A Letter from Dr. Potts at Vista Urology

Dear friends:

I am very proud of my partner's latest publication. Dr. Payne is lead author of the ICS statement regarding female genital cutting, a practice which still exists in many parts of Africa and Asia. While this ritual has been forbidden by Sharia Law, it continues to be misrepresented as a Muslim practice or male driven form of genital mutilation. However, it is a much more complex issue involving patient and cultural autonomy as well as trauma, disfigurement and complications as severe as subsequent obstructed labor and death. The coauthors, from Burkina Faso, Switzerland and U.S., contributed their invaluable perspectives, with which this article would not have been possible. Here is the abstract:

"Female genital mutilation/cutting (FGM/C) — also known as Female Genital Cutting or Mutilation — is defined as the partial or total removal of the female external genitalia for non-therapeutic reasons. This White Paper, prepared under the auspices of the International Continence Society (ICS), is intended by the ICS as a statement promoting the abandonment of this practice. The ICS also supports the respectful and evidence-based care or treatment of women and girls already affected by FGM/C, in keeping with the World Health Organization (WHO) Guidelines on the Management of Health Complications from Female Genital Mutilation. Our members specialize in pelvic floor disorders from perspectives within a range of specialties; we encounter and treat women living with FGM/C and its consequences — particularly incontinence, infections, voiding dysfunction, sexual dysfunction, chronic pelvic pain, and obstetric trauma. Understanding the ethical, sociocultural, medical and surgical factors surrounding FGM/C is central to caring for women and girls with a history of FGM/C. The ICS voices herein state strong opposition to FGM/C. We encourage members to apply their skills to improve prevention strategies and the management of those affected."

At the annual meeting for the Society of Urodynamics and Female Urology that was held this past month, Dr. Payne was an invited panelist for a discussion on innovative medical practice settings, specifically to discuss our patient-focused approach emphasizing taking the time necessary to fully understand the patient's problem. At a separate session, he was invited to share our experience as private practitioners outside of insurance and Medicare. It was both validating and inspiring to some members of the audience, while also providing justifiable pause and caution for others.

In closing, I share another Tango Lesson:

"FOLLOW WHAT YOU LEAD..."

When a tanguero leads his partner, he considers her ability, technique and agility while imagining the series of steps and figures he is initiating for her. Within seconds, he must choreograph and imagine the culmination of her interpretation, so that he can protect her axis and "meet" her in a seamless exchange of lead and follow. Not only does this require the utmost of self-awareness, as one cannot and should not lead beyond their own capabilities, but great sensibility toward others. Empathy.

It is not enough to say or posture a command, a request or an invitation. The leader guides with grace and compassion. As physicians, we cannot prescribe solutions to patients, without understanding their experience or challenges. We must take a moment to dance in their shoes.

Sincerely,

Jeannette M. Potts, MD