[NP-Clinical] (no subject)

[Sue Wiers]

I have been accused of being paternalistic on this list-serv.  Given that, I 
usually provide enough medication to meet the patient's needs until I think 
that something should be followed up on.  In my community, we are fortunate 
to have a couple of federally subsidized clinics to follow up on this type 
of issue.

Having said that, I am unaware of any medical contraindication to providing 
contraception in the presence of high-risk HPV (I do colposcopies and try to 
keep current).  If anyone has information to the contrary, I would be quite 
interested to read it.  I suspect that withholding contraception has more to 
do with assuring the patient has folllowed up with appropriate care rather 
than the contraception exacerbating the situation.

At a minimum, I would document with a letter to the patient (certified), 
indicating her PAP findings, implications, and worst case scenario (possible 
death from full blown carcinoma), the recommended actions (colp with 
biopsies), and indicate that this is your last attempt to reach her on this 
matter. That way, you have legally covered yourself if the patient should 
try to indicate that you had not fullly informed her of the implications.   
I would also make sure that the gynecologist's advice was documented on the 
chart - I am quite insistent about getting records directly from the 
provider.  You, of course, want to protect yourself against possible 
lawsuits, but also make sure that the patient understood the advice on the 
part of the gyn.

Too bad that such measure are required, but we do live in a litigious 
society.

Sue Wiers FNP



>From: "Rick/Laurel Webb" <webb at ohiohills.com>
>Reply-To: NP Clinical <np-clinical at nurse.net>
>To: "'NP Clinical'" <np-clinical at nurse.net>
>Subject: [NP-Clinical] (no subject)
>Date: Wed, 14 Feb 2007 18:58:15 -0500
>
>Hi all
>
>Fast question because I haven't been able to find answer online or in
>Contraceptive Technology.
>
>Is it contraindicated to give oral contraceptives or ortho evra to female
>with abnormal pap LSIL possibly high grade lesion.. She will not be having
>colpo or biopsy or hpv testing for about 6 months or more because of
>insurance issues.
>
>FYI: I have already counseled her about earlier treatment for abnormal pap
>etc but when I sent her to a gynecologist he told her treatment could wait
>for many years and refused to do it since she didn't have insurance, so I 
>am
>really more interested in concerns about use of birth control with the
>possibility that this abnormal pap.
>
>Laurel FNP
>
>
>


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