[Alison H.]

I saw an article over the weekend on NPR about the FDA approving the first at-home alternative to in-office pap smears (!!!) and immediately breathed a sigh of relief for women everywhere. Basically, you do the vaginal swab yourself and send it into the lab, sort of the same way Cologuard works for colon cancer screening.

The study they did before approval found the results of the at-home test to be "just as effective as that done in a doctor's office," which... blew my mind.

I'm a cervical cancer survivor (20 years, this August) so I'm like, freaking out at how excited I am for this to exist.

Would you prefer to do the self-screening at home if you could? Why or why not?

[Wednesday L.F.]

As a disabled person who doesn’t drive, this would be awesome.

[atskitty2]

I just went to the NPR article on it. I'm glad it is by prescription, so a professional will be overseeing this for now, and apparently "average risk" patients will have access. I hope that means high risk patients are done in person. As a nurse, I see so many issues with this. We generally have a health illiterate population, and I don't like this trend of sort of "hands off" health care. Telehealth has it's place, but there is no substitution for a hands on assessment by a physician. Patients staying away from their provider's office is not the way to educate and mitigate issues. I certainly hope that providers will still have high-risk women in the office for evaluation. I have had some women comment that they don't even know the difference in their holes...it worries me that we're further weakening the relationships we have with our patients. Yes, those patients are probably outliers, but they need adequate care and education. Maybe I'd feel better about that if the first one was done with the guidance of a doc or nurse, and then the following year a patient can do their own.

The other side of the coin tho', is we have a lack of physicians and providers to give this care. And mostly the ones we have are overbooked and stressed tf out. So, it's great that we have this option, but I fear it will just keep people away completely, when there are so many other things that occur during that appointment. I get a breast exam, we talk about hormones and sex, and other, general health items. When I was a younger woman, that appointment included all sorts of sexual health information. I have seen the same women's health NP for over 20 years now tho. I wish young women today had this sort of trusted relationship and bond with their providers. I think we need that more than ever.

[Alison H.]

I definitely see the worry as far as how well patients would be able to do this on their own at home to get accurate results, and I like the idea of having a doctor or nurse guide them through it the first time. I would think that high-risk patients will still be done in person (or at the very least, under a doctor's guidance closely). I have a feeling that these, like cologuard or others, will always be by prescription/doctor's order. (I don't think you can just order a cologuard without one? Hmm... not sure actually.)

I know women who have had rather traumatic pap smears/speculum exams... one of whom had her first one done in the ER by a male doctor who clearly should not have been doing them at all. But it scarred her for life. When I read that NPR article, she was the first person I texted.

I don't know that it should (or ever would) replace in-office paps, but there are definitely women who would benefit from being able to do it on their own, whether due to disability/mobility, trauma response, or something else. And apparently, at home tests are commonplace in other countries... I didn't know that. I haven't researched the efficacy vs. cervical cancer cases, but they've been around for a while now, surprisingly.

[atskitty2]

Funny you mentioned it - I did see the Cologard on the shelf at the Pharmacy just today. I think it was on sale for a whopping 12.99. I got my first screening colonoscopy in the past year, and I debated just doing Cologard, because the hospital that I worked in at the time, essentially does free ones for staff, but...seeing those folks in the halls and cafeteria was just a weird feeling to me. Nevertheless, I did it. I asked my GP's opinion on the Cologard instead, and got the standard, "it's available, but I wish patients would come to me".

It's a lot to unpack and so many details we can deep-dive on in our health care. As we all know, it's a dumpster fire and while I've only been in it a few years now, it does not seem to be moving in the right directions. As a patient, I've had the terrible experiences. Seeing it from this side just sends my head spinning.

No idea why your friend had a pap in the ED, but that's amongst the things we can do better. Poor judgement, poor technique, lack of sensitivity, etc. Curious if it was a physician? Could it have been an NP or PA? And that's another path of contention we can uncover.

I definitely have a sort of "ideal" in my mind, and maybe a "pie in the sky" hope for the delivery of health care. I was really lucky to work with some exceptional docs and mid-levels that laid a foundation for me and set a pretty high standard and expectation in my mind for providers. Not that other ways of doing things can't be great, but really high quality care is a much more narrow window, and I think that's what we should set as a goal.

[Alison H.]

It was a resident physician that did the ER pap (I took her to the hospital at like 3 in the morning because of heavy bleeding and clotting, like soaking a pad in 10 minutes kind of bleeding). And it was definitely poor technique and lack of sensitivity in her case; I was out in the hall for that part but heard all the details afterward.

I had a cologuard a couple of times; I did not know they could just be purchased at a store. Mine were doctor-prescribed, although my last one came back abnormal and I had to get a scope. Which was completely fine (and at least now I'm good for like 10 years!). I've heard the false-positives are pretty high on those...

But I absolutely agree with you too that quality of care matters, especially for things like this. If the quality was there, the sensitivity et al, people wouldn't seek to do it more comfortably at home... and that's the root of it, for sure.

I've had I don't know how many paps over the years (although mine have officially stopped, I believe... I had a radical hysterectomy for cervical cancer 20 years ago and at my last pap, I heard mention of recommendations changing for people like me and I don't think I'll be getting them anymore? Unless I misheard.)

[JonnyR]

Honestly? I'm all for "at-home" anything if it helps people be more proactive and take charge of their health.

I have family members who won't do ANYTHING proactive, no matter how smart or timely.

Bloodwork? Nope.

Teeth cleaning? What?

General checkup? Why?

So the less barriers to getting something that can screen, I say the better.

I am an exclusive user of telehealth -- it's awesome to get my meds filled, tests done, and things that I want that don't require me to visit anyone.

But when I have a more serious issue or need a specialist, you bet your butt I'm looking up the very best that I can find.

I'm just glad there's a new approach to this vs. only in person stuff.

I've used Cologuard, get regular bloodwork on my own, and love having those options.

We can't make people do the "right" things, but at least we can make it easier for them when they're open to doing them!

[Alison H.]

Yeah, there's definitely an accessibility factor with this kind of stuff. A LOT of people just flat-out refuse to go to doctors for any number of reasons (some related to the care/past care, or fear, or just... who knows). So at least if there are options for things that can be done outside of a doctor's office, it's better than nothing.

[atskitty2]

Alison H. It was a resident - say no more.

Being July and having a fresh crop of residents seeing patients, it is fresh in my mind how moronic some of these physicians can be. It's both frightening and sad, frustrating and then, there'll be one that gives me hope.

[Alison H.]

Alison H. It was a resident - say no more.

Being July and having a fresh crop of residents seeing patients, it is fresh in my mind how moronic some of these physicians can be. It's both frightening and sad, frustrating and then, there'll be one that gives me hope.

I can imagine. I know there's always *one* who keeps the torch lit with hope lol. I wish that had been the one she'd had. I left and stepped outside because she was stressed and afraid (and wanted me to wait in the hall, thinking it would help during the exam). And even though there was a female nurse in there, she was assisting and from what I understood, the resident doc was less than gentle despite being told it was her first time with a speculum and all that.

Scarred her for life, I think. The GOOD news at least is that she has an obgyn (woman) who gets it, and (probably unsurprisingly) deals with a lot of women who struggle with them.

And it's that kind of sensitivity that's needed during the process of care, for sure. It makes all the difference, especially with something that's *so* intimate.

I'm officially in the no-more-paps club as of this year (20 years post cervical cancer/no issues), but I never liked them. Definitely won't miss them.