Last week I was too appalled after an experience to write in a nice, polite manner. Ladies, you are all familiar with the wonderful pelvic exam. Now, I made a conscious choice to not go to my primary care physician. I most definitely trust him, but he's one of those guys who is somewhat like an older brother to me. I just couldn't bring myself to assume the position with someone I tease, joke with, argue with, physically shove around and probably irritate. So… I asked around and chose to have the exam with an ob-gyn I had never met. The website looked like most any other and she was younger… it's a simple pelvic exam right? Mentally, I thought younger might be better.
I would like to think there has been a change in the medical world where evidence is valued and evidence assists in making clinical decisions. After the experience I had with a younger physician who focuses on a narrow scope of knowledge, I'm not so sure. So, to narrow the focus of my visit with her down even more – it was simply a visit to screen for cervical cancer and ovarian cancer, right? Well, things have changed over the years. As I'm sitting there naked, with just a cheap cotton gown between myself and her, she brings up the traditional aspect of the exam – the Papanicolaou (Pap) test – should be combined with the primary human papillomavirus (HPV) DNA screening. She stated the HPV screening would probably not be covered by insurance. Now, I don't let that kind of thing necessarily bother me and instead generally need additional information in order to make my own health decisions. Sadly, the physician wasn't able to provide me with the sensitivity, specificity or the likelihood ratios of the test. She also did a really, really poor job of describing the various clinical scenarios with various test results and how the test would assist in determining what might occur due to test results. She narrowed the value of the HPV screening down to one simple thing – if the HPV was negative, I would need no further screening for 3 years. Now, maybe it was surprising that I wanted specific evidence on the test… maybe it was surprising that I didn't want to fork out an additional $100 without having a clear rationale about the value that test would have for me personally… maybe she just didn't know the evidence of the test. I really don't know and… I didn't confront her at the time with my appall because while sitting on an examination table naked under a cotton gown, staring at a speculum and a pile of oozed lubricant on a gauze pad just didn't feel like the right time to question her lack of knowledge any further.
What about us? We work with people every day and make clinical decisions all the time. What do we base our decisions on? Do we have an attitude that the person has insurance benefits for physical therapy and physical therapy is cheaper and safer than surgery, injections or drugs, so why not have physical therapy intervention? Do we do our best to make clinical decisions taking into consideration the strength of the evidence for those decisions? Imagine if… imagine if you could have something at your fingertips to help you remember details. Something quick and dirty… something where you can pull the information quickly – maybe even right there in front of the patient. Guess what? There's an app for that! Yup… I wish the ob-gyn had something concrete and accurate to assist me in making a decision… physical therapists do!
So, the medical and physical therapy worlds are continually evolving. How you practice today, better not be how you practice in 10 years! What strategy do you have in place to assist you in evolving with the world?