This is the best and most thoughtful of the articles I have found on this interesting and important news item.
Efficient and effective delivery of health care is incredibly complicated. Doctors strive to provide a balance between over-testing and under-testing. You might think over-testing is not harmful, but it can be. First of all, it costs patients extra time and money, secondly it can cause unnecessary stress when further tests show that the first test results were simply a benign condition or in error.
"Dr. Westhoff and colleagues wrote in January 2011 in The Journal of Women’s Health, “Frequent routine bimanual examinations may partly explain why U.S. rates of ovarian cystectomy andhysterectomy are more than twice as high as rates in European countries, where the use of the pelvic examination is limited to symptomatic women.”"
Furthermore, requiring a pelvic exam every year, even when a pap smear is not necessary, or before a birth control pill prescription can be written, can serve as a barrier to people who have fear or embarrassment regarding this intimate exam. These patients either experience added stress and anxiety over the visits, or just will not go at all, even forgoing obtaining birth control pills.
The article concludes with a thoughtful reminder regarding how our doctors are compensated for their work. Rather than implying they want to do unnecessary exams to pad their pocketbooks, perhaps we should consider that the current system of paying per procedure rather than for the time they spend with their patients is neither efficient nor effective. This to me seems in away to be the crux of the issue because many of the responses from doctors which were favorable about continuing annual pelvic exams were really about the necessity of establishing a relationship of trust, and the opportunity to talk to their patients regularly about healthy lifestyles, before symptoms of illness are found.
http://well.blogs.nytimes.com/2013/04/29/an-exam-with-poor-results/
No comments:
Post a Comment