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Re: PAP Smear after TAHFrom: Robert J Woolley (wooll005@gold.tc.umn.edu)Tue Dec 31 16:02:10 1996
On Tue, 31 Dec 1996, Zach Newton wrote:
> The absence of an indication for Pap smear translating into the absence For the 75-year-old in question? I doubt that.
> laundry list of special
issues and appropriate assessment and management
> give justifiable cause to annual gyn evaluation by a qualified and The evidence does not support this assertion. The 1996 report of the US Preventive Services Task Force, using a strict evidence-based review, lists these preventive services for an asymptomatic, post-hyst., 75-year-old female: BP q 2 yrs height/weight at intervals of clinician's discretion annual fecal occult blood testing (which pt can do at home; digital exam not recommended) Snellen visual acuity screening, at intervals of clinician's discretion (given that most elderly need some eyewear, this would usually be done separately from a physician's office visit, in conjunction with q 1-2 yr optometrist visit, IMHO) periodic questioning (no exam) about hearing problems, interval at clinician's discretion quesitoning about EtOH use, interval not specified flu shot annually dT q 10 years pneumococcal vaccine once Then a raft of counseling as needed: HRT, diet, Ca++, exercise, injury prevention, etc., intervals not specified. Now, personally, if I had seen this woman a number of times for either preventive or episodic care, and knew her status re those counseling issues, I'd tell her to get a flu shot annually (probably with a nurse BP check simultaneously), call me prn, and enjoy life without pesky doctor's appointments while she can. (Caveat: if I had indication that she would feel endangered or neglected by this approach, I'd obviously offer to do whatever she needed to feel appropriately cared for, within reason.) What evidence do you have that this hypothetical patient would benefit from the "annual gyn health maintenance" visit you propose for her?
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