Posted by: notdeaddinosaur | June 5, 2013

Picking and Choosing

I find it fascinating to hear about the different things people are willing — and unwilling — to do for their health. A similar situation to this one occurred recently.

This time it was a woman insisting that she needed an annual pap test, while refusing mammography and continuing to smoke. At least her cholesterol was normal, and she wasn’t yet 50 (so I didn’t have to push colonoscopy). Still, I tried in vain to explain to her that pap tests look for cervical cancer, that cervical cancer is caused by human papilloma virus, without HPV she wasn’t going to get cancer, and that since she’d had normal paps every year for the last 20+ years, she really didn’t need one.

She was not pleased; meaning she continued to insist. What’s a poor old Dino to do?

On top of that, I’ve begun deferring the bimanual exam, and unpleasant component of the vaunted “Annual” that has been shown not to provide useful information in the asymptomatic patient. Again displeased, she insisted.

And yet she refused to avail herself of any of the myriad of smoking cessation options available to her at no cost (insurance programs, workplace programs, counseling from me, assorted pharmacotherapeutic options, etc.)

She also refused my offer of a mammogram prescription. I couldn’t even tempt her with an invitation to my office’s annual mammogram party (Bagels and Boobs). She was sure that lump we both felt wasn’t anything. It didn’t even hurt.

I sighed (while documenting out my ass, of course.)

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Responses

  1. So this is definitely probably a question for my gyno, and I’ll ask when I get my next pap, and I don’t expect any medical advice, but if you had a 23 year old patient who had an abnormal Pap smear at the age of 21 but tested negative for HPV would you still want them to get a pap once a year? I’m just curious.

  2. Oh, for goodness sake.

  3. […] of her recent blogs served up a hefty dose of reality check. I came home from the Engage Conference all filled with […]


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