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Re: Would love to have your medical opinions on thisFrom: Charles Bloom (cdsb@bellsouth.net)Fri Apr 18 17:09:40 2008
From: Don MillerSent: Friday, April 18, 2008 8:53 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Would love to have your medical opinions on this "(e.g. many folks send out testing for Trich)." I've never done that and don't personally know anyone who does. "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."" I gave the reasons why I've done this for 26 years. 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). Unless you're not even bothering to read my posts, you don't have to presume since I clearly stated in every post that it is a urine HCG that I run. 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. Since when is a UCG a "pet" test? And if the UCG is still positive after more than 4 weeks post D&C, something may very well be not right and warrants pursuing. Please tell us what the "staggering" cost would be for following up on the abnormally elevated UCGs. Do you even know how many that would be? My practice pattern has always been considered by payers as extremely cost-effective. I consider the cost, time, risk and inconvenience for every test and medication I order. Don, your baseless attacks on my running a urine HCG on the post-op D&C visit are unjustified and uncalled for. I'm not challenging anyone for not running one and no one else is challenging me for doing so. The original question asked what we all did and I stated my practice pattern, not what I believed to be the standard of care, and I gave my reasons. Me thinks thou doth protest too much.
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