After reviewing the development of 10 month old-child of Mrs. W, I was about to send her out of the office. My supervisor had given me the okay, and the child was fine. As I was about to lift my bottom off the chair, she fortuitously asked for the results of a recent pap smear test performed by the GP intern 4 weeks ago.

I pulled the results from her file. They were abnormal. As a student, I was a little confused as to where my responsibilities lie. How do I explain the results to her? Was this out of my scope? Should I be notifying the GP supervisor again? Fortunately I had been spending a lot of my time in the OBGYN wards at the local hospital and knew a little about the cervical cancer. Yet, I had not even performed a pap smear on a live woman before, nor had I attended any colposcopy sessions.

The results yielded an HSIL result, which stood for High grade Intraepithelial lesion (HSIL), which was what I divulged to her.

“What does it mean? Does this mean it is cancer?” was her initial response.

 The report went on to characterise the risk of CIN2/3 and the immediate need for colposcopic investigation. I reiterated what the pap smear was about, what it was looking at.

“This does not necessarily mean it is cancer. The pap smear picked up some abnormal cells in your cervix which may turn into cancer. We need to do a colposcopy to find out what exactly is going on.”

“What’s a colposcopy? Does it hurt? Do I need to be anaesthetised”

“Colposcopy is microscope that looks at your cervix. The doctor will apply some vinegar in there which will highlight any abnormal cells. This part shouldn’t cause any pain, just some discomfort.”

At that point, for some reason she felt less anxious about the whole situation. “As long as it is not cancer”, she said.

“I think it is important for you to follow this up with your regular GP to arrange for the colposcopy as soon as possible.”

 Her mother who was also in the room reassured her, saying that she had had the colposcopy done before.

As a student, I found it difficult to break this news and recall the risk of cancer in HSIL which required immediate colposcopy. I was unsure whether these changes were related to her recent pregnancy. I was in a situation that I didn’t want to be in, but decided to take that dive to help someone. I could have easily said that the results had not returned and to make an appointment with the GP to discuss them later.

In the end, I decided to cover myself with a disclaimer and reminded the patient that I was only a mere medical student, to not take my word as gospel but to confirm these findings at her next appointment.

I’m not sure how I handled this situation, given that in hindsight there is a high risk for CIN2/3 and a 1-2% risk of invasive cervical cancer on biopsy. I wasn’t sure whether I should have written out a referral for her. I did not know how immediate “immediate” was. Should I have contacted the GP about this? I think that maybe I should. What should one do when faced in a situation where a student has to divulge an abnormal test result for the first time – especially one that is of high impact?

In hindsight, perhaps I should’ve explained more about her risk of cancer. I failed to discuss the possible need for a cervical biopsy. I could have discussed with her the management plan. Did I really handle this situation satisfactorily? I felt like I left the patient with the impression that she had nothing to worry about, despite stressing that she should see a qualified doctor and not me, but at the same time I felt like I did all that I could.  She left the rooms, saying “as long as it’s not cancer, I’m glad to have met you”.  Perhaps it would have been wise to at least google HSIL and clarifying the facts before counselling her. Or even, to print out a colposcopy handout from the Royal Women’s web site to give to her. These were all things I had not thought about. After all, the consult was not even for her, it was for her son.

That night I asked myself the question, what if the Pap smear test revealed AIS (adenocarcinoma in situ)? Would I have handled the situation a little differently? I’m not sure. I still feel that fear of regret, in the case in which the colposcopy results come back with invasive cancer or if she forgets to make that crucial appointment. Until then, I won’t be able to find out.