Q: I recently went to my OB/GYN for a six month follow-up after a hysterectomy. I saw a nurse practitioner who didn’t even know why I was there. We talked a little bit and she told me I had an abnormal Pap in April 2010. This is the first time I heard of it. I was shocked that no one had told me about it. She was surprised that my doctor hadn’t told me. She said I had dysplasia and then she rambled on about HPV and STDs.
I have been happily married for 25 years, by the way. I didn’t even know what to say as I listened to all of this. She then told me she wouldn’t examine me that day because insurance wouldn’t cover it, so I don’t have another appointment until next month.
I am very concerned about it so I called and said I wanted the doctor to read the pathology report and explain it to me. I was told a nurse would call me back. I haven’t heard anything from anyone. So, I called my GP and he did get back to me and said the nurse practitioner was wrong and she misread the pathology report. Now I don’t know what to do. All I know is that I am going to get a bill in the mail that I don’t want to pay because all the nurse practitioner did was cause me a lot of grief and sleepless nights. How do I handle this situation?
A: Let’s see if we can make some sense of this extremely distressing situation. Initially, your OB/GYN should have documented the results of your previous visit and Pap test results so when the nurse practitioner opened the chart, she would be updated immediately on the sequence of events. Second, the results of your Pap test should have been reported to you immediately on receipt of the information. While a medical professional might not get exercised over such reporting (or lack thereof), the individual who has the test done often waits by the phone or mailbox for the crucial results. I would certainly hope the physician and his staff aren’t so busy they simply file test results away without follow-through. That’s poor judgment and this was an egregious error. Then, if the results were interpreted as abnormal, your gynecologist should have been called in to report the findings or the nurse practitioner should have been told what to tell you. People make mistakes but it’s totally unprofessional for anyone to report abnormal findings because of a misinterpretation.
Dysplasia of the cervix simply indicates that abnormal cells were found; however, it doesn’t necessarily indicate the presence of cancer. Dysplasia can be mild or more severe and can disappear without treatment. It may never develop into cancer but in rare cases it can if treatment isn’t provided. The procedure a physician ordinarily follows with an abnormal Pap is to monitor the case for 6 to 12 months to determine if changes occur. He or she may also choose to order HPV testing. The presence of dysplasia in any form of severity will likely result in the recommendation of periodic Pap and HPV testing.
The questions here are do you really have dysplasia or is that part of the misinformation you received? Was there any indication of cancer? Was the HPB testing recommended because you to, indeed, have dysplasia? Why didn’t the nurse telephone you back, or better still, where was your gynecologist through all of this?
Quite frankly, either someone or several someones dropped the ball, or the office you are visiting is poorly run. Your gynecologist needs to be informed of what transpires under his or her direction and why you feel you cannot remain a member of the practice. Be sure to indicate you have no intention of paying for the visit that was full of misinformation. Then I would contact a new gynecologist and request all records be transferred. To be up front about it, you should briefly explain the concerns you were presented with and indicate it is extremely important you receive test results within an appropriate period of time. Break away now, you’ll be glad you did.
Other readers who are interested in related information can order Dr. Gott’s Health Report “Vaginal Infections and Disorders” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Reports, PO box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
