Women’s Experiences of Abnormal Cervical Cytology: Illness Representations, Care Processes, and Outcomes

Alison Karasz; M. Diane McKee; Krista Roybal

doi:10.1370/afm.31

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Pseudopathology in abnormal Pap smears
Joseph E Scherger

Published on: 09 December 2003
Much Needed Feedback
Lucy M. Candib

Published on: 26 November 2003

Published on: (9 December 2003)
Page navigation anchor for Pseudopathology in abnormal Pap smears
Pseudopathology in abnormal Pap smears
Joseph E Scherger, San Diego, CA, USA
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 whi...
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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
Show Less

Competing Interests: None declared.
Published on: (26 November 2003)
Page navigation anchor for Much Needed Feedback
Much Needed Feedback
Lucy M. Candib, Worcester, MA, USA
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 abno...
Show More

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
Show Less

Competing Interests: None declared.