OB-GYN-L Messages for September, 2007: Re: ASC-US

Re: ASC-US

From: FRANCES WREN

fwren@shaw.ca

Sun Sep 2 08:05:23 2007

often after I have explained my opinion...unless it is entirely unreasonable(not I hope my opinion...but their request)..then I will frequently comply with their request as graciously as possibly... saves my coronaries....and maybe my ass. and will frequently reassure the patient...???? frances wren

>----- Original Message -----
From: johnprov@sympatico.ca (Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.) Date: Sunday, September 2, 2007 4:24 am Subject: Re: ASC-US To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>

> At Sat, 1 Sep 2007, 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
> >____________________________________________________________________________
> >
> >--
> >____________________________________________________________________________
>
> >____________________________________________________________________________
> No brainer for me, I would repeat the PAP and not even bill my
> fee for
> it; then I would let her argue with the insurance company about
> the lab
> fee's. I can't see why she should not have a repeat PAP if
> she is
> willing to pay for it.
>
> --
> Take care, John
>

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<DIV>often after I have explained my opinion...unless it is entirely unreasonable(not I hope my opinion...but their request)..then I will frequently comply with their request as graciously as possibly...</DIV> <DIV>saves my coronaries....and maybe my ass.</DIV> <DIV>and will frequently reassure the patient...????</DIV>

><DIV>frances wren ----- Original Message ----- From: johnprov@sympatico.ca (Dr. John Provatopoulos  B.Sc. M.D.C.M. F.R.S.C.) Date: Sunday, September 2, 2007 4:24 am Subject: Re: ASC-US To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> > At Sat, 1 Sep 2007, 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. > > & ;gt; >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 > > > >-- > >____________________________________________________ > > No brainer for me, I would repeat the PAP and not even bill my > fee for > it; then I would let her argue with the insurance company about > the lab > fee's.  I can't see why she should not have a repeat PAP if > she is > willing to pay for it. > > -- >                                  Take care, John > </DIV>

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