Re: ASC-US
From: Larry Glazerman (l.glazerman@rcn.com)
Sat Sep 1 21:12:36 2007
I would have done the pap if she insisted, but I often tell patients
that a pap sooner than every 4-6 months is more likely to show
inflamation, related to healing from the prior pap, and will be
harder to interpret.
--
Larry R. Glazerman, MD, FACOG
St. Luke's Center for Advanced Gynecologic Care
250 Cetronia Road
Suite 305
Allentown PA 18104
484-223-3279
484-223-2830 FAX
glazerl@slhn.org
On Sep 1, 2007, at 9:44 PM, Rafael Haciski wrote:
> Pick your battles wisely - this is not a hill worth dying on.
>
> I would have explained to her that it is not medically necessary,
> and if she persisted, told her that the insurance may not pay for
> it, and that she may have to foot the bill. That usually stops
> all but the most intense, and then I do it. It's a free country.
>
> And in reality it is not the time interval that is important but
> the repeat look at the cells - PAP smear has a high "miss" rate,
> and the repeat PAP is what reduces that "miss" rate. Whether it is
> done a 3 months, or 4 months, or 6 is immaterial.
>
> I usually do follow up PAPs (for ASCUS, +HPV, L-SILs etc following
> colpo confirmation) q 3 months for a total of 4 - never had
> insurance problems.
>
> Rafael Haciski MD FACOG
> Anchor Health Centers GYN
> 800 Goodlette Rd #360
> 239-643-8780 office
> 239-571-0292 cell
> Naples, FL.
>
> On Sep 1, 2007, at 8:47 PM, 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?
>>
>> 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.
>>
>
