I did a "welcome to medicare" visit two weeks ago.
The woman came back yesterday for her pap smear. She came in the room laughing. "That sleep handout you gave me. It's so funny. We couldn't understand our kids sleeping until noon on the weekend when they were teens, but now we do. I'm sending it to my daughters."
"Really? I wrote it for a website and keep thinking I should rewrite it for clinic so it's not so sarcastic."
"No, it's funny. So much doctor stuff is boring. It's great to have something that makes me laugh."
"Well, good."
"I don't want to get a mammogram. Too much radiation."
"Well, mammograms have way less then CT scans and you can't walk by the emergency room with belly pain without getting a CT scan. I had to fight the ER once to keep them from doing a fifth one in a year on a patient. The nephrologist agreed."
I gave her the link to the US Preventative Task Force website, to read the evidence for and against mammograms herself. "I admit I am biased because my sister got breast cancer at 41."
I did a breast exam and the pap. "The mammogram can pick something up about a tenth the size that I can feel. We pick up stage 0 (carcinoma in situ), stage 1 and 2, and we used to only pick up stage 3 and 4."
"I'll think about it."
"I'm hoping the US Preventative Task Force is the most impartial, and at least they list their evidence. They now say that they can't tell the difference between doing a yearly mammogram and doing one every two years. The American Cancer Society had a fit, but that was the evidence based recommendation."
"Ok, thanks."
http://www.uspreventiveservicestaskforce.org/Page/Name/recommendations
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