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Re: PAP after TAH...new evidence (??) From: Howard Gelfand (hgelfand@pol.net) Sun May 31 06:00:29 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DoctorJoe@aol.com: "Re: GYN PAP after TAH...new evidence (??)" Previous message: Bernard Cristalli: "Re: OB: My case list..." I have all my patients return for yearly examinations including a PAP smear after a hysterectomy. The reason-there are many. First, as an Ob-Gyn we are probably the only doctors that woman is going to see in that year (if she is in good health). Second, most woman in my practice know what a PAP smear is-if I told them I was only going to perform "a digital exam" or a "pelvic exam" they might not fully understand the scope. But they all know a PAP smear means usually a complete exam also (including B/P and breast and urine screening etc.) (Don't ask me why-that's what I found). Also of importance is the cost factor. Most of my patients now are in an HMO or PPO or some other alphabet of "mis-managed care". The ICD-9 codes and the CPT codes all include the taking of PAP smear during the yearly exam-the coders for the insurance companies would not understand other codes coming from an Ob-Gyn. Also, the cost of a PAP smear to the individual company is probably negligible in the sch! eme of all costs medical. From a medical standpoint, a PAP smear can help asses the hormonal status of your patient- are her ovaries working and still producing estrogen (as an example). If she has been oophorectectomized and still shows a high estrogen level without exogenous estrogen, it can lead to further workup and possibly better care. If she presents without complaints, a PAP can still pick up a vaginitis, especially if she has a mild case of B.V. or early trichomoniasis or un-symptomatic candida (in the summer this is especially true- an early pickup of yeast can save a frantic emergency telephone call on a weekend after a long beach day etc.). I think that the articles sited are conclusions based purely on cost considerations. As physicians, sometimes we have to wonder at what cost will we continue to be led by accountants and pencil pushers instead of doing what might be right for our patients. If a PAP can be helpful in further care of our patients, and they do not cost very much, why not perform them routinely?? -- Howard G. Gelfand, M.D. Solo private practice Port Jeff Station,NY (still slugging it out!!) ------------------ Reply Separator -------------------- Originally From: avaldez@infolnk.net ------------------ Reply Separator -------------------- Subject: PAP after TAH...new evidence ------------------ Reply Separator -------------------- Date: 05/29/98 08:41pm Dear listmembers... Several months ago, I posted a question about your oppinions in getting pap smears in women after TAH for benign reasons...My position was that I don't found valuable to do that and I have a strong position to do that, and I asked for your opinions because I had some arguments for my colleagues here for that... As I remember, I found very different oppinions, pro and against that, and it didn't get so clear.. I want to ask again about some references I found... Accordin to the Guide to Clinical Preventive Services (US Preventive Services Task Force 2nd ed. W&W,1996) women who have undergone a hysterectomy for benign reasons do not benefit from PAP testing... Eaker,E., (Obstet Gynecol 1998;91:551) found that 58% of the women with a benign hysterectomy were still receiveng tests... We heard in that list disscution that some are doind that to prevent vaginal carcinoma, but...Pearce,K. (N Eng J Med 1996;335:1559) found that the prevalence of abnormal findings in PAP smears after TAH for benign reasons is extremely low...Fetters (JAMA 1996;275:940) concluded that there is insufficient evidence to recommend routine PAP smears in those women... So, in view of this evidence...Do you support to continue that guideline in PAP smear after a TAH for benign reasons, and why to do that... Thank yiou for your inputs to clear my dudes... Antonio Valdez_torres MD FACOG Hospital Guernika Ciudad Juarez, Chihuahua, MEXICO. Next message: DoctorJoe@aol.com: "Re: GYN PAP after TAH...new evidence (??)" Previous message: Bernard Cristalli: "Re: OB: My case list..."

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