Re: ASC-US
From: Joe (forcep@intercom.net)
Sat Sep 1 21:00:47 2007
You left out No. 4. Suggest she get another opinion. Personally, I don't
care for patients like her. Joe C
R. Berg wrote:
> Unfortunately, today, I had just the reverse problem.
>
> 5/07 pap, ASCUS, HR HPV *negative*
>
> Pt comes in 3 months later, c/o vague pelvic pain x 2 weeks. Exam
> completely unremarkable. She then asks for a repeat pap, based on the
> letter I sent her, suggesting that her slightly abnormal pap, although not
> concerning for dysplasia, should be followed up in 6 months.
>
> I declined to perform one, suggesting to her that a repeat in *6* months is
> probably overdoing it.
>
> She left the office (this is 4 days ago). Today, she calls me, *irate*, and
> tells me that it is her "legal right" and that it is my "legal obligation"
> to perform a repeat pap smear; furthermore, since she has celiac disease and
> that this condition is associated with lymphoma, and that her mother had an
> ovary removed for a nonmalignant condition she *needs* a repeat pap smear
> now, given that it is only 3 months less than the time I suggested for her
> to repeat the smear (I guess it's not really a "smear" anymore, more of a
> "stir" or "swish." Pap Swish doesn't really sound as clinical, I suppose).
> Again, I declined. She then informed me that her only recourse would be to
> contact her insurance company to demand that I repeat it. I told her that
> she can do what she feels necessary, but that her insurance company would
> likely agree with me, and, in any event, no matter what they said, I would
> not be repeating the test, as I do not feel that it is medically indicated.
>
> So should I have:
>
> 1) repeated the smear, coding 795.01, ASC-US on pap, just because she wanted
> one, or
>
> 2) repeated the smear, coding 300.02, generalized anxiety disorder or 300.7,
> hypochondriasis, or
>
> 3) stuck to (and keep sticking to) my guns?
>
> ____________________________________________________________________________
> ________
> ____________________________________________________________________________
> Robert E. Berg, MD
> And this affect me, how?
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E.
> Siegel, M.D.
> Sent: Friday, August 31, 2007 9:41 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Gyn: ASC-US
>
> 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.
>
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