Jack:
I am honored by your work and to be in your company. On the pelvic exam, my advice is to demand universal pelvic ultrasound training for family medicine and/or any specialty seeking early and accurate diagnosis of pelvic pathology. Even using q 6 m screening schedules and a physician with arachnodactyly, the pelvic exam does no better than chance in the prevention of death from pelvic cancers.
As usual I am still learning, but I find significant pelvic pathology every week. Yesterday, I documented an 8x7 cm ovarian mass whose presence was not reported by two physicians who performed pelvic exams in the last week. One of them was a gynecologist. She reported persistent pelvic pain which seemed different from her usual PMS. She was successfully having sexual relations 4-5 times a week. "Mild discomfort, but...."
In our first flex sig study, JFP 1984, the biggest percentage of patients in that study were patients whose symptoms had been overlooked or underemphasized. The line between screening and case finding is very fuzzy. We have agreed that these equipment advances could be the antidote to diagnostic helplessness IF the RRC demanded educational accountability.
The medical home would be more likely to make a difference if it was well equipped, and there was a requirement that some of its physicians do more than generic primary care.
As one of my patients told me, "Without the cow, you can't put the cheese on your chili dog". Yes, we speak redneck here in Tennessee. Meanwhile, Viva el NPI!
With best wishes for your professional success,
Wm. MacMillan Rodney MD, FAAFP, FACEP
Adjunct Professor of Family Medicine
American Board of Family Medicine Obstetrics
Chair, AcademicAffairs
Medicos para la Familia
Nashville, Memphis, and International
Index--pelvic exam, ultrasound, educational reform
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