Dr. Bruce Kahn is a member of the Department of Obstetrics and Gynecology at Scripps Clinic in La Jolla, CA. Dr. Kahn completed a medical internship at St. Joseph's Hospital in Chicago, IL. He completed his residency training at Cedars-Sinai Medical Center in Los Angeles, CA and Abington Memorial Hospital near Philadelphia, PA. Following his residency, Dr. Kahn was commissioned as a Lieutenant Commander in the United States Naval Reserve. He served on active duty as a staff physician at the Naval Medical Center in San Diego. He joined the Scripps Clinic in 1999 and has pioneered work in the department and the region on the technique of laparoscopic hysterectomy. Dr. Kahn spends his free time with his wife and two children.
Uterus1: When did you know you wanted to be a physician and how far into the process of medical education and training were you when you knew you wanted to specialize in obstetrics and gynecology?
Dr. Kahn: I have been interested in medicine since I was a child. However, my voyage into gynecology was through a rather unusual route. After finishing medical school I began training to become a radiation oncologist (a radiation therapist for cancer patients). Soon after beginning this training I realized that I really liked a more surgical approach to patient care and switched to obstetrics and gynecology with the idea that I’d eventually become a gynecologic oncologist (a surgeon for patients with gynecologic cancers). Finally, after discovering all the challenges and excitement that general obstetrics & gynecology offered (delivering babies and doing the laparoscopic work that I now champion), the idea of going on to sub-specialize in gynecologic oncology didn’t make sense anymore.
Now my practice combines the best of both worlds. I am able to tailor medical and surgical arts to best meet the needs of my patients.
Uterus1: Do you feel women’s health is getting the attention it deserves?
Dr. Kahn: In the past, research in women’s health was neglected; however, I feel that the future is bright in this regard. Lobbyists have persuaded Congress and the directors of the National Institutes of Health that research in women’s health care deserves specific and better funding. So I believe that research into women’s health will be better supported in years to come. A better understanding of health problems specific to women will result in better care for women.
Uterus1: What is the most prominent change in the women’s health field since you have been a medical professional?
Dr. Kahn: Two very important changes have taken place in medicine over the last 10-20 years. First, technologic advancements in medicine have dramatically improved care. Second, ethics, as a science, is now consciously considered in medical decision making.
Technologic advancements that have taken place over the past 10-20 years are truly amazing. New medical treatments and minimally invasive surgical procedures have revolutionized care for many common problems. Newer and better treatments continue to be developed every year. For example, women with heavy menstrual periods now have a whole array of medical and minimally invasive surgical options available to them short of hysterectomy. And for those women that do undergo hysterectomy, newer laparoscopic techniques can shorten recovery from the traditional 6-8 weeks to as little as 5-10 days.
As far as ethics in medicine are concerned, I believe that all U.S. medical schools now require formal training in this. It is not that physicians previously operated without ethics. Rather, the standard was that doctors often made decisions about medical care for their patients (a form of beneficence). Now patients are more often making choices about their medical care after being informed of the choices available to them (a form of autonomy). This swing toward more autonomy for patients has radically altered (and I would say improved) the doctor-patient relationship. Doctors and patients now work together to plan treatments. This benefits everyone.
Uterus1: You have done a lot of work with laparoscopic hysterectomy, is that correct?
Dr. Kahn: Yes. I have been somewhat of a pioneer of laparoscopic hysterectomy, at least in the Southwestern region of the country. In approximately 1998, I began performing laparoscopic hysterectomies, instead of a traditional abdominal hysterectomy.
I advise the patients to undergo laparoscopic surgery with the hope that it will decrease their recovery time to several days instead of weeks, through avoiding a big abdominal incision involved in hysterectomies.
Uterus1: Can you explain the detail of the procedure?
Dr. Kahn: Laparoscopic surgery utilizes very small holes in the abdomen, ¼ to ½- inch in diameter, instead of a big incision in patients’ abdomens. The less invasive nature of the laparoscopic surgery shortens the recovery period and the post-operative pain is exponentially less. Many women that still require hysterectomy now can have the procedure completed laparoscopically rather than through a traditional abdominal incision.
Uterus1: There is still a traditional abdominal hysterectomy, a laparoscopic hysterectomy, and also a vaginal hysterectomy?
Dr. Kahn: Yes. The traditional procedures are abdominal and vaginal. The latest technique is laparoscopic hysterectomy where everything is done through very small incisions.
Uterus1: When is it in the patients’ best interest to opt for a more traditional hysterectomy?
Dr. Kahn: Vaginal hysterectomy is still very useful when pelvic organs have “dropped” due to previous childbirth. Sometimes vaginal hysterectomy can be completed even when there is not much “dropping” of the utereus. In this circumstance, laparoscopic techniques do not provide any advantage. Abdominal hysterectomy is still necessary when there is a significant risk or concern for cancer, or often when no “dropping” has occurred. Laparopscopic techniques are advantageous when previously an abdominal incision would have been necessary. Since 2/3 to ¾ of all hysterectomies currently performed in the U.S. are done using an abdominal technique, there are a lot of women who could benefit with the shorter recovery provided via laparoscopy.
Uterus1: Being involved in other minimally invasive procedure, what do you think makes the biggest difference in patients’ lives? Can you qualitatively compare them or is it patient to patient?
Dr. Kahn: Minimally invasive treatments improve patients’ lives by shortening their “down time” after surgery. Patients return to their normal activities more quickly. There is also accumulating evidence that many of these procedures have less risk than traditional therapies.
Uterus1: Do you think that these technologies and procedures have made the incidence of people needing a hysterectomy much less?
Dr. Kahn: Oh absolutely. For instance, most menstrual bleeding problems can now be treated without a hysterectomy with either medical therapy or minimally invasive surgery such as endometrial ablation. In the past 20 years, many women who underwent a hysterectomy due to heavy menstrual bleeding may have avoided it if current advances in therapy such as endometrial ablation, were offered to them.
Uterus1: You have done extensive lecturing on chronic pain. Is it more common among patients now or likely more recognized thus more frequently treated by the medical professionals?
Dr. Kahn: Chronic pelvic pain in women accounts for about 10% of visits to gynecologists’ offices. Thus, it has been and remains a very common problem. Women, with chronic pelvic pain are often treated for conditions such as endometriosis, chronic vulvar pain or recurring yeast infections. The research group with which I have been working has discovered significant overlaps of these diseases with pain syndromes related to other body systems such as the bowel, the bladder or the musculoskeletal systems. For example, we have found that many patients diagnosed with endometriosis also have a bladder condition known as interstitial cystitis. Treatments for interstitial cystitis may help the pain of endometriosis. This more “holistic” view of chronic pain has helped uncover more therapies that avoid the need for surgery. In the future, I think that fewer women with chronic pelvic pain will require surgery for diagnosis and treatment.
Uterus1: Do you find that the Internet and all info out there makes a difference when a patient comes to you and is able to say, “these are the symptoms I have” or “it sounds a little bit like this, what do you think?”
Dr. Kahn: The internet can be a wonderful tool for patients. It can be useful for helping people understand medical problems. I very often will direct patients to Internet resources to learn about different diseases or treatment options for their particular problem.
Knowledge is power. I think the more people can use the Internet as a research tool to take control of the management of their care, the better overall treatment they receive. Caution needs to be used however. Patients need to understand that not all web sites with medical information are reputable. Most people understand this.
Uterus1: What are you most excited about that you see on the horizon, in terms of more advanced care or less invasive care?
Dr. Kahn: In gynecology alone, there are several exciting areas of development: First, in relation to pain care, research is highlighting many new options for non-surgical treatments. Secondly, my colleagues & I are preparing a project that will help women who desire a tubal ligation to undergo a procedure using no incisions at all. The tubes will be blocked using a procedure done through the cervix and uterus. Lastly, genetic research is bringing new insights that could lead to effective gene therapies with in the next 10 to 15 years.
Uterus1: In terms of gene therapy, how does that directly relate to the problems you see in your patients?
Dr. Kahn: Pain (where a lot of my research is directed) has a genetic component. Some women produce more proteins related to pain and we may be able to use antibodies directed at certain proteins to stop the production of those molecules. This can help pain.
Uterus1: Any advice to patients in selecting physicians and treatment options?
Dr. Kahn: In selecting a physician, make sure you feel your physician is really listening to you. Make sure that he or she seems to have heard you. At the end of a visit, patients should understand what the doctor thinks is the problem and what the plan or options are for diagnosis or treatment. Communication is what the patient/physician relationship is based upon. Trust is imperative, but there must also be effective communication. This is the most important component of the physician-patient relationship.
As far as treatment options are concerned, the more patients can learn about treatment options and the more educated they are about disease states and treatment options, the more in charge they will be and the better the treatment they’ll receive because of it. To the best of your ability, take charge of your medical care and you’ll be better off for it!