Unfortunately, we can make both errors of omission and commission. Errors of omission occur when we do not provide recommended care. Errors of commission occur when we do unnecessary care.
Sometimes, doing screening on everyone is easier than thinking. Apparently that is true for PAP smears. 10 Million Women Who Lack a Cervix Still Get Pap Tests
In their paper, published today in The Journal of the American Medical Association, Dr. Sirovich and her colleague, Dr. H. Gilbert Welch, analyzed national data on Pap testing and on hysterectomies over 10 years.
Not only are most women who have had hysterectomies having Pap tests, they found, but the proportion having them also held steady, at 68 percent, from 1992 to 2002. No professional organization recommends Pap tests for most women without a cervix.
The screening guidelines “either have not been heard or have been ignored,” the investigators wrote.
Sometimes, it is easier for physicians to do a “yearly” exam on all woman, without thinking. Many woman schedule this exam, and expect the PAP smear.
We need to educate both woman and their physicians to think prior to doing PAP smears. We need to do PAP smears when woman have had a hysterectomy for benign disease. We can also stop above the age of 65 when a woman has had 3 normal PAP smears. Most important we need to think.
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2 Responses to Overtesting
feeforservice medicinesucks
June 24th, 2004 at 8:27 am
This happens considerably less frequently in the UK. The number of useless tests doctors do/order in the US is astounding.
Where are they putting the brush ?
Do they report it as an endocervical sample ?
LOL
RGL
June 24th, 2004 at 9:02 pm
This is a classical example of mindless thinking, which reminds me of cult practitioners who do routine x-rays of patients on a part of the body regardless of what they come in for. We as physicians ought to do much better.