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A Trip to the Gynec-ologist

January 14, 2013
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A friend of mine told me about her annual trip to the gynecologist (and no, I did not give her much of a hard time about this. I don’t want to repel too many friends as they make common personal health decisions).

She was feeling a little sick that day and asked the gynecologist to check her ears. The gyn’s first response was, “You could have rescheduled.” When my somewhat passive and polite friend persisted just a little for the gyn to check the non-gyn body parts, the gyn responded, “I’m a specialist. I don’t do that.”

Of course in the HMO/managed care era, the OB/Gyns tripped all over themselves claiming they were primary care physicians. As soon as the financial connection to that phrase vanished, so did their claims. They really have no interest in the non-gyn body parts.

The other pitiful part of this story is that even the American College of Gynecology supports Pap smears every 3 years in low risk women. The U.S. Preventive Services Task Force even says they could be spaced out to every 5 years if the HPV test is also negative. Yet ACOG still tells women to come in for an annual exam. I’m sure this recommendation is a little inertia/change difficulty, and a lot greed. There’s no evidence any other part of a pelvic exam is beneficial, except for some venereal disease screening in young women (which my friend is no longer, sadly).

Here’s a simple intervention to save money with no effect on health. Change insurance benefits so that a Pap smear is only covered every 3 years unless there are very clear high-risk indications, which few insured women have, and be sure to educate the members well about why the change is being made. The costs for this intervention would therefore decrease by about 66% with no measurable risk. Voila!

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2 Responses to A Trip to the Gynec-ologist

  1. Tracie Updike MD on January 14, 2013 at 9:18 pm

    Yes indeed! I have tried to explain to my older patients with hysterectomies for benign reason that a Pap smear every year is not necessary. The gyn tells my patients I don’t know what I am doing because I am a family doctor. I practice what I preach and most of the gyns I take care of do but get them to forego a payment for a well woman exam!, and then let’s don’t even talk about my Medicare patient who has had a colonoscopy every year for the last 12 years with no polyps but Medicare pays for it. Weird

  2. Robert Watkins on January 15, 2013 at 8:03 am

    Of course, if the gyn had diagnosed an acute problem and treated it, they wouldn’t have gotten paid for doing so (or would only have gotten paid after going through three levels of appeal).

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