Patricia Robertson knew she wanted to be a doctor ever since she was a child. Not a nurse -- which is what young girls interested in medicine generally thought in the 1950s -- but a doctor.

"I didn't like needles," explains Robertson, a UCSF obstetrician and gynecologist. "I didn't want to become a nurse because nurses were the ones who gave shots in my pediatrician's office."

Unlike so many who have childhood dreams of becoming a doctor and don't act on them, Robertson continued to be avid about medicine in her teens. At the age of 13, she volunteered in the snack bar for visitors and staff at Texas Children's Hospital in Houston. "At that age, I wasn't permitted to go into the wards, so I would sneak into the galleries above the operating rooms with my candy-striper uniform on and watch Dr. Denton Cooley perform pediatric heart surgery, or walk over to the Baylor School of Medicine and watch them do experimental work on the artificial heart in cows."

After earning her bachelor's degree from Mount Holyoke College in Massachusetts, Robertson enrolled at the University of Texas Medical School at San Antonio in 1972. In those days, she says, there was an unspoken agreement among the medical schools to cap the number of women at 10 percent of the class. Given her early experiences and the expectations of the time, it would have been easy to imagine Robertson becoming either a pediatrician or a cardiac surgeon. Instead, Robertson chose ob-gyn -- in large part because of her medical school experiences, during which she saw teenagers dying in the hallways from botched, back-alley abortions.

Robertson also worked during medical school in a free clinic, which was housed in the office of a doctor who had died in prison from tuberculosis. The doctor had been jailed for doing safer, but still illegal, abortions. Further career confirmation came in Chile, where Robertson worked the summer after her first year of medical school. "I saw how the quality of women's lives and that of their families were improved by women's access to health care," Robertson says. Working with a pediatrician in Chile also dissuaded her from pediatrics. "I realized that if I wanted to have children of my own, I couldn't do pediatrics." Her reasoning: the joyful but chaotic and difficult realities of child rearing would be just too much to have both at the office and at home.

Changing a discipline

In 1976, Robertson came to UCSF for her ob-gyn residency, and then went into private practice in Santa Monica for five years. But the lure of teaching pulled her back to San Francisco. Indeed, not only does Robertson enjoy teaching, but she also sees it as an important tool. "There was so much in women's health care at that time that needed to be changed, and in private practice I felt I was affecting only a small group of patients. I wanted to have a broader influence by teaching students who would themselves enter into practice."

Robertson has gotten her wish. As director of medical student education in her department, she has helped to change the way ob-gyn is taught. She also is one of 22 founding members of the Academy of Medical Educators at UCSF. Wary of being too critical of past practices, Robertson is happy to see as well that the field of ob-gyn has become more sensitive to women's needs and more evidenced-based.

One of these needs -- managing high-risk pregnancies -- has become a Robertson specialty and the subject of a book she has written especially for women. She also recently published a study, with medical student Rachel Goldstein, assessing the neonatal risk of conception immediately after miscarriage. And she now has begun to study the cardiovascular effects of exercise in older pregnant women, in collaboration with her faculty colleagues in cardiology at UCSF. Not surprisingly, Robertson has a busy faculty practice in high-risk obstetrics, and she does outreach to hospitals that send high-risk pregnant women to UCSF for their delivery.

If that were not enough, Robertson has also made her mark on the otherwise unmet health care needs of lesbians. More than 20 years ago, she cofounded the Lyon-Martin Clinic for San Francisco lesbians. Her current emphasis is improving primary health care for lesbians. Part of that effort is to speak out to physician groups so that they understand the special health care needs of this population and to provide lesbians the same standard of care as other women. "I still hear horrible stories in which a doctor will either leave the room or make an inappropriate remark when a lesbian patient discloses her sexual orientation." Robertson, as codirector of the Center for Lesbian Health Research, is working with the faculty of the Center in the areas of access to care, treatment of depression, and prevention of substance use.

Robertson has still another opportunity to wield influence and change lives as well. As this year's chair of the Faculty Council in the School of Medicine, which represents 1,200 faculty members, Robertson is spending a good deal of time evaluating the options for UCSF's new hospital. "We have an incredible opportunity to shape the future of UCSF for the next decades by our decisions this next year." If the past is any guide, Robertson will be leading the way.