with a full assessment of ocular health before discussing a management plan with patients. “I evaluate for conditions such as strabismus (abnormal alignment of the eyes), amblyopia (lazy eye), cataracts and glaucoma,” she says.
Ophthalmologists can sometimes spot the first sign of a brain tumor. “Brain tumors can occasionally cause vision symptoms alone, without headaches or any neurologic symptoms,” Nishimura says. “On exam, we might find a pale or swollen optic nerve. This prompts an immediate brain scan, which reveals the tumor.”
Nishimura says the wait time for an initial visit is about three weeks or less.
AVERAGE WAIT TIME: Less Than a Week
Although not physicians, dentists should still be on everyone’s checkup list. Doctors of oral health, dentists’ duties include diagnosing oral diseases, monitoring growth and development of the teeth and jaw, and performing surgical procedures on the teeth, bone and soft tissues of the oral cavity.
Dr. Mason Savage has been practicing for 22 years and offers treatments including direct fillings, inlays, root canals, veneers and removable prosthodontics. At his Kāhala practice, Savage also uses digital scanning of the teeth and the supporting structure of the jaw and face to develop treatment plans, fabrication of orthodontic aligners and the designing of custom crowns.
Dentists take care of more than just teeth and gums. They may care for muscles of the head, neck and jaw, tongue and salivary glands. Looking for abnormalities in the mouth during comprehensive exams, these doctors can detect early warning signs that may indicate disease somewhere else in the body.
“Dental health cannot be separated from medical health. Multidisciplinary coordinated care across all specialties of medicine and dentistry is required to assure longevity,” says Savage.
People only have to wait a few days for a first appointment, with many dentists reserving time in their schedules for new patients, according to Savage.
On the Front of Preventive Care
Dr. Chien-Wen Tseng is the first Hawai‘i doctor to be weighing in on the federal guidelines doctors follow for preventive care.
Cervical cancer screenings once every three to five years. Annual mammograms. The U.S. Preventive Task Force is the main group that recommends when you should be screened for everything from lung cancer to aneurysms. Dr. Chien-Wen Tseng is a local family physician who has been treating patients for 20 years and teaching at the John A. Burns School of Medicine at UH since 2002. And in 2016, she became the first Hawai‘i doctor to join the 16-member task force.
It’s a lot of work. For every recommendation, Tseng says it takes more than a year of evaluating hundreds of pages of evidence, reviewing public comments, weekly conference calls and regular meetings in Washington, D.C. But Tseng says being able to add experiences with patients in Hawai‘i adds valuable perspective to the process.
“I talk about diversity, culture or something as simple as how easy or hard it is to find a primary care doctor when we’re working on each recommendation,” she says. “In Hawai‘i, 1 in 5 residents is overweight, 1 in 3 has high blood pressure, and 1 in 8 has diabetes. So good preventive care can catch these conditions early before they do long-term damage.”
Read more from Tseng about recent recommendations that could affect your health and other topics the task force is discussing (including a new potential screening for kids), here.