Jones et al stated that researchers and doctors should not harm patients and should work to help individual patients, not patients in general.1 In 2016, the Canadian Task Force on Preventive Health Care recommended not performing pelvic examinations in asymptomatic women. Dr Ladouceur proposes that discontinuing routine pelvic examinations “could ... have a negative and unexpected effect on physician competence—and, by extension, on women’s health.”2
A pelvic examination takes time, causes embarrassment and discomfort, and worst of all initiates the diagnostic cascade: if the doctor finds something, he or she feels compelled to order more tests, including biopsy. The likelihood that 2 pathologists will agree on the interpretation of a slide is 80%.3–7 This means that if a woman is diagnosed with ovarian cancer, there is a 20% chance that another pathologist would say that the patient does not have cancer.
Recently, a 65-year-old woman asked if I would consider helping her die. She has chronic pain from multiple vertebral fractures due to severe osteoporosis. When she was 26 years old she was found to have an ovarian cyst. The first 2 pathologists who studied the tissue were not sure what to call the pattern. The third pathologist said, “It’s cancer.” The patient had bilateral oophorectomy.
I agree with the recommendation of the Canadian Task Force on Preventive Health Care that we should not do pelvic examinations on asymptomatic women. If a doctor wants to maintain competence in a skill, the doctor should take a course in which the human participants know they are being used for training.
Acknowledgments
I thank Cliff Cornish and Valerie Dupuis of the library service of the Island Health Authority for finding the articles about the interobserver variability among pathologists.
Footnotes
Competing interests
None declared
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