What Work Goes Into The Pap Smear

As to this file/page, you have been directed to & now @ Dr. Shaw's personal website

How often you have a Pap smear depends on your age, your sex habits, your family history of cancer in relatives, and your personal medical history, otherwise. It is YOUR responsibility to help yourself by knowing that you need disease-detecting health care, being knowledgeable about inheritance matters (does cancer "run" in your family?), showing up for scheduled appointments, and being truthful in answering your doctor's/nurse's questions. Society attempts to do its part by "recruiting" you to do these things through public school health education, friends talking among friends ("Have you had your Pap smear?"), awareness campaigns by organizations, and reminder notices from organizations or health care providers. The main purpose of the Pap smear is to detect pre-cancer before it becomes cancer AND/OR detect the cancer at a very early stage. You can greatly help yourself by making special efforts to be cooperative and provide current and accurate information. Here is how the work goes:
 

• Notification work (see above)
    
• Getting lined-up with a health-care provider (such as a doctor or clinic). Ask friends or coworkers about doctors/providers, check local phone books, search with the internet, or call your local hospital library.
    
• Scheduling your appointment (can take lots of calls, etc., to get the right time for you). You must initiate the request for an appointment.
    
• Provider work seeing you, the patient:
  
  providing a reasonably comfortable and private setting.
  
  providing adequate employees to help you.
  
  obtaining your information from you or maybe even previous providers.
  
  properly recording your information.
  
  maintain a reasonable & accurate charging & financial records system.
  
  filing, or assisting you with filing, insurance claim forms for office/clinic services.
  
  maintaining an office function for handling your financial dealings.
  
  maintain a reasonable medical records system.
     
• Provider work setting up and "taking" the Pap smear and doing the pelvic exam:
  
  maintain adequate purchased and already paid for supplies to provide services.
  
  provide qualified doctors/nurses to serve.
  
  expertly obtain a good uterine cervix sample!
  
  "prep" that sample as best as they can (proper sample smearing and spray-fixing or depositing into transport media).
  
  maintain a working relationship with a qualified pathology group (hopefully a "point of service type of relationship".
     
• Provider work dealing with pathology lab:
  
  provider office maintains relationship with lab via lab's pathologist, cytotech, or customer service rep.
  
  provider office maintains an in-office pick-up spot for lab courier (or, office mails or transports specimen to lab).
  
  provider office properly packages specimen to send to lab.
  
  provider office accurately fills out lab requisition:
  
   > transcribe/record accurate patient-identifying information so as to prevent mix-ups.
   > transcribe/record accurate medical details about the patient (note: this is often crucial for correct     claims filing to your greatest advantage...is it a diagnostic Pap or a routine Pap?) onto the requisition form.
  
  office supplies other info (maybe a copy of your insurance card) to help lab file favorable claims to your insurer for you.
     
• The lab's work:
  be excellently directed (medical director/pathologist and supervisor) so that high quality is delivered.
  
  be excellently staffed (doctors/pathologists, cytotechnologists, and others) so that high quality is delivered.
   
  seek and maintain certification (which includes adhering to Federal/government mandates) so that quality is indicated (certification, however is no guarantee AT ALL of quality).
   
  maintain an adequate medical records system.
   
  maintain an excellent quality assurance system.
   
  excellently receive specimens and accurately transcribe information into lab info system.
   
  excellently process, prep, stain, organize for screening, and file Pap smears.
   
  expertly screen the smears at microscopic magnification so that all areas of the smear are viewed & most cytotechnologists do this by moving around all areas of the slide by the "random meander" technique (not a robotic exactly repetitious movement as a machine could do.
   
  90% of screened Paps are "normals" which must be accurately "resulted" into lab info system.
   
  distribute screened non-normal cases to pathologist (trivial abnormals may be "resulted" by a senior cytotech/supervisor in some labs).
   
  10% of "normals/"trivial abnormals" to be diagnostically confirmed so by pathologist.
   
  retrieve cases from pathologists and enter their determinations into lab info system, including the CPT coding.
   
  assure issuance of an accurate, signed report.
   
  mail or courier the reports to the correct doctor's office.
   
  if subsequent cervix tissue biopsy comes in from provider as workup of an abnormal Pap, correlation information to be gotten with the case during processing.
   
  keep provider offices supplied with forms and specimen supplies.
   
  contract with a billing company or maintain an adequate billing system.
     
• Results notification by doctor's/provider's office:
   
  maintain a system that notes the Pap pathology reports arrival from the pathology lab.
   
  have a system in place of when & how notification takes place.
   
  attempt to notify (by patient's return visit, phone, e-mail, or snail mail) while maintaining patient's privacy.
     
• Follow-up activities:
   
  If Pap test is normal: advise as to time interval until next Pap.
   
  if Pap test is abnormal:
   
  > questionable/possible cancer/pre-cancer abnormality: start back above at setting an appointment.
  > other abnormality:
   
  - a need to repeat the specimen because it was less than optimal: start back above at setting an appointment.
   
  - discuss possible detection of infection or abnormal "germs"/viruses/bacteria/fungus/etc.: start back above at setting an appointment.
   
  - discuss possible detection of hormone problem: start back above at setting an appointment. 

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  (posted 30 Dec. 2000; latest addition 9 December 2006)