Saturday 26 July 2014

Pelvic exam

Whatever the liberals say, men and women are different, and that is nowhere clearer than in the "pelvic region" which is where "pelvic exams" are carried out.  It may seem like an absurd euphemism to refer to a process whereby a woman exposes her private parts to her doctor. But as a rectal exam is often carried out at the same time (while it is available), perhaps "pelvic exam" is the best title to cover an investigation of all the soft-tissue between the hips.  Doctors love inventing kit to make their jobs easier - stethoscopes for starters and they have to buy a speculum [R] to carry out a pelvic exam. As well as kit, doctors have a tendency to baby-talk to their patients - the Consultant Paediatrician we had occasion to visit ten years ago persisted in calling me The Dad. It wouldn't surprise me if some Ob/Gyn chaps say to their patients "I'm just going to put Daffy Duck up your wee-wee".  And did you know that they need a set of specula as well as a couch with stirrups? No, me neither.

It would not surprise you to hear that the tail gets to wag the dog. If the medico has all this gear, then he (it's still mostly he) is determined to use it; so vast numbers of, particularly American, women have for the last generation been subjected to regular, often annual, pelvic exams.  They justify this invasive procedure in the belief that they can detect asymptomatic infection and growths early and expedite their treatment. Well, the American College of Physicians has just issued new guidelines in the Annals of Internal Medicine to say that routine pelvic examinations are unnecessary if not counter-productive in normal asymptomatic healthy women.  In particular, the bi-manual (one in, one out) physical palpation of the uterus and ovaries is useless for early detection of ovarian cancer, although a pap-smear from the cervix may still have utility for detecting uterine tumours.  But a pap-smear is only recommended every 3-5 years rather annually and poking around "down there" leads to referrals to other specialists as benign masses get confirmed in their status as . . . benign masses.  Needless to say, it wasn't difficult to find a gynaecologist who found the new recommendations laughable. “We continue to urge women to visit their health care providers for annual visits, which play a valuable role in patient care” said John C. Jennings, MD, President of the American College of Obstetricians and Gynecologists, and that will be at least $125 each time, thank you. The average annual renumeration for gynecologists in the US is North of $200K.

We've seen similar turn-arounds on prostate palpation - last (and second) time I went for my M.O.T. with my G.P. he said he'd wield his proctological finger if I requested it but as it identified so many more false positives than true positives the current best practice was to rely on a test of prostate-specific antigen that would be carried out on the blood and urine samples that he took off me.  Same for routine mammograms where the detected tumours were just out-balanced by the new tumours induced by the X-rays send through millions of breasts.

Pelvic exam is held to be handy for detecting STIs like Chlamydia by the observation of a "strawberry cervix" despite the fact that only 2% of Chlamydia infections result in the inflammatory expansion of capillaries than give it a reddish glow.  Because they don't have a cervix, men are just asked for a urine sample. It's always structured easier for men.

In Ireland a fantastic amount of the annual budget (€13bn) is sent off to the department of health and every year they over-spend their allocation and rapaciously ask for more. Reducing the number of annual pelvic exams will reduce the number of Ob/Gyn blokes and they could be retrained to operate a comprehensive programme of preventive medicine.  For starters levering 8 year old children off the sofa to run 2 miles to go and buy cigarettes for their mothers.  The children are less likely to get obesity, diabetes and cardio-vascular insufficiency, the treatment of which consumes 70% of the healthcare budget AND their mothers will die earlier and be a shorter time on the pension.

1 comment:

  1. For men wishing to get a "feel" of what a pap smear process is like, think of jacking up a car to change the wheel. I have tried to advise the medical community that it would make the whole process easier if rather then telling women uselessly to relax before inserting said car jack, they issued a double gin and tonic, but as usual the patient is ignored.