Review of Dr. Sermons Dunwoody OBGYN

My 11 am appointment with Dr. Sermons.  

First of all I didn’t want an appointment.  I spent the last 10 years in Wisconsin and my doctor there made me come back every 5 years to keep my birth control prescription current.  Regardless this one required I come back in and despite not really having time to do wo I was there.

The first problem with the appointment itself was that the appointment was for 11am.  I was there 5-10 minutes early.  I wasn’t called back until 11:40.  At this point we are already at almost an hour of my day when I have much better things to do.

The second problem was that the nurse asked me to urinate in a cup.  I wasn’t expecting this and didn’t need to go to the bathroom.  I asked her why.  She gave me an unsatisfactory answer about checking for proteins.  I asked what relation that had to birth control and she said it was part of the well woman check that I was there for.  I objected. After all I’ve still not been given a satisfactory answer concerning the test.  The doctor interjected that the exam was a legal requirement for him to write me a refill for my birth control.  I found this to be interesting as I”d already heard this claim and had been unable to find any evidence to support it.  He refused to give me any details so that I could look at the law myself.  He didn’t even offer to answer my initial question about what they were testing for or how it actually related to birth control.  I went in the bathroom and tried to urinate in the cup as they were holding my birth control hostage and I felt I had no choice.  I failed, but I did try to comply.

Next he brought me 2 samples of the NUVA ring and told me I could go.  I told him I wanted my birth control.  He agreed to the exam and the nurse lead me to a room to undress.  I was taken aback.  The US Preventive Service Task Force did not find enough benefit to recommend annual pelvic exams when they did their study.  They also spoke of several other groups on their website:

Across various organizations, guidelines range from recommending against performing screening pelvic examinations to recommending that they be performed annually. The American College of Physicians recommends against performing screening pelvic examinations in asymptomatic, nonpregnant adult women.22 Based on the American College of Physicians’ review and recommendation, the American Academy of Family Physicians also concluded that performing screening pelvic examinations in asymptomatic, nonpregnant adult women is not recommended.23 The American College of Obstetricians and Gynecologists recommends performing pelvic examinations annually in all patients 21 years and older.24 While it found no evidence to support or refute the benefit of annual pelvic examination or speculum and bimanual examination in asymptomatic, low-risk patients, it concluded that the decision to perform a complete examination at the time of the periodic health examination should be a shared decision between the patient and clinician. The Well-Woman Task Force, convened by the American College of Obstetricians and Gynecologists in 2013, recommends that for women 21 years and older, external examination may be performed annually and that inclusion of speculum examination, bimanual examination, or both in otherwise healthy women should be a shared, informed decision between patient and clinician. The Well-Woman Task Force also recommends speculum examination and/or bimanual examination for asymptomatic patients with specific indications (eg, intrauterine device placement or cervical cancer screening).25( https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/gynecological-conditions-screening-with-the-pelvic-examination )

The strongest recommendation in there is a couple of organizations that say they think it should be done, but ultimately it should be a decision made jointly between the patient and the doctor.  Why then was I not consulted?  In fact not only was I not consulted, but when I complained about it being medically unnecessary I was told we were done and I could find a new doctor.  I had to leave without my prescription even though I was willing to submit to unnecessary testing to get it.  I just wasn’t willing to pretend to be happy about it.  

So what’s the big deal?  Why not just smile and pretend that you don't care?  Even better why not just not care?  

• This costs money.  Money that could be spent elsewhere.  
• It costs time.  Because i had this appointment on Wednesday I had to wait until Friday to take my car in for the new tires that I paid for last week and will be spending today driving on bald tires.
• I don’t like taking my clothes off on command
• The exam itself is uncomfortable
• From the same study I mentioned above:
•    A few studies reported on false-positive rates for ovarian cancer, ranging from 1.2% to 8.6%, and false-negative rates, ranging from 0% to 100%. Among women who had abnormal findings on pelvic examination, 5% to 36% went on to have surgery.4 Very few studies reported false-positive and false-negative rates for other gynecologic conditions.4 No studies quantified the amount of anxiety associated with screening pelvic examinations.4 ( https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/gynecological-conditions-screening-with-the-pelvic-examination )

Perhaps that isn’t a high rate of false positives leading to surgery, but when paired with the fact that studies show it is actually not very good at detecting cancer shouldn’t I get a say in whether or not I want this test.

Finally the question of what this has to do with birth control.  The answer is nothing.  I’ve had doctors in the past that it’s because birth control increases the chance of cancer and this is a cancer screen.  Of course they leave out the fact that it’s not a very effective one.  They also leave out the information on common false positives.  More than that according to the National Cancer institute both Ovarian Cancer and Endometrial cancer the risk goes down when on birth control.  There is a correlation effect concerning higher risk for Cervical Cancer in women that are on birth control and have high risk forms of HPV.( https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet )  Oregon and California have in fact gone so far as to pass a law allowing pharmasists to write prescriptions for birth control.  The  American Congress of Obstetricians and Gynecologists, only complaint in the article I read about this was to complain that it might slow down the process of making birth control truly over the counter.( https://www.nytimes.com/interactive/2016/01/04/health/birth-control-oregon-contraception.html )  That’s right The American Congress of Obstetricians and Gynecologists think that birth control should be an over the counter drug.  

Dr.  Sermons was not interested in all of this information though.  All he cared about was doing the pelvic exam and when I complained that it was unnecessary kicking me out of his office with a couple of samples and telling me to find another doctor.  I work in the food industry.  I did not take an oath concerning my customers.  I would however have lost my job if I treated a customer that way not matter how unreasonable I felt they were acting.