Posted by: notdeaddinosaur | January 23, 2013

More Specialist Over-Reach

Why do you need to get a PSA to have a vasectomy?

Answer: you don’t. But if you want a vasectomy, you need a urologist. Urologists roll over in bed at night and murmur in their sleep, “Get a PSA.” The only way to set foot in the office of a urologist and not get an order for a PSA is to be a woman.

Then what? Your PSA is less than 1. You get your vasectomy. You recover from your procedure and get your two clean semen samples. Do you still need the urologist. No; not really. But what they say is, “Come back in a year with a PSA.”

This is how they rope you into a lifetime of urology “checkups”. This is what makes you think that what they do is primary care. It’s not. Urology is a surgical specialty. Healthy middle-aged men (ie those who tend to go for vasectomies) with no urinary symptoms DO NOT NEED TO SEE A UROLOGIST.


And don’t get me started on Gynecologists who keep getting women to come in every year for their “Annual”, including paps (which only need to be every 3-5 years after normals with negative HPV tests, and NEVER if you don’t have a cervix anymore) and bimanual exams, which have not been shown to provide useful information in the absence of symptoms.



From the comments: If all you have is a hammer…

My response: Then all you can do is order a PSA.



  1. Seriously? I’ll consider that another mark in favour of socialized medicine (Canadian style). My husband didn’t need a PSA for his vasectomy, and I’ve never had a pap done by anyone other than my family doctor. We’ve had several specialists tell us there was no need for further appointments or to do follow-up with our family doctor (for both of us and for our kids). I still see my pediatric oncologist, but that’s part of a long-term study, not out of necessity.

    Is it profit motive, job conservation, or “defensive medicine” at work? Or is it something else entirely?

  2. It gets worse: A friend of mine has a gynecologist who won’t give her a prescription for more than 6 months’ worth of birth control pills, forcing her to submit to office visits, pelvic exams, AND Pap smears twice a year. This is a woman in a stable, long-term monogamous relationship.

    I have finally convinced her that she is being thoroughly scammed so she’s looking for a new GYN.

  3. Well actually if your paps have been CIN 2 or worse and you’ve had a hysterectomy the recommendation if for screening every 3 years until 20 years have passed.

    Of course they are just guidelines, and patients don’t always fit into them. Just had a 20 year old 6 months ago who presented with a large cervical cancer. (of course I didn’t pap her, the health department did, and they sent her to me not because of the large lesion on her cervix, but because she had CIN 2 on her pap)

  4. HOWEVER, if the hysterectomy was for benign disease there is no need for PAPs after that. Ever, like never. That is also in the guidelines.

  5. If the only tool you have is a hammer…

  6. OK Dino Let me show you the otherside of the story:
    Patient of mine with a malignancy comes in friday (no active disease on adjuvant therapy) with a sys BP north of 200 off his meds. He is also off his BP meds, synthroid, statin, and everything else. Why? Because his NP left town and the FP overseeing the NP is not comfortable treating him due to, ” his new patient load” with this NP’s retirement. Personally I think this is patient abandoment. What did I do as not only an onc but given my previous life as an internist? I treated him, then put him back on his meds and I have now inherited yet another patient for primary care because the FP couldn’t do his DAMN JOB. I am on oncologist, but my “general medicine” patients are continually increasing because of this BS as quite a few FP’s have this moronic idea that once you have a cancer as a patient they are done with you. Next time you do my job and give chemo then well talk ok.

  7. @Anon 3:22: I agree that what you are describing constitutes abandonment, though more on the part of the NP. I also agree that just because you have cancer doesn’t mean you don’t need me anymore; hell, at the end, I’m the one trying to get the patient to at least ask why the onc keeps wanting to give him more and more chemo. I also agree that FPs should do their DAMN JOBS, though it really would be nice to get paid for it appropriately.

    None of which has anything to do with inappropriate screening tests by specialists.

  8. Dino
    It has everything to do with your constant bitchfest against specialists.
    PS: this might come as an utter shock to you but since I run an outreach clinic that accepts all comers, a large proportion of the PCPs who refuse medicaid make more than I do.

  9. Hee-hee, as a family doc, commited to decreasing unnecessary tests, I first thought PSA stood for Public Service Announcement, I got about half-way through and realized I was wrong!!

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