In 1994, our health department began serving as the primary care provider for thousands of patients who had previously only received public-health type services in our clinics. This switch to a “medical model” in our neighborhood clinics was quite a change not only for the patients but also for the staff, who were more accustomed to providing chronic disease follow-up and preventive care, and now were being asked to provide acute care/primary care as well.
Because of this change, I was now a public health nurse in a primary care setting, working with the physician who was trying to meet the women’s health needs as best he could. Not having done a lot of women’s health previously, he was somewhat disorganized in his visit sequence but usually covered all aspects of care in a thorough, professional manner.
This particular day, the physician was completing a visit with a new, elderly patient. In his usual quiet way, as the patient was preparing to leave the examining room, he said offhandedly, “Oh, Ms. R., would you like to have a Pap smear today?”
Ms. R. appeared surprised and a bit confused because she was already dressed, had received her prescriptions, and thought her appointment was over.
“Why, yes, Doctor, that would be nice,” the patient said.
“Ms. R., the Doctor is asking if you want your PAP SMEAR done today — your test for cancer of the womb. You would need to get undressed again for that test,” I tried to explain.
Ms. R. looked embarrassed and replied, “Oh, Doctor, I’m sorry. I thought you said PABST BEER! No, I don’t want a PAP SMEAR today, thank you.”
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