Despite Physical Challenges, Oregon Family Physician Driven to Succeed

Battle With Chronic Disease Lends Perspective, Insight Into Work as Physician, Legislator

May 02, 2012 05:15 pm Matt Brown

Elizabeth Steiner Hayward, M.D., is one amazing woman. At the very least, she's a woman who does amazing things.

Call it a trifecta of accomplishments: First, Steiner Hayward is an associate professor in the Department of Family Medicine at Oregon Health & Science University (OHSU) in Portland, as well as associate director of faculty development for the department. She also serves as director of the Knight Cancer Institute Breast Health Education Program at OHSU. In her time at the university, Steiner Hayward has led extensive research on women's health and other family issues and has stepped up to volunteer at OHSU's Southwest Community Health Center clinic -- a safety net operation that serves the area's uninsured population. She also just finished up a term as president of the Oregon Academy of Family Physicians (OAFP).

Second, Steiner Hayward recently was appointed state senator from Oregon's 17th district. She won the seat after bypassing a sitting state representative who also sought the appointment. It all came down to a 5-4 decision, she said, with the final vote coming over the phone from a county commissioner who was, at the time, vacationing at the Panama Canal.

Third, Steiner Hayward is a wife and the mother of three girls, two of whom still live at home. An involved parent, she volunteers for the Girl Scouts and several local nonprofit boards, including that of the school her daughters attend.

But what really begins to define Steiner Hayward's story as amazing is that she does all of this while battling multiple sclerosis (MS). And she does it with a smile on her face.

story highlights

  • Family physician and Oregon Sen. Elizabeth Steiner Hayward, M.D., balances her work and family life with her chronic disease, multiple sclerosis (MS).
  • Steiner Hayward said her experience as an FP, as well as the lessons she has learned battling MS, make her a better legislator.
  • Individual responsibility is an important theme for FPs when building the patient-doctor relationship, as well as for lawmakers when considering health legislation.

Meeting the Diagnosis Head-on

Steiner Hayward received her preliminary MS diagnosis in October 1994, during her fourth week in medical practice and six weeks after getting married.

"It was a real problem for me because I was busy trying to get pregnant, so I had to make a decision because I couldn't take the drugs and continue on that path," she said. "So I decided I was cool with taking no medication, which turned out to be the right decision.

"I did get pregnant and had my daughter, and then I went three-and-a-half years without an episode."

On April 5, 1998 -- her 35th birthday -- Steiner Hayward's luck ran out.

"I had another issue that day, which meant I'd had two discrete episodes inside the allotted period of time," she told AAFP News Now. "So my doctor says, 'You have MS,' and I said, 'Shit!'"

The problem, Steiner Hayward said, was that she was going full throttle in her FP career and also was in the process of trying to get pregnant for the second time. At that point, she wasn't sure she should go without the drugs again.

"I was also headed to China for two-and-a-half weeks," she said. "So I tabled it and went on the trip, but it turns out I didn't have to think too hard, because I came back and realized I was already pregnant. So I had the baby and then consulted a neurologist about my options."

The subspecialist informed Steiner Hayward in no uncertain terms that she was going to start interferon therapy immediately and she would not be allowed to breastfeed.

But Steiner Hayward had other ideas.

"Breastfeeding protects against autoimmune disorders, and I have MS," she said, laughing and shaking her head. "So I did the research and told her I thought interferon was too big to get into breast milk and that I was going to go ahead and breastfeed.

"She, of course, thought I was crazy and told me I was not to do that. So I went out and found another neurologist who respected the fact that I was an FP and I knew what I was talking about, and he agreed that (breastfeeding) was OK."

Understanding Patients' Struggles

Although her irrepressible spirit and the unrelenting nature of her chronic disease have not always coexisted in harmony, Steiner Hayward said those struggles have served to inform her work and inflame her passion to be a better FP.

"There was a period where I had been in major denial about my MS -- not taking my drugs consistently because they made me feel so crappy -- and I crashed big time," she said. "I was out of work on leave from April 2001 until December 2002 trying to recover."

Thanks to an understanding department chair and some serious self-realization, Steiner Hayward said she was able to reorganize her life and find her passion again, landing a research grant that focused on clinical breast examinations and focusing more of her time and talents on teaching.

"Teaching is one of my true professional loves," she said. "It feeds my soul." The students Steiner Hayward works with apparently agree, honoring her and a number of her FP colleagues last June during the department's 21st Annual Family Medicine Student-Mentor Graduation Dinner.

It is that passion (along with the need to supplement the meager $22,000 salary Oregon state senators are paid) that propels Steiner Hayward to continue teaching at OHSU while also fulfilling her legislative responsibilities.

"I also want to keep doing some clinical work to stay connected to front-line medicine for all sorts of reasons," she said.

All of this juggling -- her work in the legislature, her career at OHSU, her family and the disease she confronts each day -- combine to create Steiner Hayward's unique point of view.

"I think any life experience we have allows us to come at things from another perspective," she said. "I have learned so much about balance and self-care and the challenges people with a chronic disease face when taking care of themselves."

In that sense, said Steiner Hayward, having MS can be considered a good thing because it has helped her better understand her patients' struggles.

"I, like a lot of physicians, am a pretty hard-driving person," she said. "But I am a little more realistic these days. I understand now that it is a never-ending battle and that people are going to have their up or down periods and that we, as doctors, need to help them manage through those times."

Entering the Political Scene

Steiner Hayward told AAFP News Now she decided to go into politics after a fruitful stint running external and legislative affairs for the OAFP for several years.

"We'd had some significant success with legislation targeted at improving access to primary care for Oregonians (student loan repayment and loan forgiveness, for example)," she said. "Ultimately, it became clear to me that people can't be healthy without being well-educated and having access to good food, transportation, living-wage jobs and so on.

"Therefore, when the opportunity to pursue this Senate seat came up, it seemed like a great way to be able to have a role in shaping all these other areas in Oregon. Additionally, of course, the possibility of being involved with health care reform at the legislative level during this really crucial time was incredibly exciting."

Steiner Hayward has been busy since joining the state senate, helping to pass several medically significant bills during the session. One, which Steiner Hayward co-carried, created the state's structure for coordinated care organizations, and a second established Oregon's health insurance exchange. The legislature also passed a bill to continue a major revamp of early childhood services, which will include direct and ancillary health care services.

Video: FP's Health Experience Informs Legislative Work  

Oregon Sen. Elizabeth Steiner Hayward, M.D., of Portland, talks with a local news anchor about four major bills the state legislature passed in its recently concluded session that dealt with health insurance reform, collaborative care organizations, education and foreclosure protection. As a family physician, Steiner Hayward lends a uniquely patient-centered perspective to politics in Oregon.

Never Stop Learning

Steiner Hayward credits much of her success as a legislator to the broad, multifaceted approach to handling health issues that being a family physician carries with it.

"(FPs) are lifelong learners," she explained. "There is always more to learn here (in the legislature), which is one of the things that I love about it. So this is why it works so well … there are little nuancey things you've got to learn, of course, but I've got the right training for this."

Her chronic disease also has played a role in shaping her political beliefs, said Steiner Hayward, particularly regarding the appropriate role of patients in their own health care. Personal responsibility plays a big part in dealing successfully with a health care problem at the individual level, just as it does at the societal level. That's a message FPs need to deliver when building strong relationships with patients, and it's one that legislators also need to focus on, she noted.

"We cannot fix everything with pills and procedures," she said. "We have to have engaged partners -- our patients have to be engaged partners -- so I have to be an engaged partner in my own health care."

If you are, or you know, an FP who -- despite a serious chronic illness -- carries on providing the kind of top-notch patient care, academic leadership, and/or passionate advocacy that exemplifies family medicine, won't you let us tell that story? Please contact AAFP News Now Online Editor Matt Brown to let us know of your interest.