Is my ob-gyn scheduling this follow-up too soon?

November 14, 2017 2:29 AM

Is 3 months enough time to heal, or to let the abnormal cells possibly go back to normal, or to show a different result?

My recent test results show that I have CIN 1 / mild dysplasia. I did a bit of reading before my ob-gyn sat down with me to explain the test results and nothing in the conversation was different from what I read.

Except for her follow-up recommendations.

She wants me to go back in for a pap in 3 months (which she assumes will be abnormal) and in 6 months for a colposcopy. I read some research ranging from the last 1-9 years, and all recommendations point to a follow-up pap in 6-12 months, with maybe a colposcopy. But my doctor seems dead-set on scheduling the biopsy. She gave no other reason for her rationale other than "I'd like to do close monitoring." My results show negative results for the high-risk strains of HPV.

I get the sense that she's just trying to make some extra money from an unnecessary follow-up (or, in this case, a too-soon follow-up).

I plan to get a second opinion, but am not sure if I need to do another pap with a new doctor for that. Help?

posted by anonymous to Health & Fitness (5 answers total)

You should be able to have your records sent to another doctor for your visit about a second opinion. There's nothing wrong with a second opinion and with another pap, well, I'd personally be on the side of caution. If I understand, she just wants to get the colposcopy on the books right? Like, if your next pap IS clear, then you won't need that appointment. My GYN books out like 2 months, so if they schedule it, and don't need it then great! But if they don't schedule it, and the pap is more abnormal, then there might be a scheduling issue - especially if they only do certain procedures on certain days.

I'm sure there are others here with more experience but I have my own with abnormal paps.

Abnormal pap, colposcopy and biopsy a couple weeks later. (College campus clinic.) Results meant they recommended me for a LEEP about a month later. (Outside doc for that.) That appointment ended up just being a colposcopy as my body had healed in that first couple of months. Therefore it went from "You might need part of your cervix shaved off" to "Nah, Do another biopsy in 6 months" within the span of about a month.

Then back to my clinic for a follow up colposcopy and biopsy (second biopsy total) 6 months after that. That was still slightly abnormal, so another pap 6 months after that. That was slightly abnormal, so ANOTHER pap six months after that. That one was clear, then the past 3 have been clear. I'm due for another one (I should go yearly, but it's been about 18 months now. Technically the recommendation goes back to every 3 years since I've had clear ones.)

So, my initial stuff moved REALLY quickly. Though I think I had more severe dysplasia. Though, everything healed without major procedures and there was dramatic healing between my biopsy and my LEEP appointment. (I personally think the biopsy snipped out the worst of it.)

Overall, medical scheduling can be ... frustrating. I deal with chronic illness and have booked more tests/appointments than I can count. So, go ahead and schedule it. Unless they have some insane policy then you have the next few months to get another opinion and figure out what you should do according to those. But you can also ask your doctor WHY they want to book it out already, do another pap, etc. Then take what you will from their answer. You can advocate for yourself to get a stronger answer. And I totally get if you just don't trust this doctor and want a new one.

ETA on preview: Yes, a colposcopy is an exam with a camera sorta thing. A colposcopy with BIOPSY is a biopsy. They don't always do a biopsy.
posted by Crystalinne at 3:46 AM on November 14, 2017

Your doctor is trying to keep you healthy and alive. This is not a scam. If you want a second opinion, get one, but the notion that your doctor is setting up unnecessarily frequent screening of a patient who has shown concerning symptoms in order to make a few extra bucks is the least probable of all options.

I had a friend whose life was saved by her doctor in exactly this scenario. Her symptoms seemed to warrant the standard monitoring but the doc had a gut feeling, based on experience, that something more was needed, and they ended up discovering aggressive cancer at a stage early enough to be completely removed with surgery alone. When your whole life is on the line here, going in for some extra tests is really not ever the worst idea.
posted by something something at 5:03 AM on November 14, 2017

Different situation, but analogous to what others have said.

I was once experiencing some really unpleasant ongoing pelvic pain for months and months. I sought a second opinion. That doctor prescribed me a course of antibiotics in case of infection and ordered a CAT scan as well. The CAT scan came up negative and the abx mad no difference. She then referred to me to a specialist in pelvic pain. The specialist prescribed me another treatment while also booking me in for larascopic surgery where she was very clear if the treatment worked, the larascopic surgery wouldn't be necessary, but as scheduling was three months out for the surgery, if the treatment didn't work, I would need the surgery. But if it did work, then I just cancel the surgery and it frees up the spot for someone else.

A lot of follow up in medicine is differential diagnosis --- in trying to assess what is wrong, different things may need to be done, but some of those processes need to happen simultaneously for better outcomes.

But as others have said, you definitely need to ask your doctor more about WHY this course of action instead of a different one. It doesn't sound like a problem in treatment but a problem in communication. Doctors can be awful in clear communication.
posted by zizzle at 6:16 AM on November 14, 2017

The three-month followup is likely a safety measure: it's expected to be basically the same, but if it's notably worse, the rest of the plan changes.

It's possible the results were iffy enough that she wants the extra monitoring - not quite bad enough to set off the "fix now!!!" warning bells, but not on the mildest end, either. It's not like medical conditions come in neatly packaged "severity 1, 2, 3" structures.

Mild dysplasia means 1/3 of the cells viewed are abnormal. Moderate means 2/3 are abnormal. In between those levels is up to the doctor to label; if you had "more than 1/3, less than 1/2," she might want to do a bit of extra checking.
posted by ErisLordFreedom at 11:38 AM on November 14, 2017

I think the likeliest explanation is that if your pap smear is again abnormal and has worsened it might take longer than 3 months to get on the schedule for a colposcopy.

I saw my gyn in September, she decided I needed a hysteroscopy based on symptoms, and scheduled it for the end of November which is the soonest my doctor could see me. If that one November date hadn't worked for me her next available surgical appointment was in January.

Get it scheduled, it's easy to cancel if she thinks your circumstances have changed for the better after the next pap.
posted by lydhre at 11:47 AM on November 14, 2017