Posted by: notdeaddinosaur | July 10, 2010

You Have Got to be Kidding Me!

From the American College of Obstetricians and Gynecologists (full text here):

The American College of Obstetricians and Gynecologists recommends that the first dedicated reproductive health visit take place between the ages of 13 years and 15 years. This visit will provide health guidance, screening, and preventive health care services and offers an excellent opportunity to begin a physician-patient relationship.

Oh, for fuck’s sake! This is right up there with the ENT’s recommendations about ear wax.

It’s not enough that they don’t follow their own recommendations for screening frequencies (pap tests every two years from age 21 to 29, then every three to five years; every GYN in town is still insisting on seeing everyone every year! And holding birth control pills hostage to boot!), but now they want to see teenagers?!? Just to talk, they insist. No, of course the visit won’t include an internal exam (though it does recommend “visual inspection” of breasts and genitalia “to assess development”), “unless the patient is symptomatic”, of course. I don’t know how you feel about it, but just assuming the lithotomy position feels pretty darned humiliating to me, not to mention to a teen who isn’t even sexually active. Holy shit!

Regular adult patients can’t get an appointment for a routine exam for six months out or more, but they continue to expand their “recommendations”? What the hell next? Go to the OB at age four to learn the facts of life?!?? Why don’t the urologists recommend that young males come to see them as teenagers as well? Don’t boys deserve health guidance for sexuality, contraception, prevention of STDs, and discussion of gender identity, not to mention their very own “physician-patient relationship” too?

This is one of the more egregious instances of specialists trying to usurp my scope of practice. They may think it makes sense in the context of highly specialized (and fragmented) care, where every body part has its own doctor. But all it leads to is spiraling health costs with absolutely NO improvement in actual medical care rendered.

ACOG, go back to researching home birth and let me take care of the teenagers for you. I’ll do my best to keep them from signing up for your OB clinic for another ten years or so.


Responses

  1. I’m the one who commented about this in response to Midwife With a Knife’s post about the death of FP.

    I wasn’t sexually active until my early 20s and managed just fine without an OB/GYN. As OB/GYNs are lousy PCPs, I see no need to see one anytime soon unless I’m having a problem related to my reproductive tract.

    I think this is an aggressive move by ACOG (an advocacy group for OB/GYNs, NOT their patients) with the sole purpose being financial. Get ’em in young so an OB/GYN can grab those “well woman” visit dollars, and heaven forbid a woman choose a midwife for childbirth (I don’t have a dog in that fight, as I am childless by choice.)

  2. ” And holding birth control pills hostage to boot!”
    Let the people say, Amen!

  3. You tell ’em. The world needs more dinosaurs like you!

  4. As someone in my late 20s, my gyn is basically my primary care doctor. I haven’t seen a FM/Internal Medicine doctor in a long time since I don’t go to them for colds.

    At my annual visit to my gyn, I can get my blood pressure checked, weight, lungs/heart listened to, a breast exam, and the pap. That is basically everything except for the blood test.

    But I completely agree with you that the 13-15 age is beyond ridiculous. There is going to be a lot of crying kids during the exam

  5. >>At my annual visit to my gyn… a breast exam, and the pap. That is basically everything except for the blood test.>>

    As #1 Dino already stated, the recommendation is for pap every 2 years, then every 3-5 years. Annual breast exams are no longer recommended, nor are annual “blood tests” for healthy 20-somethings.

    As I stated already: OB/GYNs make lousy PCPs. Unnecessary testing does not help the patient… that’s why it’s not recommended.

  6. @Hello:

    So your ob/gyn listens to your heart and lungs. How well do they understand what they’re hearing? Or would they just send you to a cardiologist if they heard a murmur? It’s great that they check your blood pressure, but what would they do if it started going up? Even if they did a blood test, do they know what to do with the results? Would they offer diet counseling for your LDL of 175?

    When was your last tetanus shot? Do they ask? Do they even stock it in their office? Do they know about Tdap, and do they talk to you about whooping cough? Perilously few of them even discuss it with their pregnant patients, and those are the ones who should be getting it to protect their babies.

    Like Anon said (twice), ob/gyns do lousy primary care. There are two reasons for this: first they’re trained as specialists. Second, their specialty (and therefore their training) is basically surgical. Just because they can get away with it for most healthy 20-somethings doesn’t make it right.

  7. notdeaddinosaur,

    Unfortunately, I have a non-thorough primary doctor as well. On my first visit, he didn’t even bother to ask me what shots I have received nor did he even palpate my abdominal area (sorry, my last experience with a primary doctor are with pediatric visits, so that’s what I remember from checkups). Actually, I’ve been to 3 different primary doctors and all 3 of them never asked me about my shot updates. I felt my gyn did a more thorough job as he’s an old school doctor. I am still on the hunt for a thorough primary doctor.

  8. “What the hell next? Go to the OB at age four to learn the facts of life?!??”

    No, they’ll revise their guidelines so that the first visit is 8-9 year olds to learn about menstruation.

    Eff-ing ridiculous.

  9. Overall, OBGYNs are not good PCPs in spite of their organization’s attempts to claim otherwise, and the good ones will tell you they’re not. The others attempt to treat depression, which they do very badly, measure cholesterol but then have no clue what to do with the results, and refer the rest to specialists when it’s something I could have taken care of. And not one of them in my area has a clue about vaccinating the new moms for Tdap. Wonder how the pediatricians are feeling about the new recommendations for the 13-15 year olds?

    s

  10. As an OB-Gyn, I hate ACOG, which explains why I dropped them.

    I AM NOT A PRIMARY CARE DOCTOR!!!! I was not in the least bit trained to deal with outpatient care…I don’t know (and quite frankly, don’t care to keep up) with all of the stuff that primary docs do. That isn’t to say PC isn’t important, it’s just not what made me happy in med school. I am a damn good surgeon and talented OB but I have no desire to do PC.

    As for holding OCPs hostage, I won’t write for any med without seeing you yearly. There can be changes in your history (including the woman a few months back who had a PE while traveling…and kept taking her OCPs after hospital discharge!). I’ll refill until your appointment, but I do need to check to see if your needs/history have changed.

    Anon2:23 – at my hospital, my department put Tdap on the routine PP orders. So all new moms get them. 😉

  11. >>As for holding OCPs hostage, I won’t write for any med without seeing you yearly. There can be changes in your history>>

    So, what does an annual visit entail?

  12. One more thought: If OB-Gyn’s can substitute for primary care physicians, they should be able to pass the Family Medicine or general Internal Medicine Board exams. Wanna bet what the pass rate would be?

  13. Ah, MM, I can only imagine. I don’t write any rx for anyone I haven’t seen in a year either, and that includes OCP. Like ER’s Mom, I will refill them until they get an appointment.

  14. Um… so dino, you think that you’re better at talking to teens about sex than a gynecologist? The recommendation originated in part because of increasing pregnancy and std rates in younger and younger ages. Sexually active teens still need regular STD screening, no matter what they think about the monogamy of their potential partner. I agree that in the absence of some sort of symptoms, nobody needs a pelvic exam until after they’ve been sexually active. However, they do need counseling on birth control methods and STD prevention. Whoever has the skills to provide that should be providing it.

    Are you suggesting that gyns should not be providing reproductive healthcare to young women of reproductive age or are you suggesting that you can do my job better than I can?

  15. @MWWAK:

    You are a subspecialty trained perinatologist with amazing skills. You are a specialist. Whether or not that counts as “providing reproductive healthcare to young women of reproductive age” is not, in fact, a given, ie, I’m not at all sure that speaking with NON-SEXUALLY ACTIVE 13-year-olds is indeed part of “your job” anymore. The question is whose job is it, and can it be done by more than one kind of doctor. I say yes, as can routine well-woman care, contraceptive counseling, STD screening, and even routine OB with appropriate attention to training, protocols, and backup.

  16. >>they do need counseling on birth control methods and STD prevention>>

    What brand of physician should be counseling sexually active young MEN on birth control methods and STD prevention, not to mention routinely screening this group for STDs? Urologists?

  17. In the case of counseling 13 year olds about STDs etc., I do believe a family physician is better person because of the relationship they have built with the patient. Family physicians are also accustomed to talking to 13 year olds. OB-Gyns are not and may not understand the different ways young teens communicate and what makes them tick.

    I can’t imagine being 13 and being sent to a *complete stranger* who, on the first meeting, asked me very personal questions and talked about STDs and birth control. Talk about weird!

  18. amen sister!

  19. @MWWAK

    My 13 year old daughter isn’t going anywhere near you. She has her primary care physician who is more than capable at discussing age appropriate health concerns with her. What makes you think that you know so much that your knowledge base trumps a relationship she has had with her physician since birth? What specific training did you receive in counseling early teens or is this knowledge hardwired into your brain and therefore inaccessible to the rest of us? You have some ego, I must say.

  20. […] for sure:  Dinosaur accuses the American College of Obstetrics and Gynecology of “usurping” primary care’s scope of practice with new guidelines recommending OB/GYN visits for younger teenagers; MD Whistleblower blows the […]

  21. I actually don’t see the *need* for anyone with healthy reproductive organs to see an OB. A good FP can do all the detection, and refer you an OB if you need a surgeon, which is really the only time you need them. If that is a preference, no problem. But it should not be a requirement.

    For low risk pregnancies, again, I see no reason for an OB. Some FPs catch babies, those that do usually enjoy it immensely and are excellent care givers. None of my FPs have been baby catchers, so I use midwives. (the one time I did not I SERIOUSLY regretted choosing an OB) I DO tend to get my well woman care from my midwives, but that is only because after catching a baby under the midwifery model, I have a great open relationship with them because we have spent so very much time together. This is my last belly bump, so once my military hubby moves again I will likely switch to getting well woman care with a good FP.

    Oh, and no fair distracting with Home Birth!! Most OBs really suck at research as well if the latest bit of statistically flawed drivel they produced is any indication…

    -A

  22. A lot of women prefer a GYN as primary. If a mom prefers one, why not have her daughter see her doc too once she’s reached an age where it’s appropriate. This isn’t about patient autonomy to you – it’s a turf battle – shame on you!

  23. @Nemo: A lot of people prefer to use the handle of a screwdriver instead of a hammer to pound in a nail. It sort of gets the job done, but that doesn’t make it the right tool. GYNs make lousy primary care physicians, even if women want them to function as one. It’s about patient care, not turf.


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