Ladies – there is NOT an app for Women’s Health!
I was scheduled to get every woman’s favorite exam last week – the Pap Smear. To give you a little history, I was going because I had an abnormal exam a year ago – Atypical Squamous Cells of Undetermined Significance (ASCUS). In December 2014, I had an abnormal exam – Endocervical adenocarcinoma in situ (ACIS) – requiring a follow-up colposcopy biopsy for cervical cancer. If you have never had a colposcopy done, God bless you, as it is an even more invasive procedure than the pap smear and makes you feel like an endlessly nauseous and bleeding mess for a few hours.
In the midst of a global pandemic, securing a medical appointment is damn near impossible. However, my Reserve unit having been activated in support of the pandemic provided me a better opportunity to get one so I reluctantly but proactively scheduled it.
The day arrived. While I have had a few of these by now, it is not something that becomes “routine”- and certainly not for a woman like myself who has lived in 7 different places in the last 6 years. That means a different doctor every single time. There is absolutely nothing routine or comfortable about that. During one experience even, the doctor was using my exam as an opportunity to teach a medical student – how did I get so lucky to draw that short straw?! Nothing like being propped open and studied while the doctor explains the difference between light and dark colors of your cervix and vaginal wall….
Anyway, this new doctor walks in with a big smile on his face proclaiming to have great news for me. What could be greater news than, “You can relax now, exam over.” ?! He ecstatically informs me that I do not need an exam for 3 years…
I’m confused. Look, I wasn’t exactly looking forward to spreading my legs onto stirrups, being propped open with a metal or plastic speculum and getting cells scraped from my cervix with a cervical spatula and cytobrush, but I scheduled this appointment because I did in fact need one.
I question the doctor and his reply dumbfounds me, “I plugged your records into my “algorithm” and it said you were good to go for 3 years.”
You know that inherent trust you place in a physician because, you know, they have that medical degree? Well, it immediately took a hike. Flabbergasted, “Excuse me, your what?” Since when did we start making women’s health decisions via a technical algorithm on the computer?
“Here,” he says, “let me show you,” as he pulls out his PHONE and opens the application. Am I dissecting this situation correctly – did he just seriously pull out a phone with a women’s health application on it?! (Face Palm)
While it is loading he asks me to tell him why it is I thought I needed an exam. So I explained what I wrote above. Perplexed, he tells me he didn’t see these details in my records. (Face Palm #2) Well, no shit Sherlock, that is blatantly obvious. He brings up my records and asks me to watch him plug the information into his now loaded “algorithm” aka, app on his phone. Surprise, NOT– it comes back with a DIFFERENT result – jumping a level even – suggesting a repeat colposcopy biopsy – that more invasive, leave you a bleeding, nauseous mess procedure…
The doctor, himself shocked by the different result, informs me that while he is familiar with the procedure, he was not practiced enough to administer it. Well, you know what buddy, I decided 10 minutes ago that you were not coming anywhere near my ladyhood after you told me what my body didn’t need based off your scientifically fancy termed “algorithm” – the one you just clearly demonstrated you do not know how to effectively use. Unless of course your intention is to cause patients to effectively lose all faith in you as a practicing physician which in fact I have. You also did not prioritize my health enough to have paid any detailed attention to my records the first time you plugged my information into your apparently medical degree earned Android.
He proceeds to inform me that he will put in a referral for me to see a gynecologist but only after he plugs my records into his algorithm a THIRD time, WITH A COLLEAGUE, because he wanted to ensure he GOT IT RIGHT THIS TIME. My polite face has disappeared. Only those that really know me can imagine the facial expression and tone of voice I am giving and using on this “doctor” whose medical degree I now question.
Needless to say, I will never return. I also may have written a very thorough and telling medical satisfaction survey about my visit one statement iterating that medical accompaniment should be by that of a human brain and not an application that acts like those decision making storybooks each with a different ending dependent on the path you choose.
Diagnostic and treatment algorithms were designed to aid in clinical decision making. However, ladies, I implore you to not let a doctor use this and use this alone to diagnose you and tell you what it is you do or do not need. Be your own advocate! Question what is being told to you. Challenge the first opinion; seek a second if necessary. You know your body better than any doctor and certainly better than any phone app!
Cervical Cancer is detectable, preventable and treatable. When caught in the early stages, a woman has an 80% chance of beating it. Get tested because it’s the right thing to do. Don’t not get tested because some algorithm tells you not to – there is NOT an app for Women’s Health.
Or at least there shouldn’t be.