The P&S Journal: Spring 1998, Vol.18, No.2
Alumni News and Notes
Lila Wallis: LifeLong Advocate for Women's Health
By Peter Wortsman
In the more than four decades of her medical career to date, Lila Wallis’51, a soft-spoken academic-activist who has been called “the godmother of women’s health,” has witnessed “a modest improvement in the scant attention paid to medical concerns and research specific to women,” an improvement hastened in no small part by her tireless efforts. Clinical professor of medicine at Cornell, Master of the American College of Physicians, past president of the American Medical Women’s Association, founder and first president of the National Council on Women’s Health, Dr. Wallis has labored from consultation couch, clinic, lab, and lectern to help put women’s health on the medical map.
An internationally recognized authority on osteoporosis, estrogen replacement therapy, and menopause, she is also an inspired educator. The Teaching Associates Program that she instituted at the New York Hospital-Cornell Medical Center in 1979 and directed for 11 years revolutionized the teaching of sensitive and competent breast, genital, and rectal examinations. Her landmark “Textbook of Women’s Health,” published in December 1997, has been hailed as the first of its kind. “It fills in some of the gaps,” Dr. Wallis allows with a smile and a sigh, conveying an inkling of the distance traversed and the distance still to go.
Visible Symptoms, Unexplained Causes
Some of her women patients, for instance, presented with recurrent bouts of cystitis followed by yeast infections. Because the male urinary tract had been taught as the standard, conditions unique to the female tract had never been addressed in lecture or text.
The only physician in the United States, male or female, to have acquired board certifications in internal medicine and hematology as well as endocrinology and metabolism, Dr. Wallis decided to pursue her own independent course of “post-postgraduate” training, with the expert advice of urologists and gynecologists she knew. She evolved her own guidelines of diagnosis and care for recurrent urinary tract infections, such as culturing urine, establishing antibiotic sensitivity, preventing yeast superinfection, and explaining precautionary measures to her patients.
She also saw women with suspicious bruises. These women were often accompanied by their spouses or partners. After taking the patient aside and risking indelicate questions, she established the truth and confronted the previously taboo issue of domestic violence. And while colleagues urged her to back off and mind her own business—”You’re a doctor, not a social worker!”—she concluded that the physical and mental trauma of her patients was indeed her medical business. No shelters for battered women existed at the time. “It’s my patients who have always guided me and taught me much of what I needed to learn,” she insists.
A Necessary Occupation
The brutal realities of war convinced her of the importance of medicine: “I realized that there were four necessary occupations, no matter what: medicine, teaching, the priesthood, and farming. I’d tried teaching and, well, I couldn’t be a priest, and while I loved gardening, and still do, I wasn’t about to devote my life to it. That left medicine.”
Immigrating to the United States after the war, she attended Barnard College, graduating with a B.A. degree in chemistry, summa cum laude, in 1947. A Columbia scholarship and grants from outside foundations enabled her to attend P&S, where she made Alpha Omega Alpha in her junior year. Delighting in “the sheer pleasure of discovering knowledge and learning new skills,” she made lifelong friends among her classmates and “felt privileged to be learning my chosen calling from famous teacher/physicians.”
She did, however, experience occasional snubs from a few of the more immature male students who could not fathom a serious young woman, already married and determined above all to pursue her studies. “After losing so many years during the war, my job was to gather education, not to socialize!” A certain degree of hostility to women in medicine unfortunately was condoned, if not fostered, by some members of the faculty who saw the education of women medical students as a wasted investment because they would probably get married and leave the profession.
But she also found staunch supporters on the faculty, inspiring professors like Yale Kneeland’26, who brought “great elegance to the teaching of physical diagnosis” and his sister, Virginia Kneeland Frantz’22, who “made surgical pathology come alive.” Her outstanding academic record notwithstanding, when Dr. Wallis confessed to Dr. Frantz a slight anxiety about learning the ropes at Cornell, where she had been accepted for training, the latter assured her young protégé that P&S had prepared her to meet any challenge. New York Hospital-Cornell Medical Center, in fact, became Dr. Wallis’ home base, and she has taught and practiced there since. Following her training, she joined the faculty as an instructor in medicine and rose in the ranks to her current title of clinical professor and attending physician.
Her early research performed in conjunction with her mentor, Dr. Ralph Engel, focused on multiple myeloma. Together they published a book on immunoglobinopathies. They also co-authored a series of important papers in the American Journal of Medicine on the combination of adult Franconi syndrome and multiple myeloma. (She is the author or co-author of more than 50 peer-reviewed publications.) Lecturing on her findings to the Department of Endocrinology, Dr. Wallis shifted her research focus to osteoporosis and developed a proneness index based on patient history.
In 1974 she instituted the “Update Your Medicine” program at Cornell, one of the earliest, longest running, and most successful continuing medical education programs in the country.
While relishing the research, she was all too aware of the absence of women principal investigators at the time: “I would always have been second fiddle, and I didn’t want that.” Given her facility with patients and enjoyment of the “intellectual challenge of differential diagnosis,” she opted for the clinical track.
In addition to her private practice, she saw patients in New York Hospital’s endocrine and hematology clinics. Despite her obvious qualifications, she was excluded as a woman from practicing in the Vincent Astor Clinic, which was devoted to the care of corporate VIPs. Dr. Wallis’ practice has always included both men and women. She fondly recalls a patient she had seen while still a student, a male hemophiliac who told her she would make a fine doctor, “because I had a gentle touch.”
Teaching the Gentle Touch
Honing her skills over years of practice, Dr. Wallis sought to promulgate the practical wisdom she had picked up from peers and patients through the Teaching Associates Program. Inspired by an experiment conducted by Dr. Robert Kretschmar at the University of Iowa, in which non-medical women served as demonstrators and subjects for the teaching of pelvic exams to medical students and residents, and with the input and advice of members of the Boston Women’s Health Book Collective, Dr. Wallis fine-tuned the concept into a workable pedagogical model that has since been adopted by medical schools around the country.
Until then, pelvic exams had been demonstrated on clinic patients who were often sedated. The procedure was not only degrading to patients but also flawed; the students were left more or less in the dark, never knowing if they were inflicting pain or even palpating the right structure.
Alternating as subject and examiner in teams of two, the teaching associates demonstrated that pelvic exams never need be painful, unless there is pathology or the examiner is rough or untrained. A major portion of the discomfort felt by patients, it turned out, had been due to the inadequacy of training. Student trainees at Cornell got top grades from their toughest referees—the clinic patients—and the program caught on.
With the help of the Teaching Associates Program, Dr. Wallis documented the painlessness of downward (as opposed to painful upward) pressure on the uterus and emphasized the importance of language. Instead of frightening the patient by talk of speculum blades, she called them bills and preferred the term footrests to stirrups. Taking pains to warm the instrument before inserting it in the vagina, she acknowledged anxiety and discomfort and discounted the tendency some doctors have of “distracting” the patient with extraneous conversation during breast and pelvic exams. Most importantly, she taught that “ovaries are just as sensitive as testes: Nobody squeezes the testes, so why squeeze the ovaries!” At the request of male medical students, Dr. Wallis later added the teaching of male genital and rectal exams.
“Education works both ways,” Dr. Wallis firmly believes. “Doctors learn from patients, and patients learn from doctors.”
In 1989, following her tenure as president, she chaired AMWA’s Task Force on Women’s Health Curriculum. In that capacity, she developed an “Advanced Curriculum in Women’s Health” for physicians who take care of women and helped found the National Academy of Women’s Health Medical Education to oversee the infusion of the basic principles she had helped develop into medical school and postgraduate education. The curriculum targets the health challenges of women at different life phases from a multidisciplinary viewpoint.
Why Women’s Health?
Case in point: Intending to include a model form for physical exams in her “Textbook of Women’s Health,” Dr. Wallis discovered that the outline of the body used in hospital charts is a man’s body. “I had to redo the curves,” she smiles.
The differences are more than cosmetic. “Pain patterns of heart disease are frequently different in women,” Dr. Wallis points out, but classic cardiology has been concerned only with “the heart problems of the businessman in the prime of his life.”
While promoting the advancement of women’s health on the clinical and research front, she is opposed to establishing an independent specialty in the field. This, she believes, “would marginalize women’s care, drawing all those interested away from other specialties and allowing other physicians to leave it to the women’s health specialists...and not themselves feel the need to learn anything about women. I definitely don’t want women to receive second-class treatment.”
Support and Tribute
Encomia have come from many quarters. In 1986, with the financial support of grateful patients, Cornell established the Dr. Lila Wallis Distinguished Visiting Professorship in Women’s Health, the first of its kind in the country. AMWA saluted her in 1990 with its highest honor, the Elizabeth Blackwell Medal, and, more recently, established an annual Lila Wallis Award in Women’s Health. In 1994, she received the Georgeanna Seegar Jones Lifetime Achievement Award from the Society for Advancement of Women’s Health Research, Warner-Lambert, and the National Health Council. That same year she received the Woman of the Century Award from the Women’s Medical Association of New York City and was elevated to mastership in the American College of Physicians. The keynote address at the annual Women’s Health Program of the National Council on Women’s Health was named in her honor.
She is currently putting the finishing touches on a mass market book on women’s health over various life phases. Her goal is “to educate women to become their own doctors and to use physicians as their consultant.” When that’s done she will turn her attention to a variety of other book projects, including a fifth edition of “The Modern Breast & Pelvic Examinations, A Handbook for Health Professionals.”
Dr. Wallis continues to lecture worldwide and, though officially retired from private practice, still sees some of her old patients. “Teaching the patient how to take care of herself is one of my greatest joys.” Not one to stand still for long, she reflects on her life’s journey: “It’s not what happens to you that matters, but what you do with it.”