A patient recently sent me an article from the NY Times written by Jane Brody where she questions the value of the routine pelvic exam for women.
With Gynecologists increasingly refusing to see patients over 65 for routine checks due to Medicare reimbursement, and the lack of enthusiasm of women for this routine check, I think it’s worth considering.
On a routine physical for women, I do a pelvic exam mostly as a result of ‘habit’, having been taught as a medical student that every woman seen in the hospital must have an pelvic exam before the morning rounds with the attending physician. I remember having to do pelvic exams at 2 or 3am in the morning on women who were admitted to the hospital for routine matters or unrelated issues, such as pneumonia or other surgical issues, and how unhappy they were that we were wheeling them into the exam room at that early hour, for a pelvic exam. It seemed crazy to them, but they put up with it, because we told them it was ‘required’ by the hospital.
Over the years, the amount of real health issues I’ve fou
nd doing tens of thousands of exams is very little, in women without any problems. True, there have been some important findings, but the question is ‘is this the best use of our medical time and resources, particularly in this age of medical efficiency that we are trying to develop?’
Old habits die hard…so I will have problems forgetting my teachings and leaving my professors wisdom behind, but maybe there are still some new tricks left in me.