Tuesday, February 22, 2005

More thoughts on screening

It is frustrating to me to hear women refer to "my annual," meaning their PAP smear and pelvic. I know of no reputable group that recommends annual PAP smears in low risk women, as most women are. The nurses with whom I work are generally in this group. Monogamous for many years, no history of positive PAP smears, no history of STD's, etc. But even these educated medical professionals are seduced by the routine of annual pelvic exams.

I asked an OB/GYN colleague what she recommended. She told me that she continues to do annual PAP's, even in low risk patients, even in post-hysterectomy patients, because, "That's the only way to get them to come in every year." Yeah, but for what? Why ask these women to come in every year? Why are you doing bimanuals in post-hysterectomy patients? What are you looking for? The answer is usually something about ovarian cancer. But no authority has recognized bimanual exams as effective screening tools for anything, let alone for ovarian cancer.

My patients would be amazed when I would try to educate them regarding the actual recommendations for these exams. Of course, some of them were skeptical and probably went elsewhere to get these tests. It's hard for me to practice EBM when some of my colleagues are ignoring the evidence and performing these unnecessary tests.