KAILUA KONA, HAWAII — Think of both ends of the fertility spectrum when advising women about preventing or treating cervical cancer, Kimberly D. Baker, J.D., said at a conference on obstetrics, gynecology, perinatal medicine, neonatology, and the law.
An increasing number of malpractice cases are being brought by teenagers who claim that no one adequately explained the risks of sexual activity and of avoiding Pap smears, said Ms. Baker, a defense lawyer in Seattle who also holds a bachelor's degree in nursing.
These adolescents lack an understanding of the threats that sexual activity and a lack of screening can pose to their bodies, their fertility, and even their lives if they contract a sexually transmitted disease. Physicians “are being too casual about this,” she said. “You need to document exactly what you said” in counseling the patient.
Explain things in terms that the teenager can understand, Ms. Baker said at the conference, which was sponsored by Boston University.
If a cervical lesion needs treatment, be sure to discuss the potential effects on fertility—especially when counseling young patients and older patients, she added. As more and more women delay childbearing, an increase in malpractice cases related to cervical cancer is being seen on the older end of the premenopausal age spectrum when treatment fails to protect fertility and the patient isn't warned of possible effects on fertility.
“Along with that, there needs to be a frank discussion about what is not available to them” if cervical cancer treatment affects fertility, she said. Without that discussion, women who cannot get pregnant may waste time, money, and energy on assisted reproductive technology that may not be appropriate for them.
If your “bedside manner” isn't the best, consider putting patients with cervical lesions in touch with a mental health care provider to provide support. Lack of rapport between patients and providers is a major contributor to lawsuits, Ms. Baker said.
Obstetricians need to keep in mind the whole health of the patient, not just the pregnancy, she added. In one case, a 22-year-old woman had Pap smears taken just before a pregnancy and in the first postpartum exam, but neither was followed up. She died of cervical cancer 18 months after giving birth to the child.
“While you're trying to be excited about the birth of her child and talking about contraception, weight loss, or whatever, be mindful” of conducting Pap smears and following up on results, she advised.