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Re: PAP Smear after TAH From: Arthurfree@aol.com Wed Jan 1 13:55:59 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Arthurfree@aol.com: "Re: technical bulletins" Previous message: Arthurfree@aol.com: "Re: potential teratogenic exposures from sexual relations?" In a message dated 96-12-31 21:17:17 EST, you write: > >I report one case of ovarian cancer. What else did I find in my well >care follow-ups? Diabetes, hypertension, cancer of the breast on annual >mammograms, depression: there are many quality of life issues that are >hard to quantify. To construe the annual "pap" as only the search for >pelvic neoplasia is to sell our roles as medical professionals short. I >do not argue about the cost effectiveness of detecting one case of >neoplasia, my point is the pap brings the patient to the doctor in a >global sense for an evaluation of her health which goes beyond detecting >gynecologic neoplasia. Is this not part and parcel of primary care? > Ah, Harrison, You have identified yourself as a true primary care physician here. The original post kept referring to "Gyn prevention" and I almost replied there, because this is a small part of preventive medicine (note how few of the task force recommendations Bob listed relate to gyn, and note that those recommendations are population based screening for asymptomatic individuals - people with symptoms/complaints need intervention based on those, not just evidence based screening). One of the things we, as providers, do rather poorly is disease finding. Often the symptoms (depression is a good example) are there if we only ask, yet we depend on the patient knowing when a symptom is important enough to generate a complaint. (Strong potential role for computer based review of systems products here) You also identify the true conundrum of this subject. Women equate well woman care/screening with the pap smear. I continue to do (probably unnecessary) annual paps in healthy monogamous women with no history of dysplasia BECAUSE it is the hook that gets them in for the other interventions that do make sense. However, we should not equate the two, and explicitly realize when we are intervening based on common sense rather than evidence. Arthur Freeland, MD Warrensburg Missouri Next message: Arthurfree@aol.com: "Re: technical bulletins" Previous message: Arthurfree@aol.com: "Re: potential teratogenic exposures from sexual relations?"

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