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Cervical Cytology
An early approach to provide arrangements for a cervical cytology service
to 'well women' in the area was made. The Consultant Pathologist at Mile End
Hospital was able to make available trained technicians to 'read' the slides,
and additional provision was offered to local practitioners by St. Andrew's
Hospital, Bow. This is fortunate for the borough as one of the limiting factors
elsewhere has been the scarcity of such trained staff. Following discussions
with local doctors, and consultation with the Inner London Medical Committee an
agreeable working method was evolved. The policy of the department has been to
assist family doctors to provide the service for their own patients, and where
required to supplement this provision with sessions at our own clinics.
Equipment including cervical spatulae and aerosol fixative, slide containers and
record forms are made available to doctors wishing to take specimens in their
own surgeries. Initially, a local authority clinic session was commenced, on
alternate weeks, at two centres. Family doctors can refer patients direct, or
women may attend of their own volition. In addition to the taking of a smear
the doctor examines the breasts, and a specimen of urine is tested. At the same
time, opportunity is given to the woman to discuss other health matters, and
general advice on hygiene is given in this setting. Such an approach limits
the number able to be dealt with in a session. However, it is considered that
the criterion of utility depends less on quantitive factors than on the general
service now being presented and therefore not more than 12 or so persons per
session are seen. Reports from other areas of 50 women examined per session
are based on a smear examination scheme only. This can only ignore the many
other incidental findings which are revealed in the course of these examinations,
and by-pass the extremely important health education function that is possible.
All results, whether positive or negative, are sent to the family doctor.
Where a re-examination is called for, from whatever cause, a home visit is
made by the health visitor to explain the need for a further test. With
positive results, the general practitioner on being informed accepts full
responsibility for such further investigation of his patient as is required.
%
Subsequently,to facilitate attendance of women on the Isle of Dogs, arrangements
were made whereby a local general practitioner, also having a session as a
general practitioner obstetrician at our 'Island' clinic, could take specimens
from his own patients'able to attend this clinic. Some ancillary help is being
provided. Again, a pilot scheme has commenced with a general practitioner who
maintains a 'sex/age' register of his patients. This enables rapid delineation
of the names/addresses of patients known to be 'at risk'. A weekly afternoon
session is held at his surgery to which his patients are invited to attend by
letter sent from the health department. Clerical and nursing assistance is
provided by the department. It is hoped, after a suitable interval, to
evaluate the above methods i.e. direct work by the general practitioner(general
practitioner assisted by health department), general practitioner at local
authority clinic, and local authority clinic sessions.
7.