Assurance in Accuracy of Pap Smear and Diagnostic Laboratory Medicine at MDC

Carcinoma in-situ by Cytology of Cervix/Pap smearModerate to Severe Squamous Dysplasia (HSIL) of Cervical Tissue

Typically, when a patient visits a clinician for laboratory medicine evaluation, i.e. pap smear, cellular or tissue biopsy, blood or body fluid testing, the medical laboratory that receives the sample is relatively dependent on the clinical office staff, non-laboratory staff member at hospital, and/or physician for appropriate collection of test sample, accuracy of labeling  test sample as well as other  documentations regarding the test sample.  This level of dependency, which by the way loses credibility simply by being manipulated by multiple persons before testing, requires appropriate communication and documentation about the patient’s demographic, clinical information, and descriptive characteristics pertaining to the pap smear, cellular/tissue biopsy, or blood/body fluid sample submitted.  Often times this most important first-step in communication and documentation is compromised, leading to error and/or potentially harmful medical outcome for patients. Remember in general, “Quality and Accuracy in Laboratory Medicine Diagnosis” starts with appropriate communication and documentation before the sample reaches the medical laboratory for testing.

In our unique medical practice at MDC-Atlanta, we are able to essentially eliminate this potential compromise in patient care, because there is a direct complete medical evaluation/communication between the patient and the general practitioner/ laboratory medicine specialist at MDC, which assures accountability for appropriate therapy and management as well as  continuity of care.

For example during a pap smear evaluation, our physician directly interviews the patient regarding ALL pertinent clinical information.  This would include collecting information directly from the patient as it would relate to the patient’s gynecological history such as previous  pap smear result(s), previous or current gynecological diagnosis(es) and/or treatment(s), last menstrual period and its regularity or lack thereof, history of pregnancy, presence or absence of previous sexually transmitted diseases, other medical diagnoses,etc. Once a complete history is obtained, our physician provides a thorough clinical pelvic examination using standard medical procedures.  We also perform a bi-manual examination to palpate for abnormally enlarged ovary, uterus, or any other palpable abnormality. A swab sample of the vaginal canal, external and internal cervix is collected and appropriately smeared onto a glass slide, and prepared for immediate microscopic review of the cells collected for accurate diagnosis by our physician the same day while the patient wait. The most important component to this process, is that the physician collecting and reading the sample, can determine if the sample is adequate or representative of any abnormal changes during the clinical examination. We believe that a conventional pap smear is just as effective in detecting pertinent vaginal/cervical and even uterine lesions in some instances as the liquid-based pap examination; and this has been documented in the medical literature (JAMA. 2009;302(16):1757-1764).  Furthermore, a decision can be made along with the patient for further diagnostic testing as it relates to, for example, the necessity for Human Papilloma Virus (HPV) testing, or molecular testing or other diagnostic testing at the time of the initial clinical visit. Keep in mind if a Pap smear is within normal limits, then Human Papilloma Virus testing or any other additional tests may not be necessary.  In general, this process of having a laboratory medicine specialist directly evaluate the pap smear alone saves patients unnecessary expense as it relates to the pap testing and/or diagnosis.

Our physician routinely consults with associated, appropriately credentialed laboratory medicine physician consultant/specialist with respect to second review and/or second opinion to highlight our commitment to accuracy and quality diagnostic testing.

We are essentially able to minimize or eliminate false negative and/or false positive results from ANY CELLULAR OR TISSUE TESTING, through direct-patient care/evaluation by our physician.  This is the assurance that we give to our patients, and we provide immediate medical therapy and/or appropriately refer our patients in the proper direction for continuity of care as deemed necessary.

Saving patients hundreds of dollars as well as anxiety and frustration through direct-patient care by General Practitioner/ Laboratory Medicine Specialist!

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