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Re: The lowly PAP smear...From: Joanne Bulley, MD (jbulley@cheshire.net)Sun Jul 23 00:37:20 2000
At Sat, 22 Jul 2000, RModugno@aol.com wrote: > >In a message dated 7/22/00 4:20:55 PM Eastern Daylight Time, gklein@icsi.net >writes: > ><< we check the insurance and do thin prep when the insurance will authorize >it > -- > _______________________ > Geffrey H. Klein, MD >> > _______________________ > >What is your rationale for doing a medical test based on insurance coverage ? > >Robert Modugno MD MBA FACOG >Marietta, GA I Agree - either the test is indeed 'better' enough to justify doing - or it isn't. If it is only 'better' for those with insurance, then you are up a crick without a paddle. Our hospital - with discussion with the gyns's decided to go with the AccuPrep (the other brand...) and bought the equipment. So it is the standard and they have one cost for the pap - whichever method is sent. Cervical cytology is cervical cytology. Compared to the other costs the hospital eats, anything that is eaten here is more than covered by a single 'failure to diagnose cancer' suit... There are more costly things we can't imagine doing without that have little or no proven value - or high cost per life saved or iomproved. But times changed - so now we monitor everyone, ultrasound everyone, Rhogam twice or more in every pregnancy for Rh neg moms, triple screen everyone etc etc etc. Who has the data on the cost of all those triple screens, the MFM and genetic counselor consultations and tertiary level US and amnios etc per identified case. Have we TRULY made a difference? The pap gives us a bit more clear endpoint for the comparison and although it may offer no 'true' advantage for the reliable patient - I have seen reliable patients turn un-reliable due to sudden change in circumstances. These have included but are not limited to - moving and not finding a new doctor, an ill child (so mom doesn't go for care), struggling with her own diagnosis of Lou Gehrigs or MS and not doing the pap because she is ovewhelmed with the other diagnosis. In short - we don't know when there will be a sudden circumstance that results in the woman suddenly not getting a Pap for 3-5 years - so her LAST one was hopefully a very adequate ThinPrep... Even if full scientific EBM may not say it is essential...
-- Joanne Bulley, MD Keene, NH, USA
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