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D. K. Ohrt, MD, MSM
Blue Cross and Blue Shield of Minnesota St Paul

JAMA. 1990;263(4):515-516.

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In Reply.—

Dr Keffer appropriately emphasizes a number of reimbursement issues relevant to quality. I agree and have clearly stated that adequate financing of diagnostic cytology is necessary. The clinician or the clinician's agent must negotiate quality back into the price.

Dr Neely is correct in stating that the American College of Obstetrics and Gynecology technical bulletin does not delineate a "treat and repeat approach" to a specific category of atypical Papanicolaou smears. A close reading of this document leaves much to the imagination. It clearly makes a recommendation for colposcopic evaluation of preinvasive cervical neoplasia, but nothing is spelled out regarding follow-up for the mild abnormalities, including inflammatory and regenerative processes and metaplasia. Such lesions are currently subject to discretion in clinical management. By inference and experience, I have interpreted the American College of Obstetrics and Gynecology's recommendation to mean that watchful waiting is the preferred course for most . . . [Full Text PDF of this Article]

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