Re: Gyn: ASC-US
From: FRANCES WREN (fwren@shaw.ca)
Sat Sep 1 18:56:17 2007
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although I tend to colpo those...and then I feel obligated to act...treat etc...
I frequently think I should just follow these young women as often it will resolve within 2-3 years...
just have not quite had the courage to simply follow.
frances `wren Md Frcs
>----- Original Message -----
From: Rafael Haciski <haciski@earthlink.net>
Date: Friday, August 31, 2007 7:22 pm
Subject: Re: Gyn: ASC-US
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> Although I agree with your approach, I have heard others suggest
> a
> less intensive approach: serial PAPs to observe. In the younger
> and
> healthy female most of these will resolve on their own. But I
> like to
> CYA.
>
> I am intrigued by your office policy
> > I explained that due to insurance issues and office policy, we
> need to
> > have two separate appointments for her issues--one for the pap
> issue,> and another for the dyspareunia. They said, "No
> problem, we'll
> > reschedule a colposcopy."
> So you do not handle multiple problems?
> I routinely will evaluate several issues at one visit -- maybe
> that
> is why I have trouble making money :(
>
> Rafael Haciski MD FACOG
> Anchor Health Centers GYN
> 800 Goodlette Rd #360
> 239-643-8780 office
> 239-571-0292 cell
> Naples, FL.
>
> On Aug 31, 2007, at 9:40 PM, Garry E. Siegel, M.D. wrote:
>
> > 16 YO P0000 seen by CNM for annual in April, and the pap is
> ASC-US,
> > reflexed to HR HPV positive.
> >
> > Cancelled appointments, multiple calls--doesn't come in for
> follow-up.
> >
> > I sent a certified letter, and today she came in with her
> fiancee.
> > For
> > those of us who are parents, let's say that these two had more
> tattoos> and piercings than I think we would generally like to
> see in our own
> > children.
> >
> > So, after taking a history and explaining what was up with her pap,
> > etc., she said, "We want to bring up another issue. It
> hurts when we
> > have sex." The fiancee said, "Yeah, we only can have sex like
> once a
> > week."
> >
> > I explained that due to insurance issues and office policy, we
> need to
> > have two separate appointments for her issues--one for the pap
> issue,> and another for the dyspareunia. They said, "No
> problem, we'll
> > reschedule a colposcopy."
> >
> > So, I had to convince her that after 4 months of attempting to
> contact> her for an evaluation, that my opinion was that we
> needed to do
> > today's
> > colposcopy today, and she reluctantly agreed.
> >
> > It was pretty hard not get very "parental" on her, but I didn't.
> >
> > Garry
> >
> > --
> > Garry E. Siegel, M.D.
> > Private Practice
> > Roswell, GA
>
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<DIV>although I tend to colpo those...and then I feel obligated to act...treat etc...</DIV>
<DIV>I frequently think I should just follow these young women as often it will resolve within 2-3 years...</DIV>
<DIV>just have not quite had the courage to simply follow.</DIV>
<DIV>frances `wren Md Frcs</DIV>
<DIV> </DIV>
><DIV>----- Original Message -----<BR>From: Rafael Haciski <haciski@earthlink.net><BR>Date: Friday, August 31, 2007 7:22 pm<BR>Subject: Re: Gyn: ASC-US<BR>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net><BR><BR>> Although I agree with your approach, I have heard others suggest <BR>> a <BR>> less intensive approach: serial PAPs to observe. In the younger <BR>> and <BR>> healthy female most of these will resolve on their own. But I <BR>> like to <BR>> CYA.<BR>> <BR>> <BR>> I am intrigued by your office policy<BR>> > I explained that due to insurance issues and office policy, we <BR>> need to<BR>> > have two separate appointments for her issues--one for the pap <BR>> issue,> and another for the dyspareunia. They said, "No <BR>> problem, we'll<BR>> > reschedule a colposcopy."<BR>> So you do not handle multiple problems?<BR>> I routinely will evaluate several issues at one visit -- maybe <BR>> that <BR>> is why I have trouble making money :(<BR>> <BR>> <BR>> Rafael Haciski MD FACOG<BR>&
gt; Anchor Health Centers GYN<BR>> 800 Goodlette Rd #360<BR>> 239-643-8780 office<BR>> 239-571-0292 cell<BR>> Naples, FL.<BR>> <BR>> <BR>> On Aug 31, 2007, at 9:40 PM, Garry E. Siegel, M.D. wrote:<BR>> <BR>> > 16 YO P0000 seen by CNM for annual in April, and the pap is <BR>> ASC-US,<BR>> > reflexed to HR HPV positive.<BR>> ><BR>> > Cancelled appointments, multiple calls--doesn't come in for <BR>> follow-up.<BR>> ><BR>> > I sent a certified letter, and today she came in with her <BR>> fiancee. <BR>> > For<BR>> > those of us who are parents, let's say that these two had more <BR>> tattoos> and piercings than I think we would generally like to <BR>> see in our own<BR>> > children.<BR>> ><BR>> > So, after taking a history and explaining what was up with her pap,<BR>> > etc., she said, "We want to bring up another issue. It <BR>> hurts when we<BR>> > have sex." The fiancee said, "Yeah, we only can have sex like <BR>> once a<BR>
;> > week."<BR>> ><BR>> > I explained that due to insurance issues and office policy, we <BR>> need to<BR>> > have two separate appointments for her issues--one for the pap <BR>> issue,> and another for the dyspareunia. They said, "No <BR>> problem, we'll<BR>> > reschedule a colposcopy."<BR>> ><BR>> > So, I had to convince her that after 4 months of attempting to <BR>> contact> her for an evaluation, that my opinion was that we <BR>> needed to do <BR>> > today's<BR>> > colposcopy today, and she reluctantly agreed.<BR>> ><BR>> > It was pretty hard not get very "parental" on her, but I didn't.<BR>> ><BR>> > Garry<BR>> ><BR>> > --<BR>> > Garry E. Siegel, M.D.<BR>> > Private Practice<BR>> > Roswell, GA<BR>> <BR>> </DIV>
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