Wednesday, November 25, 2009

Hair pulling

Are the new guidelines published by the task force. We now have multiple competing guidelines on mamms, worried patients, an avalanche of papers to read before I decide to change my practice (I am a thinking doctor, after all).

And buried deeply in the back of a practicing docs head...the knowledge that a missed breast cancer is a leading cause for lawsuits.

It adds up to one big, hot mess.

OTOH, I'm glad the pap smear guidelines got publicized. It makes sense not to do paps on teens. For years, I've been trying to avoid doing them. We know that the natural course of HPV is clearance in these young girls. Now if I can only convince people that they need a pap every 2 years. I've had an easy time with post-hysterectomy patients, they are thrilled to know that they don't need a pap.

I have to say, I'm sick of talking about it already. Reminds me of the HRT debacle back in 7/02, when those studies were published.


Megan said...

I think the reason people think they need a pap every year is because they want their bc script renewed and most dr's wont do that without a physical. I think some people assume the pap is actually part of the physical.

Grumpy, M.D. said...

A thinking doctor in a surgical subspecialty! That is so cool!

ER's Mom said...

Megan, a lot can happen in one year. You can develop new conditions or start taking new meds prescribed by someone else that preclude taking certain meds. A good doc wants to see you to refill your meds. I don't need to do a complete exam, but I do need to keep up with that's going on healthwise.

Plus, the feds don't allow for refills past a year.

And Grumpy, OB is a funny hybrid of primary care (the part I strongly dislike - I have a surgeon's personality) and surgery. It's like we're the bastard stepchild of the specialties. IM and surgeons don't respect us...until they have a pregnant patient!

Grumpy, M.D. said...

I'm teasing you, ma'am. Nobody respects your field more than I do.

Yes, you are at an odd cross of surgery and medicine, with a dash of peds tossed in.

And you do a damn good job!

Happy Thanksgiving.

Future OB/GYN said...

Would you still recommend having the first pelvic at age 18 or does that guideline now move to 21?

ER's Mom said...

21. I will test for STDs in sexually active teens, but you can do that with a urine screen, pelvic exam not needed. I will prescribe birth control without a pelvic.

I also place IUDs in teens (obviously needing to do a speculum exam there!). About 50% of my postpartum patients get an IUD, and I have a large teen patient population. The youngest one to get an IUD was 13.

Mary said...

I am 44 years old and had a hysterectomy two years ago. I'm still getting a pap from every dr that gets down there. I'm not sure what they are scraping because the cervix is long gone but they ARE scraping. I think I counted I have had 40+ in the past 25 years.

Anybody missing one could have one of mine. I would gladly have skipped a few of them.

Wick E. Scratch said...

Totally misunderstood the comment on the frequency on paps ... Thought you were going the route of making sure women get it done.

Either way, I wish I could do SOMETHING to get people to get them done (even if it is every year!) - My mom went 7(!!) years between them once.

I'll spare the sob story, because I'm sure you can tell where it is going ...