VDRL or RPR
Hepatitis B surface antigen
Sickle cell prep or hemoglobin electrophoresis
Genetic screening (Quad screen) at 16 weeks
Early first trimester ultrasound for dating
Notez bien que s’il s’avère nécessaire de faire une visite à la salle d’urgence ou de subir des examens de laboratoire à l’hôpital avant l’accouchement, ce sera un coût supplémentaire.
This country made several attempts since after World War 1 to provide every American, regardless of income, access to health care. Finally, in 2010, President Obama signed into law the Affordable Care Act ( ACA ) which would aim to cover most of the 47 million uninsured.
The people of this country, the richest in the world, waited long enough. The only developed country without any health insurance with the metrics to show it. It spends 17.9 % of its GDP on the health of its nationals or $8,607.9 per person per year. Yet, it ranks among the lowest among the developed countries in terms of health metrics. (A table is included to illustrate this point. I have included Cuba to represent the poor countries.)
Country HC Spend 1 MD cont 2 Mort rate 3 Mater Mort 4
Cuba 429.8 (10%) 67.23 476 73
Canada 4520 (11%) 19.75 320 12
United States 8607 (17.9) 24.22 460 21
France 4085 (11.6) 34.47 360 8
World Health Organization Statistics 2011
1. Health care spending (percent of Gross domestic product GDP) 2.Doctor per 10,000 population 3.Mortality rate deaths per 100,000 population 4. Maternal mortality maternal
Furthermore, it has been estimated that the United States spends approximately one third of its health care dollars on care that is unnecessary and on care that is sometimes harmful. Most experts knowledgeable about this issue think that some 30,000 people die every year because of either medications given to them or surgeries performed on them that are not indicated.
Will the recent law (ACA) enacted by Congress and President Obama solved these problems? I doubt it, but it is a start. It will give millions the care they need to prevent suffering and premature deaths. But it is also to be expected that health care professionals will provide more unnecessary care whose cost society will have to assume.
One must keep in mind that more care does not mean better care. The politicians and the health care professionals will have to consider other means of delivery, improvement in the education of doctors, and the taming of the litigiousness of the American society; The Affordable Care Act is just the beginning.
First Do No Harm
I offer the full gamut of obstetrics and gynecologic services with respect, courtesy, and compassion. We give complete pre-natal care and manage all physical or psychological complications of pregnancies that were intended or accidental. We counsel our patients about contraception and make available to them all the safe contemporary options including Birth control pill, IUD’s (paragard and mirena), Implants( nexplanon), vaginal insert, and tubal ligation . I help my patients avoid unintended pregnancies. Knowing that no method is fail safe, we do not abandon our patients when they confront failures.
We resort to surgery only when all the conservative medical approaches have failed and only surgery will cure, relieve pain, or prolong life. And when surgery is necessary, I help patient make choices involving minimally invasive techniques that are safe, leave minimal scars, and have been proven to work in accordance with my philosophy. In other words, surgery must be needed, must work, and must be safe.
Most of the medical problems of women can be solved without major surgeries. That is the approach that people call Minimally Invasive Surgery. In our specialty there are two broad categories of minimally invasive techniques: Hysteroscopy and Laparoscopy.
Hysteroscopy– A small tube with a tiny light source and a camera, the size of a pencil, is introduced into the womb. My patient may be wide awake or may be put to sleep as desired. No cutting is involved. The cavity of the womb can be seen. Should any abnormal lesion be found, tumor, polyp, fibroid, or early changes of cancer, it can be rid of at the same time. Absent any complication, my patient can go home on the same day after a short observation.
The female problems that are can treated by hysteroscopy are:
Endometrial ablation which is burning the lining of the womb to completely stop the period.
Remove fibroid tumors inside the cavity of the womb.
Remove early changes in the lining of the womb ( Endometrial hyperplasia) that can lead to cancer.
Remove small growth inside the womb (polyp) that causes heavy and/or irregular vaginal bleeding.
Essure- technique used to tie the tubes.
Diagnostic hysteroscopy- just looking inside the womb to see what is causing the abnormal bleeding.
Laparoscopy– I make a 1/4 inch incision at the belly button and introduce again a small light source with a camera attached to it. All the organs of the abdomen and the pelvis can be seen including the womb, the tubes, and the ovaries. This is usually the way the tubes are tied and picture are taken to show my patient afterward. If there should be any abnormal finding such as endometriosis, fibroid, ovarian cyst, tumor, or scar tissue it is treated at the same time with the addition of one or two more 1/4 inch incisions. As after hysteroscopy referred to above, my patient can leave the office or the hospital after a short observation.
The female problems that can be treated by laparoscopy are:
Hysterectomy- removing the womb with or without the tubes and the ovaries
Removing ovarian tumors or cysts
Tubal ligation- tying the tubes to prevent future pregnancy
Treating ectopic pregnancy-removing pregnancy that has lodged in the fallopian tube.
Lysis of adhesions- removing scar tissue that is causing pain or infertility
Repairing the womb or the vagina that is falling out of the vagina.
Diagnosing the reason for infertility or to see whether the tubes are blocked.
Robotic Surgery– I have been trained in robotic surgery. In some occasions, this technique may be superior to plain laparoscopy.
Robotic surgery is the same as laparoscopy except that a million dollar robot holds the camera and
the instruments for cutting and retracting tissue. The surgeon is in the room sitting at a console to guide the robot.
It is more delicate and the movements are finer. Furthermore, the surgeon sees in three dimensions. Its takes
it takes much longer to do surgeries and it is two to three times more expensive than using just plain laparoscopy .
Is it for everybody? No. I help my patients navigate through these questions.Hospital Affiliations Memorial Miramar Hospital 1901 SW 172nd Avenue Miramar, Florida 33029 Memorial West Hospital 703 N Flamingo Rd Pembroke Pines, Florida Office Location Memorial Miramar Office 1951 SW 172nd Avenue, Suite 200 Miramar, Florida 33029 Tel. 954-600-3744 My staff and I are available on a 24-hour basis to make appointment. My patients and potential patients can talk to me any time; I care.
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We accept most insurance plans. Call the office for any question.
You and I are constantly bombarded with commercials urging us to have that Pap test or that PSA. Do you want to live? Don’t you want to live to see your grand kids? Every year, there are millions of Americans undergoing pap tests for cancer of the cervix, colonoscopy for colon cancer, chest x-ray for lung cancer and PSA for prostate cancer. It makes sense. If you catch cancers early, you can perhaps stop them in their tract and avoid death. It is just like everything else. Take care of small problems before they become big ones.
Cancer in general fits the category of a small problem that can be prevented from becoming a big one. lt starts as one cell that multiplies and grows. It encroaches on organs. It invades our blood vessels and spreads throughout the body to cause malfunction, suffering, and death.
In its early stage,that is at the begining and for some time, its presence evades our attention. We don’t see or feel it until it reaches a critical size. If we can detect it when it is small, the surgeon can cut it out with the knife or the medical oncologist can administer drug or radiation to exterminate it. And that is why screening seems important.
We undergo screening in order to detect disease before it is big enough to cause pain or other dysfunction in our body. Our technology affords us this opportunity. Our Pap smear displays the abnormal cells before there are enough of them to make the cervix bleed. The Ct scan will unearth any tumor as big as a pin head. The PSA test that the urologist uses to diagnose prostate cancer measures a marker, a chemical that indicates the presence of cancer, in the amount of one millionth of a gram. That is very impressive indeed.
The question of whether we have a Ct scan to detect lung cancer early, or pap smear to pick up cervical cancer in a curable state seems a no brainer. However we should all be very careful. The use of these tests have downsides. They can undoubtedly save lives. But some of these tests themselves have not been shown to do what they were designed to do. Furthermore, they can lead to a cascade of unnecessary testing with its associated cost, pain, and constant anxiety. Rarely, they can cause death, the very thing they were supposed to prevent or delay.
And why is that? A magazine article mentioned a few months ago the most important discoveries of the last few years. One of them involves the growth of cancer. We have found that some cancers are very aggressive. They multiply very fast and kill us in no time. Others, however, divide very slowly and remain with us all our lives until we are done with by cardiovascular disease. Still, some cancers are successfully detected early by our immune system and are destroyed before they can harm us. The difficulty for us is deciding which of these should be treated.
The experts via the American College of Obstetrician and Gynecologists (ACOG) and the well respected United States Preventive Service Task Force (USPSTF) have analyzed all the existing evidence and have revised the guidelines for cervical cancer screening. Teenagers do not have to undergo smear in order to obtain their Birth control pills from their gynecologists. They can wait until they reach 21 years old and if it’s normal they can have one every three years. At thirty, a woman is recommended to have a pap smear every three to five years depending on whether the testing includes high risk HPV.
Very few cancers will be missed with these new guidelines. These young ladies will be spared the anxiety and all the complications, however rare, associated with screening: infertility, incompetent cervix, preterm labor, and of course expenses.
As for the old physical examination and counseling, there is no change: as needed or every year. More, especially in medicine, is not necessarily better; it has taken us a long time to learn that.
Dr. Coupet will be addressing the topic “Should I be screened for cancer?” at an annual symposium which will be held in Doral, Florida on September 21, 2013. He will present the pros and cons of screening, lead you through the web of its jargons, and help you decide whether it prevents diseases or deaths. It will be for the consumption of all health care practitioners, for policy makers, and for all those who are not yet called patients.