Re: The lowly PAP smear...
From: art fougner, md (evsono@pipeline.com)
Mon Jul 24 08:08:58 2000
not quite Dan -
patient was informed re new technology which "might" be more efficacious
but not currently covered by insurance since data thus far inconclusive.
patient was informed of options and risks and benfits were explained.
following such a discussion, patient chose traditional smear.
sounds like reasonable informed consent discussion to me.
personally, in our neck of the woods, the clinical labs are so snake bit
that we are amidst an epidemic of ascus - we are unsure if this is a
true epidemic or cya by cyto labs.
so which truly is more cost-effective - to do thin prep or a gazillion
colposcopies? only time and data will tell.
stay tuned ...
art
At Mon, 24 Jul 2000, Braun, R. Daniel wrote:
>
>Same Lawyer: "Dr. Siegel, you beleive the Thinprep to be better than the
>standard Pap smear and you still did the standard Pap smear on Mrs. Jones
>only because she couldn't pay for it and now she is dying of cancer you
>could have prevented??????????
>
>Dr. Siegel: "XXXXXXXXXXXX"
>
>Dan
>
>R. Daniel Braun, MD FACOG
>Clinical Professor
>Department of Obstetrics and Gynecology
>Indiana U. School of Medicine
>Indianapolis, IN 46202
>
>OBGYN.net
>International Representative for United States
>
>Certified AllExperts Expert
>Check out my bio/ratings page!
>http://www.allexperts.com/displayExpert.asp?Expert=1236
>
>-----Original Message-----
>From: garrys@mindspring.ocm [mailto:garrys@mindspring.ocm]
>Sent: Sunday, July 23, 2000 7:39 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: The lowly PAP smear...
>
>At Sun, 23 Jul 2000, Braun, R. Daniel wrote:
>>
>> The minute that you hint that you think it is better, then you better DO
>it
>>not offer it on all patients.
>>
>>Dan
>
>Now, Dan, for the sake of discussion, let's agree that a Cadillac is
>"better" than a Chevy.
>
>Thus, I tell a patient that I think that the ThinPrep is better, but it
>may or will cost her more. She decides to get the regular pap. I can
>live with that and would defend it.
>
>In my other example, when a patient tells me "whatever you think," I'll
>live with my rationale to do a ThinPrep if she has something of note in
>her history, and to do a regular if she is pretty low risk. This would
>be harder to defend, I guess.
>
>I hear the points made that we have not shown to lessen cancer by doing
>Thins versus regulars. Interesting to put this together, as many
>patients will know about the ThinPrep even if we didn't give them a
>choice (already been there, done that). So, if you don't offer the
>choice, and someone gets cancer, how do you defend it?
>
>Mean lawyer--"Dr. Braun, in 2000 when Mrs. Litigious visited you, she
>asked for a new kind of pap smear. You explained to her that the old
>kind was sufficient, and thus your practice didn't offer the new kind.
>Now she is dying of horrible cancer that you could have prevented. Why
>didn't you offer the newer test she asked for?"
>
>Fine, upstanding Dr. Braun--"{please fill in the blank}"
>
>Garry ;)
>
>--
>Garry E. Siegel, M.D., F.A.C.O.G.
>Private Practice
>Roswell, GA
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
