The College encounters inadequate screening for cervical cancer in a number of settings. It may be a complaint describing tragic circumstances—advanced cancer at diagnosis and a fatal outcome. Sometimes in the course of a practice investigation it comes to light that Pap smears were not being done.
The College acknowledges the challenge. Women naturally experience speculum examinations as invasive and uncomfortable. Many describe them as traumatic. Some may refuse to be examined by a male physician for religious or cultural reasons. Others may avoid screening because of a history of sexual trauma. Most women prefer a same-sex provider, but the College has received complaints alleging misconduct related to pelvic examinations even when the physician is female. Regardless of the reason for their reluctance, such women may avoid raising the issue of a Pap smear with their physician.
BC Cancer advises that: “The single most powerful motivator for women to be screened is an invitation or suggestion by her primary care provider.”
The College expects family physicians to ensure that eligible women are encouraged to access screening. Reasonable efforts must be made to accommodate women who are unwilling to be examined by their own physician. Passive advice to attend at a walk-in clinic or otherwise make their own arrangements would be considered inadequate in most cases. Registrants should actively address the issue by making formal arrangements with other physicians or clinics and offering to book appointments for their patients.
Cervical cancer screening is a foundational standard of care in family practice. Every family physician must have an approach tailored to the individuals and communities they serve. In the event of a complaint or practice review, the College would be critical of registrants who are not actively engaged in facilitating screening, as best they can, for the safety of their female patients.