Dear Doctor: Cynthia Krause
The Upper East Side gynecologist on advancements in private practice and the importance of educating patients on new research.
Dr. Cynthia Krause, a gynecologist on the Upper East Side, has the honor to treat her patients throughout their lifetime, forming long-lasting relationships from when they’re young through menopause (even seeing a few patients she delivered herself, back when she practiced obstetrics). Her approach to care is simple, but essential: making her patients comfortable and heard. Dr. Krause’s practice offers traditional gynecology services, as well as other procedures — like ultrasounds, hysteroscopies, biopsies, and Mona Lisa Touch Laser treatment — making her practice dynamic and accessible. Read on to learn about how her time in a multispecialty center informed the values of her private practice today, what exciting developments she uses in house, and about the book idea she has brewing!
“I’ve been interested in medicine since high school. I originally thought I wanted to be a psychiatrist because I loved working with people and hearing their stories. But when I got to medical school at Duke I realized that while I did like psychiatry, there were so many other options. Post-graduation, I went into internal medicine and did a primary care residency for two years before switching to OBGYN.”
Mount Sinai’s Women’s Health Center
For ten years, I practiced general OBGYN and loved practicing obstetrics. However, a few years later, Mount Sinai opened a Women’s Health Center — so I left private practice to work there. It was an interdisciplinary program; the director was an internist, I was the director of gynecology and there was also a therapist, a nutritionist, a few other internists, and one other gynecologist. We practiced and collaborated well together — it was a great experience and we learned from each other.
The center was open for seven years. It was mainly a clinical center, yet we also conducted a few research studies on site. The challenge was how to most seamlessly take care of patients with multiple specialties. It worked very well for the patients. However, it was a hard model to reproduce. The center was opened at a time when managed care was just beginning and our model focused on comprehensive care, not seeing lots of patients in a quick period of time. We had not yet incorporated managed care into our model, which lead to financial challenges and ultimately the closing of the center. We all spent a lot of time with our patients, which from a medical point of view was successful and of course our patients loved, but it could not withstand the change.
Back to Private Practice
Spending time in internal medicine during my training has definitely helped me a lot in my gynecology practice today. I’m not intimidated by patient’s medical issues and I’m able to look at women’s general health overall. For example, while I don’t treat heart disease now, being well versed in it and its repercussions can help me guide patients to appropriate treatment options.
Being in private practice allows me to spend more time with patients than I could if patient volume was dictated by institutional or corporate metrics. On the daily, I see new patients, but I also have a group of patients I’ve known for many years.
I really take the time to listen to my patients and look at them as a whole.
I love getting to know them as people — it helps me provide the best possible medical care and I think they really appreciate it as well. I feel very fortunate to be able to practice this way.
Always Working with New Technologies
I see many patients in the menopause age-range, and I’m very interested in estrogen and alternative therapies for that group. One alternative for menopausal symptoms of vaginal dryness and atrophy is the Mona Lisa Touch laser. This is a good option for women who prefer not to use topical estrogen, who are advised not to use estrogen (such as breast cancer survivors), or for whom other therapies are ineffective. I also do my own ultrasound in the office. I find it really helpful to be able to evaluate a problem right at the time of an office visit.
Another exciting piece of technology called a hysteroscope has now been developed in a mini size that allows gynecologists to use it in their offices. The actual procedure, a hysteroscopy, has been around for a while — we use a scope to look inside the uterus to figure out why there is abnormal bleeding and if there are polyps. It’s a common procedure, but it’s usually done in the hospital in an operating room (the operative hysteroscopes are large so you have to dilate the cervix). Now, the scopes are so small we’re able to do it in the office to further investigate an ultrasound. Instead of doing a biopsy blind, which can potentially miss something, we can do the hysteroscopy with the biopsy when appropriate and this improves our accuracy. The scope adds visibility. If there’s something that needs to be removed like a polyp, you’d still have to go to the hospital, since this scope is too small for removal.
On Bioidentical Hormones
There are many diverse opinions about menopausal hormone therapy and its risks, but for many patients it’s safe and of great benefit. It has been controversial and the risks have been exaggerated, causing many women to avoid effective treatment. There are of course pros and cons, but when the risks and benefits are clearly explained to patients they are able to make a more educated decision.
Many patients request bioidentical hormones. Bioidentical means prescribing the same hormones that our bodies produce naturally. What is often not understood is that bioidentical estrogen and progesterone are available as standard prescriptions. It does not need to be compounded by a pharmacist in order to be bioidentical. I’ve seen a number of patients who believe that the compounded hormones are safer or somehow without side effects, but they are actually the same hormones that are available by regular prescription. Compounded hormone preparations are also quite costly. It’s definitely important to be sure that patients are aware of all the risks and side effects before starting them on a treatment plan.
Educating and Writing
I try to stay as current as possible and incorporate anything that I think is reasonable into practice. There are constant changes in medical practice as new research becomes available. Communicating new developments and medications to patients is really important. Medicine should primarily be evidence-based; there’s so much out there that isn’t. We have to constantly teach patients about what we really know and admit what we don’t. It’s our role as doctors to keep up with medical literature and evidence. New studies alter our thinking and new knowledge is generated — we need to clearly disclose that.
One day, I’d love to write a book. One that is less hype and more evidence-based about menopause. But I’d also like to help patients understand how we gain medical knowledge, how we actually know what we know through research and that not all studies are conclusive. I think medical literacy is very important and that includes understanding where information comes from. We don’t know everything, but we use what we do know to make the best decision possible.
Lightning Round
One piece of advice I leave my patients with…the importance of exercise at any age and that anyone can start no matter how old you are!
If I weren’t a doctor, I’d be…doing something in public policy.
Favorites
NYC museum: I love the new Whitney.
NYC park: Central Park. I love walking my dog there, it’s so relaxing.
Podcast: My daughter always recommends ones to me, like Slow Burn, Serial, The Daily, and a lot of news ones.
You can learn more about Dr. Cynthia Krause here.
Know a great female doctor in NYC? We’d love to meet her, introduce us here!
