Re: Would love to have your medical opinions on this
From: Frances Wren (fwren@shaw.ca)
Fri Apr 18 11:57:27 2008
unless have GOOD reason to suspect molar chasnge or poss ectopic...no
reason..waste of $ I think
frances wren
>----- Original Message -----
From: "art fougner, md" <evsono@pipeline.com>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.obgyn.net>
Sent: Friday, April 18, 2008 6:16 AM
Subject: Re: Would love to have your medical opinions on this
> Is there ANY medical evidence favoring a practice of routine post-op
> HCG's after D&C for miscarriage? Anyone? Bueller?
>
> Art
>
> At Fri, 18 Apr 2008, Don Miller wrote:
>>
>>At Fri, 18 Apr 2008, Charles Bloom wrote:
>>
>>>Equating doing a $1 urine HCG at the time of a post-op visit for D&C with
>>>doing a chest x-ray is preposterous.
>>
>>An HCG done 26 years ago was not $1 (it may have cost more than a chest
>>x-ray). I would guess that the overwhelming majority of practices would
>>bill for such testing especially if sent to an outside lab (e.g. many
>>folks send out testing for Trich). Anyway, the comparison was not about
>>cost - the comparison was about routine testing, done without clinical
>>evidence or cost-benefit analysis, just because that is "what I've done
>>for 26 years."
>>
>>>Since it is part of the visit, I don't
>>>bill insurance so no red flags for that dollar.
>>>
>>>Benefits to me:
>>
>>Personally, I don't have a problem at all if physicians take the hit
>>themselves financially and do something for their own peace of mind
>>especially when the *first* test is non-invasive (urine HCG I presume).
>>
>>What I do have a problem with is the follow-up visits, follow-up testing
>>(serum HCGs?, ultrasounds?), and subsequent patient anxiety that results
>>when "pet" tests are performed and something is not quite right. The
>>costs of all of that when projected to 1 million spontaneous abortions
>>yearly in the U.S would be staggering.
>>
>>In the real world unfortunately, to patients, doctors who do extra
>>testing are considered "thorough" and "better" than those doctors who
>>choose to avoid such testing. That goodwill is often incentive enough
>>for some to continue unfounded practices.
>>
>>>Since
>>>no one has a given a good reason for not doing it, I'll continue with my
>>>current practice.
>>
>>I'm sure you will.
>>
>>--
>>Donald W. Miller, Jr., MD, FACOG
>>eNATAL, LLC
>>http://www.eNATAL.com
>>
>
> --
> art fougner, md
> "May The Wings of Liberty Never Lose a Feather." - Jack Burton
>
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