Dollars and Sense

One of our patients last week presented with a cervical lesion that was somewhat concerning on gross appearance; we told her to return the next afternoon for colposcopy (a colposocope being an instrument that permits a magnified visualization of the cervix).

Dr. Merisier was not overly worried following this subsequent exam, and at the time, I was somewhat surprised that he chose not to actually biopsy, as the woman had already returned and it was possible to do it right then and there. After all, with a biopsy, we could more or less definitely determine if the woman had a precancerous or cancerous lesion. Dr. Merisier explained, however, that although this is often done in the States, he would prefer to wait until the woman’s HPV status was known (for if she was negative, it was unlikely her given lesion was pathological/cancerous). His main reasoning: the patient would have to pay a considerable sum for this biopsy and there was no need to place such a financial burden on this patient unless it was clear the given procedure was truly necessary. Of course, cost effectiveness is important in the US too, but here, where the majority of individuals cannot afford routine healthcare, financial conservatism is of the essence.