Life expectancy in America has increased some 30
years in the past century. It is estimated that 25 of those years
are attributable to public health measures such as sewers, immunizations,
cholesterol awareness, anti-smoking awareness, health department
measures, and Pap smears. Amazingly, Pap smears1 alone
are under intense and opportunistic malpractice pressure arising
from a long commercial lab history of "low balling" the
charge on Pap tests to doctors who then "mark up" the
charges to the patient, leading to a "Pap-mill-like" approach
to providing the service of smear preparation and "reading".
Some women were hurt by this and lawsuits followed. A small
industry arose which played on, and drummed up, the unreasonable
public expectation of zero-error performance on Pap smears. [societal adverse impact of lawsuits] And,
so-called expert witnesses were always able to discern negligence
in almost every case.
Therefore, in today's litigeous climate, the medical system MUST be almost overly sensitive to any Pap smear finding which seems (is visually interpreted) "not quite right"..."a little unusual"..."atypical"..."not quite normal"..."abnormal". That is, there is a shade of gray between "normal" and "abnormal". In the 1970s, that gray zone was considered trivial and was diagnosed as "class II Pap, probable inflammatory change". Today, if there is any finding which is not strictly "typical" (that is, it is "atypical"), then a decision is made to either (1) "follow" the patient or (2) reflexly determine...using residual lquid specimen from that Pap smear sample...the "HPV status" by doing an HPV test (there are a number of different ways to test).
Due to lawsuits, and as is happening with mammograms, an increasing number
of providers is electing to discontinue processing Pap smears.
Sadly, even though the Medicare program in all states has made
it illegal for doctors to mark up Pap smear charges (see above),
and even though some states have made "client billing" an
illegal activity for ANY Pap smear, it is still a common practice.
We are proud to say that most physicians practicing in Lexington
county do not do this! And, our lab does not provide Pap services
to any "client" under that "fee splitting" arrangement
(an unethical practice by American Medical Association...AMA...standards).
Also, a unique program has been created which
attempts to add some truth to the Pap litigation scene...the slides
from the plaintiff's case must be blindly reviewed in with other
normal and abnormal Paps (almost 100 cases have been submitted
to this as part of the legal proceedings of the case)1.
Check it out in the CAP Today1 archives on the
CAP web site and also see the guidelines policy in the advocacy
area of the CAP website.
file, 2 pages, general comments (by Dr.
Pap, ASCUS/SAUS, and reflex HPV
Pap CPT4 billing codes
schematic charts of factors involved
in Pap smears: [lab
the concept of "false
positive" and "false negative"
the WORK involved
in a life-saving test costing about what two & a half cartons
of cigarettes cost
(shoping for cigarette discounts.
the TYPE of Pap process: conventional
vs. thin-layer, liquid-based (ThinPrep
vs. SurePath [AutoCyte]) click on item #5 ...19 July 2001-present conclusions
how soon can you get results (the
issue of TAT)?
file, one page, about receiving an abnormal-Pap report (Dr.
- reactive change
(mildest cell abnormality)
- about the human papilloma virus
P. David Kearns, M.D., J. D. & R.
Marshall Austin, M. D., PhD., letters section of CAP Today,
August 2001 issue.
(posted Jan. 2001; update 2 July 2002; latest addition 14 August