The Doctor as Patient

Dr. Judith Reichman was addressing a group of 600 people who had gathered at the best teaching hospital in St. Louis to hear her speak about cancer prevention, when her conscience kicked her in what laymen call the gut. As the well-known “Today” show women’s health correspondent, she has a following that’s always eager to hear her analysis of the most recent breast cancer study, her judgment on the latest fertility treatment, her perspective on the advisability of hormone replacement therapy for menopausal women.

Midway through her lecture late last September, Reichman thought, “Less than a month ago, I had a bilateral subcutaneous mastectomy with immediate reconstruction when precancerous cells were discovered in my breast. I thought I’d recover from the surgery quicker than I have, but I’m just not physically and emotionally prepared to share that information with this audience, even though I’m here talking about what I did as one viable course of treatment. There’s something really not right with this picture.”

In January, Reichman told her story on the “Today” show. She didn’t look like a woman who’d recently had major surgery. Even on a bad day, she is the antithesis of a woman’s worst menopausal nightmare.

At 54, she is thin, pretty and in command. Her Westside gynecology practice is top heavy with many of L.A.’s most high-octane women, including writer-producer Diane English, radio host Dr. Laura Schlessinger, TV host Cristina Ferrare, agents, judges and movie stars.

Like many of her patients, who have become friends, Reichman is a hard-working, very accomplished woman in what appears to be the prime of her life. Yet her nagging conscience made her feel that if she were a role model with a secret, she’d be missing an opportunity to do one of the things that’s most important to her--educate women about their health.

Initially, her instinct for privacy had been so strong that she checked into Cedars-Sinai Medical Center under the name of her husband, producer-director Gil Cates, so even the private-duty nurses who attended her didn’t know she was Dr. Reichman. Only her office staff, a few close friends and family were aware she had become a patient.

“Going public was a very tough decision, because I don’t like to talk about myself when it comes to my health,” she said. “I just want to say, ‘I’m doing everything I’m supposed to do, and I’m fine.’ I always feel people don’t come to the doctor to hear about the doctor. When patients are with me, it’s their time. But I discussed it with my family, and we all came to the conclusion that it would be difficult to talk about what I’d gone through, but ultimately, I would feel more uncomfortable not talking about it.

“I shared my story because there are a lot of women who have the same dilemmas and I just wanted them to know that I’m human. I had those dilemmas, and here’s what I did. It doesn’t mean that every woman in the same situation should make the same decision. But if it helps women to see that I’m healthy now and I feel great, and I’ve gotten beyond it, then so be it.”

Influenced by Family History

The treatment Reichman chose was heavily influenced by her family history: Her mother, at 47, had undergone a double mastectomy after being diagnosed with an early stage of breast cancer. Twenty-eight years later, she remains healthy. When abnormalities appeared in Reichman’s annual mammogram, she was trying to complete her third book, “Relax, This Won’t Hurt--Painless Answers to Women’s Most Pressing Health Questions” (William Morrow, 2000). While she spent a “lousy” week at her vacation cottage on Cape Cod writing a chapter on the effect of genetics on women’s health, she didn’t know the outcome of a biopsy she’d undergone. After a second surgery confirmed that all unhealthy tissue had been removed, she decided to add an epilogue to the book about her experience.

That chapter is informative yet dispassionate.

“It was hard enough for me to talk about it without getting sloppy about my feelings. It’s not that kind of book. Most of the book was written to advise women about their health, and so much of women’s health has nothing to do with our breasts. I didn’t want it to be Reichman’s breast story. I had always been small, and my self-image doesn’t have to do with my breasts. If it did, I’d be in real trouble,” she said with a smile.

Although Reichman made sure that her health crisis wasn’t the focus of the book, it’s clear that being a woman has made her more effective as a doctor for women. She knows just how to talk to boomer women terrified of the M word, much less its potential to screw up their lives.

At a book-signing party earlier this month at the home of Frances Rothschild, an L.A. County Superior Court judge who is a patient and a close friend, a woman in her late 40s waited for Reichman to inscribe her book. Her body was admirably slim, her face unlined, yet she had just started to experience some of the discomforts of perimenopause, the three- to four-year stage before menopause when symptoms such as hot flashes, forgetfulness, sleep disturbances, mood swings and depression often occur.

“I’m terrified of menopause,” she told the doctor when her turn came. “I’m thinking about taking hormones, but the information is so confusing. I want a magic bullet.”

“So do I,” Reichman said.

Instead, in the chapter on how women can try to stay healthy in their 50s, she reviews the benefits and drawbacks of hormone replacement therapy.

“I’ve been identified as being pro hormone replacement therapy,” she said. “I’m not sure it’s always the case. Whenever I write about HRT, I say it can be the right choice for the right woman, and these are the reasons. What I try to do is point to what I think are the more valid studies, but it depends on symptoms and health history. I don’t give a ‘one prescription fits all’ kind of answer. The only black and white rules are if you smoke, you don’t exercise and watch what you eat and you don’t try to control your weight, then you will be sicker than the women who do.”

Weighing Cancer Risk and Hormones

Many women, including Reichman’s patients, are frightened by studies that link hormones and breast cancer, and have trouble reconciling those fears with research that credits hormones with reducing the risk of osteoporosis and heart disease.

“I don’t want the entire way we conduct our health to be based on our fear of breast cancer because with early pickup, we have a tremendous cure rate,” Reichman said. “I get the patients coming in who are suffering from such horrific perimenopause and menopause, whose lives have been horrendously upset, so I’m trying to help them. The woman who sails through menopause and has great genes and great bones and a great heart, if she comes in and says, ‘I don’t know why I should take hormones,’ I’ll say, ‘I don’t either.’ In every book I’ve ever written, I talk about the alternatives to HRT.”

The Boston Women’s Health Collective published “Our Bodies, Our Selves” in 1971, giving voice to the idea that women need to be knowledgeable about their bodies, take responsibility for their own health and be demanding partners with their doctors. Reichman was an intern then, one of a handful of women vastly outnumbered by men in white coats, and the only one to insist that women’s questions should be answered.

“Medicine was excellent, but human contact was missing. I brought that into the department,” she said. “The nurses liked it, and the response from women when I explained things to them was amazing.”

As her patients have grown up, and their health concerns have changed, she’s progressed with them. Her two daughters, from a 15-year first marriage to a law professor she met when he was a paratrooper in the Israeli army, are 20 and 30 now. The elder is a television producer in Israel, the younger a college student. Reichman no longer delivers babies because, at this point in her career, she’s most interested in communicating with large numbers of women. She feels it would be impossible for her to be up all night and keep the schedule she does, which includes writing, speaking engagements and flying to New York twice a month to appear on the “Today” show.

“As I moved into my 40s,” she said, “I no longer took my health for granted. My patients were baby boomers, and as we’ve headed, en masse, to the same ultimate fate of perimenopause and menopause, we’re all interested in what we can do so we won’t become our mothers and our grandmothers. So my interest in menopause and disease prevention was self-serving and patient-serving too.”

In becoming a media doc, she hasn’t abandoned one-on-one care. When NBC’s “Today” show producer Stephanie Saft mentioned that a friend was having infertility problems, Reichman said, “Tell her to call me.” (Since her practice is closed to new patients, the gesture was purely an attempt to help.) On the days when Katie Couric talks with the doctor about solutions for women with sluggish libidos or how pregnant women should take care of themselves, Reichman finishes her live segment, catches a 10:30 a.m. flight from New York and is in her office, seeing patients, by 2 p.m.

“She doesn’t have a lot of leisure time,” her husband of 13 years said. “The books and the appearances on TV are important but, I think, secondary to her work at the office treating patients, which requires an enormous amount of time. She doesn’t complain about it. She just puts her head down and does the work. She really cares a lot about her patients and worries about them. That doesn’t always make for the most tranquil home life, although she’s a very loving wife.”

An Early Love of Math and Ballet

The first child of a pianist and a theoretical physicist whose idea of father-daughter bonding was teaching her advanced mathematics, Reichman grew up in Little Silver, a small town on the New Jersey shore. As a young teenager, she was enrolled in Professional Children’s School while she attended the New York City Ballet Company’s school for aspiring dancers. Classmate Suzanne Farrell was more George Balanchine’s idea of a prima ballerina than Reichman, who was too tall, too long-waisted and whose feet weren’t ideally suited to being on point.

From ballerina to doctor, in some ways, isn’t such a quantum leap. Both callings require discipline, dedication and stamina. At 16, Reichman entered Barnard College, where she studied math for the first year. Switching to biological science was as much of a rebellion as she could muster.

When she speaks about giving up her dream of the ballet, it seems that the realization that she wasn’t destined for stardom played a part. Although she’s someone who expects to excel at anything she attempts, her need to be center stage has diminished.

“I’m always impressed with her intelligence, commitment and sincerity,” said Saft, the “Today” show producer who works most closely with Reichman. “She’s incredibly bright, but she isn’t arrogant about her intelligence. I really feel that she’s an advocate for women. It’s always about sharing the information, not about her personal aggrandizement.

“We see a lot of people who love to be on TV because it will showcase them personally. It’s never about that with Judith. She really, genuinely cares. She’s someone who wants to save the world.”

Mimi Avins can be reached at mimi.avins@latimes.com.