Annals of Family Medicine -- Comments for Karasz et al., 1 (4) 196-202

QUICK SEARCH:

	Author:		Keyword(s):
Year:		Vol:		Page:

TRACK to:

Original Articles:
Alison Karasz, M. Diane McKee, and Krista Roybal
Women’s Experiences of Abnormal Cervical Cytology: Illness Representations, Care Processes, and Outcomes
Ann Fam Med 2003; 1: 196-202 [Abstract] [Full text] [PDF]

TRACK: Submit a comment to this article

Electronic letters published:

Pseudopathology in abnormal Pap smears: Joseph E Scherger (9 December 2003)

Much Needed Feedback: Lucy M. Candib (26 November 2003)

Pseudopathology in abnormal Pap smears 9 December 2003

Joseph E Scherger,
San Diego, CA, USA
Clinical Professor, University of California, San Diego
Send response to journal:
Re: Pseudopathology in abnormal Pap smears

The qualitative study by Karasz, et al, is a welcome warning about the potential for harm with mildly abnormal Pap smears. The impact of a disease label is well known. In a sexual organ, this effect must be magnified. Since a small percentage of mildly abnormal Pap smears have any real clinical significance, better specificity in testing is needed. The use of HPV testing methods will hopefully move us to a method in which healthy women are not victims of our screening.
Competing interests: None declared

Much Needed Feedback 26 November 2003

Lucy M. Candib,
Worcester, MA, USA
Family Physician, Family Health Center of Worcester and U-Mass Medical School
Send response to journal:
Re: Much Needed Feedback

This provocative article by Karasz, McKee, and Roybal challenges our assumptions that we understand our patients’ concerns and communicate well with them. These authors have demonstrated how rarely we inquire into patients’ systems of meaning or explanatory models and how little we recognize their distress over information we deliver. As busy clinicians, doing dozens of pap smears a week, we are unperturbed by mild abnormalities thus fail to recognize the impact of an abnormal reading on a patient. What is routine for us is not routine for the woman who hears that HER cells are abnormal. We forget that our assumptions about the meaning of tests and her assumptions about abnormal cells are very different, and we are not particularly effective at exploring her assumptions or clarifying our own. This work challenges us to scrutinize our own systems for giving patients abnormal results and to reexamine how we personally explain pap smear results and explore patients’ concerns.
Competing interests: None declared