IGeL services Gynecologist What should be considered?

IGeL services at the gynecologist: what patients should pay attention to

04/03/2015

Ultrasound examinations of the ovaries or breasts, tests for sexually transmitted diseases or for the early detection of cancer: In the gynecologist women are offered many so-called individual health services (IGeL). Patients should weigh the benefits and risks of the chargeable services.

Paid extras at the gynecologist
If women go to the gynecologist, they are often confronted in practice with a long list of possible paid extras. Some examinations, such as for the early detection of cancer or tests for sexually transmitted diseases, are not covered by the statutory health insurance (SHI). If patients decide to do so, they will have to pay for these so-called individual health services (IGeL) themselves. As reported by the news agency dpa, Elisabeth Buchinger of the Independent Patient Counseling Germany (UPD) advises patients to inform themselves in advance what exactly is done during an examination and what benefits the examination can have.

Not to be persuaded to an investigation
Furthermore, it is important to include in the decision how well the method is tested, which risks are possible and what the consequences of the outcome are. For example, according to Buchinger, ultrasound scans, the most sought-after IGeL, reveal many harmless findings. This can cause uncertainty and lead to further investigations. The expert advises in general, not to be persuaded to an investigation. „It is always possible to get a second opinion from another doctor.“ IGeL are never urgent. It is essential that the patient ask for the costs before treatment and conclude a written treatment agreement with the doctor. Although the costs are calculated according to the fee scale for doctors, but may vary from doctor to doctor. Further help is provided by the IgeL Monitor, which evaluates the benefits and harms of self-payer benefits based on scientific studies.

No screening for ovarian cancer screening
For the ultrasound examination of the ovaries Christian Weymayr, project manager of the IGeL-monitor of the medical service of the top federation of the health insurances (MDS) explained that women have no use of it, if they examine their ovaries without concrete suspicion by ultrasound. The damage, on the other hand, can be massive if women are mistakenly treated as cancer patients by the investigation. According to a guideline of the Association of Scientific Medical Societies, the German Cancer Society and the German Cancer Aid, women with high risk should not conduct screening for the early detection of ovarian cancer, the report says.

Additional ultrasound examination makes sense for some women
According to Christian Albring from the professional association of gynecologists (BVF), it makes sense for women with high tissue density, in addition to mammography ultrasound to make a breast ultrasound. However, the IGeL monitor comes to an ambiguous conclusion for women with average tissue density who use ultrasound outside the age range of the mammography program or in addition to mammography as a standalone screening tool. As Weymayr explained, more tumors would be found at the ultrasound scan, but part of it would never have to be treated anyway. For the ThinPrep test (thin-film cytology) Albring said: „The ThinPrep test is not recommended by the Gynecologists' Association, as it does not show any better results than the conventional cytological examination.“ Thin cell cytology is the same as the traditional cell swab (Pap test) for early detection of cervical cancer in benefit and harm, Weymayr said. Therefore, the IGeL Monitor rates the ThinPrep test as unclear.

Positive HPV test with fatal impact
According to Albring, the test for human papilloma viruses (HPV), which are sexually transmitted and of which some types of viruses can contribute to the development of cervical cancer, is of no significance for women without a conspicuous cancer smear. On the one hand, a cervix disease can not be ruled out by a negative HPV test, and on the other hand over 90 percent of the infections heal without consequences. However, Albring warned that a positive test could be fatal: „The woman thinks she is very ill.“ A chlamydia test, which is an IGeL for women over the age of 25, recommends Albring if they have changing sexual partners. Because the infection does not trigger any symptoms, it usually would not be detected.

Tests for sexually transmitted diseases on specific occasion
Albring further stated that tests for sexually transmitted infections, such as HIV, syphilis and gonorrhea (gonorrhea) without disease symptoms outside of pregnancy, would make sense if a cause is to be assumed. In his opinion, hormone analyzes such as menopausal test and hormone status are pointless if the patient has no complaints and does not have to fight any changes in the body such as tiredness and sexual aversion. The problems that are found with the help of such tests are only in need of treatment if the patient suffers from complaints such as bleeding disorders and hot flashes. Whether with the gynecologist or with other doctors: since last year patients on the Internet portal www.igel-aerger.de the consumer center (VZ) North Rhine-Westphalia, have the opportunity to complain in connection with additional services. The VZ had pointed out at the start of the portal that physicians often do not adequately educate their patients about the costs and risks of such a service. (Ad)