Risa B. Burns, MD, MPH; Jennifer E. Potter, MD; Hope A. Ricciotti, MD; Eileen E. Reynolds, MD
Acknowledgment: The authors thank the patient for sharing her story.
Grant Support: Beyond the Guidelines receives no external support.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1220.
Requests for Single Reprints: Risa B. Burns, MD, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, E/Yamins 102, 330 Brookline Avenue, Boston, MA 02215; e-mail, firstname.lastname@example.org.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Current Author Addresses: Drs. Burns, Potter, and Reynolds: Division of General Medicine and Primary Healthcare, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.
Dr. Ricciotti: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.
Pelvic examinations have historically been a part of regular preventive care. However, because women can now be screened for cervical cancer at intervals up to every 5 years, the question of whether women need to be seen annually for routine pelvic examinations has arisen. In July 2014, the American College of Physicians (ACP) issued a guideline presenting the available evidence on screening for pathologic conditions using pelvic examination in adult, asymptomatic women at average risk. The American College of Obstetricians and Gynecologists (ACOG) Committee on Gynecologic Practice had previously issued a committee opinion in August 2012 on the need for annual examinations and provided guidelines on important elements of this procedure, including when to examine asymptomatic women. ACOG reaffirmed its initial position after publication of the ACP guideline. The guidelines differ—the ACP guideline recommends against and the ACOG committee opinion recommends
in favor of routine annual pelvic examination. This paper summarizes a discussion between an internist and a gynecologist on how they would balance these recommendations in general and what they would suggest for an individual patient.
Beyond the Guidelines is an educational feature based on recent guidelines. Each one considers a patient who “falls between the cracks” of available evidence and for whom the optimal clinical course in unclear. Presented at Beth Israel Deaconess Medical Center (BIDMC) Grand Rounds, each conference reviews the background evidence and 2 experts then discuss the patient and field audience questions. Videos of the patient and conference, slides, and a CME/MOC activity accompany each article. For more information, visit www.annals.org/GrandRounds.
Series Editor, Annals: Deborah Cotton, MD, MPH
Series Editor, BIDMC: Risa B. Burns, MD, MPH
Series Assistant Editors: Eileen E. Reynolds, MD; Gerald W. Smetana, MD
This article is based on the Department of Medicine Grand Rounds conference held on 12 March 2015.
Moderator: Eileen E. Reynolds, MD
Discussants: Jennifer E. Potter, MD; Hope A. Ricciotti, MD
Patient Interview and Grand Rounds videos
Questions and comments
Table 1. Routine Pelvic Examination in Asymptomatic, Average-Risk Women Who Are Up to Date With Cervical Cancer Screening: An Evidence-Based Appraisal of Proposed Benefits
Table 2. Routine Pelvic Examination in Asymptomatic, Average-Risk Women Who Are Up to Date With Cervical Cancer Screening: An Evidence-Based Appraisal of Potential Harms
Table 3. Diagnostic Accuracy of Screening BME for Detection of Ovarian Cancer
Table 4. Summary of ACOG Recommendations* for Annual Pelvic Examination and Cervical Cancer Screening
Dr. Burns is a member of the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center and an Assistant Professor of Medicine at Harvard Medical School, Boston, Massachusetts.
Dr. Potter is Director of Women's Health Programs at Beth Israel Deaconess Medical Center and at Fenway Health and an Associate Professor of Medicine at the Harvard Medical School, Boston, Massachusetts.
Dr. Ricciotti is Chair and Residency Program Director in the Department of Obstetrics and Gynecology at Beth Israel Deaconess Medical Center, the Obstetrics and Gynecology Clerkship Committee Chair for Harvard Medical School, and an Associate Professor of Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School, Boston, Massachusetts.
Dr. Reynolds is Vice Chair for Education in the Department of Medicine at Beth Israel Deaconess Medical Center and an Associate Professor of Medicine at Harvard Medical School, Boston, Massachusetts.
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In this video, the patient, Ms. C, tells her story and is concerned about the potential change to her yearly examination schedule.
Eileen E. Reynolds, MD, moderates the Department of Medicine Grand Rounds conference held on 12 March 2015 at Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Ain Shams university, Faculty of medicine
October 6, 2015
Shall we retire other "classical" signs in the clinical examination ?
I would like to touch on another point that wasn't thoroughly discussed in the talk , which is the issue of the other physical findings in general examination , Many signs have low sensitivity and specificity when put to evidence, yet they are marked as classical.And the eponymous rare clinical signs like Duroziez sign, Corrigan;s pulse, Quincke's pulse....etc or even the heart murmurs that was proved to have a wide range of variability as proved by books like that of Dr Steven Mcgee "Evidence Based Clinical Diagnosis" and studies like "Eponyms and the diagnosis of aortic regurgitation" by Babu AN published in the annals at 2003.We still need to auscultate every patient thoroughly and examine very patient scrupulously attaining those signs and others even if they may be nonspecific and the investigations can provide a final diagnosis anyway.So why not do the same in the issue of BME ?? Tell the patient what we know and let her decide if she wants to have it done or not .I am talking from being in a developing country where women don't seek medical care regularly even when symptomatic and it seems logical that BME may provide a benefit .References:1)Babu AN, Kymes SM, Carpenter Fryer SM. Eponyms and the Diagnosis of Aortic Regurgitation: What Says the Evidence?. Ann Intern Med. 2003;138:736-742. doi:10.7326/0003-4819-138-9-200305060-000102)https://books.google.com.eg/books/about/Evidence_based_Physical_Diagnosis.html?id=rG5rAAAAMAAJ&redir_esc=y
Burns RB, Potter JE, Ricciotti HA, et al. Screening Pelvic Examinations in Adult Women: Grand Rounds Discussion From the Beth Israel Deaconess Medical Center. Ann Intern Med. 2015;163:537–547. doi: https://doi.org/10.7326/M15-1220
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Published: Ann Intern Med. 2015;163(7):537-547.
Cancer Screening/Prevention, Education and Training, Hematology/Oncology, Prevention/Screening.
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