I recently attended a conference with the Florida Academy of Family Physicians which outlined several changes in the recommendations for pelvic exams, rectal exams, pap smears and whether or not to fast before obtaining blood work.
Pelvic exams have long been a part of medical practice but that is changing. Studies have not shown any evidence they are actually beneficial to the patient. This led the American College of Physicians to recommend against performing a screening pelvic examination in asymptomatic, non-pregnant, adult women. They further concluded that there are harms such as anxiety, overtreatment and procedural harms. It is important to come in yearly for physical exams mainly focusing on preventive care and treatment of existing conditions.
Routine pap smears are not recommended in patients under 21 years of age. Pap smears are recommended every three years between ages of 21 and 65. Of course, Pap smears would have to be done more frequently if there are abnormalities. Another option is to get a Pap smear and HPV test with the exam, every 5 years. This option is only recommended between the ages of 30 and 65. We have adapted this recommendation if patients so choose.
Another new recommendation is to omit the rectal exam on all patients of any age who don’t have any symptoms. This is because studies have not shown any benefit to the patient by performing rectal exams. Just like pelvic exams there are potential harms such as anxiety, over treatment and procedural harms. We also know some patients do not come in for physicals because they do not want the rectal exam. We give patients a choice of whether or not they want a rectal exam.
We no longer require fasting before obtaining your blood work. Certainly it would be reasonable for patients to fast before getting blood work. We have found that requiring a patient to fast frequently results in them never getting the blood work. It is inconvenient to have to make another trip just for blood work. The blood work can easily be interpreted based on whether or not you are fasting. Studies suggest by not insisting you have to be fasting for the blood work you’ll still get the health information you need and it will make it easier for you to get the test done. If patients prefer, they can get their blood work obtained several weeks prior to the appointment so we can go over the results during the physical exam.
These changes are fairly significant and we would like to give you a choice as to what you would prefer. We would be glad to discuss the new recommendations with you.
Karl Hempel, M.D.
Stacia Kutter Groll, MD