Clinicians not following breast cancer screening guidelines

Elias Peter pheski69 at GMAIL.COM
Sun May 21 18:38:15 UTC 2017


I’m not sure this is a problem.

The 40 yo average risk woman at her annual visit asks for a mammogram. I explain and document the explanation:
All tests have both potential harms and potential benefits.
Here are the potential benefits.
Here are the potential harms.
Do you have any questions?
If you want, we can schedule the mammogram. 
If she says yes, we schedule.
If she says no, I make sure she understands she can change her mind.
At the end of the visit, I give her a copy of the OV note documenting the above conversation.

This is an excellent example of how I used collaborative, out-loud decision-making coupled with real-time documentation, with shared office visit notes.

Peter Elias, MD


> On 2017.05.21, at 12:43 PM, Tommaso MD, Laura <ltommaso at NCH.ORG> wrote:
> 
> 
> Imagine a 40 year-old average risk pt presents and requests to get a mammogram. You tell her that it not the current recommendations of some of the governing bodies that set guidelines and the associated risks/benefits. She gets breast cancer at 42 and was found at a late stage.  She had asked you for the mammogram..
> From: Edward Winslow [edbjwinslow at GMAIL.COM]
> Sent: Saturday, May 20, 2017 7:08 PM
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> Subject: Re: [IMPROVEDX] Clinicians not following breast cancer screening guidelines
> 
> The Medscape article is fairly unbiased. 
> 
> One problem with our current guideline process is the plethora of guidelines available. The national guideline clearing house has between 32 and 52 sets of guidelines on breast cancer screening. While the USPSTF guidelines are probably the least biased, other well meaning people with or without any of several potential biases, may believe another set of guidelines. 
> Quis custodiet ipsos custodes? Literally translated from the Roman Poet Juvenal as "Who will guard the guards themselves". In this context I meant a more focused use of the concept. "Who will guide the guideline writers".
> 
> On Fri, May 19, 2017 at 11:36 AM Elizabeth Cohen <lesotholiz at gmail.com <mailto:lesotholiz at gmail.com>> wrote:
> http://www.medscape.com/viewarticle/878405#vp_2 <http://www.medscape.com/viewarticle/878405#vp_2>
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