text:
|Sybill Patricia Trelawney
|Biographical information
|Blood status
|Physical information
|Hair colour
|Eye colour
Dark green
|Skin colour
|Family information
|Family members
|Magical characteristics
- Sybill Trelawney: "Certainly I knew, Minerva. But one does not parade the fact that one is All-Knowing. I frequently act as though I am not possessed of the Inner Eye, so as not to make others nervous."
- Minerva McGonagall: "That explains a great deal."
- — Professor Trelawney and Minerva McGonagall.[src]
Professor Sybill Patricia[5] Trelawney (b. 9 March[6] before 1963[1]) was a witch and professor of Divination, alongside Firenze[7], at Hogwarts School of Witchcraft and Wizardry. The great-great-granddaughter of the celebrated Cassandra Trelawney[8], she was also a seer.
It was Trelawney herself who made the prophecy concerning Voldemort and the one with the power to vanquish him (Voldemort took this to mean Harry Potter) during her job interview with Albus Dumbledore[7]. At the end of the 1993–1994 school year, she accurately predicted the escape of Peter Pettigrew and return of Lord Voldemort [9]. Two school years later, Trelawney was greatly distressed by Dolores Umbridge, who dismissed her and attempted to banish her from Hogwarts Castle, though Dumbledore allowed her to remain at the school[8]. She was greatly offended when she later had to teach alongside the centaur Firenze[7], and participated in the Battle of Hogwarts, dropping crystal balls on Death Eaters' heads[10] and tending to the wounded with Padma Patil[11].
Professor Trelawney's later life is unknown. She presumably continued to teach - however, since Firenze was welcomed back to his herd[12], it is possible that she taught Divination on her own again.
Early lifeEdit
- Dolores Umbridge: "And you are a great-great-granddaughter of the celebrated seer Cassandra Trelawney?"
- Trelawney: "Yes."
- Dolores Umbridge: "But I think – correct me if I am mistaken – that you are the first in your family since Cassandra to be possessed of the Second Sight?"
- Trelawney: "These things often skip – er – three generations."
- — Sybill Trelawney being questioned by Dolores Umbridge.[src]
Sybill was born into the half or pure-blood Trelawney family[2], with three generations between her and Cassandra Trelawney, who was a renowned seer. No one in the family, since Cassandra, had possessed the Second Sight.
Presumably purchasing or inheriting her wand at the age of eleven, it is likely that Sybill attended Hogwarts School of Witchcraft and Wizardry, which she referred to as her home. Being sorted in 1975 at the latest, she may have been a member of the Slug Club[4] because of her ancestry. In her third year, Sybill presumably took Divination as one of her elective subjects, and achieved high grades in her O.W.L and N.E.W.T.
Job applicationEdit
- "The one with the power to vanquish the Dark Lord approaches... Born to those who have thrice defied him, born as the seventh month dies... and the Dark Lord will mark him as his equal, but he will have power the Dark Lord knows not... and either must die at the hand of the other for neither can live while the other survives..."
- —Sybill's prophecy which secured her job.[src]
In 1980, Sybill, who, by this point, had begun making false predictions, arranged a meeting with Albus Dumbledore in the Hog's Head, where she was staying, in the hopes of acquiring the position of professor of Divination at Hogwarts School. Dumbledore agreed to give her a chance because of her ancestry.
Sybill displayed none of Cassandra's divinatory skills, which disappointed Dumbledore, who was planning on discontinuing the subject anyway. After courteously telling her she was not fit for the position, Sybill entered a trance and made a prophecy about Voldemort's defeat. It so happened that the Death Eater Severus Snape was eavesdropping at the door. Hoping to protect Sybill, Dumbledore hired her.
Career at HogwartsEdit
Early years (1980 - 1990)Edit
- "Sybill Trelawney has predicted the death of a student every year since she came to this school. None of them have died yet."
- —Minerva McGonagall on Trelawney.[src]
As a professor, Trelawney taught in the Divination Classroom on the seventh floor of the North Tower[9]. She presumably also ran the Divination Workshop. Minerva McGonagall, claimed that she predicted the death of one of her students every year.
- "My name is Professor Trelawney. You may not have seen me before. I find that descending too often into the hustle and bustle of the main school clouds my Inner Eye."
- —Trelawney introducing herself to her class.[src]
Professor Trelawney very rarely attended meals in the Great Hall with the rest of the school, preferring to remain in her tower. She appeared to be acquainted with a certain colleague of hers, but frequently clashed with Professor McGonagall[9].
1991-1992 school yearEdit
- "Do not disturb, crystal gazing"
- —Trelawney's notice.[src]
At some point in the 1991–1992 school year, Professor Trelawney locked her classroom door, with a notice saying "Do not disturb, crystal gazing". Harry Potter, who had just joined the school, attempted to open it without realising that it was locked[13].
1993-1994 school yearEdit
- "So you may have chosen to study Divination, the most difficult of all magical arts. I must warn you at the outset that if you do not have the Sight, there is very little I will be able to teach you. Books can take you only so far in this field..."
- —Trelawney meeting her new third year class.[src]
During the 1993–1994 school year, Professor Trelawney gained Harry Potter as a student, who had only chosen to take Divination because his friend, Ronald Weasley, had[14]. She opened her lesson with normal fortune-teller practices and vague predictions, including that Neville Longbottom would break at least one teacup, that something Lavender Brown was dreading would happen on 16 October, and that, around Easter, one of her students would drop the subject.
During a class on tea leaves, Trelawney saw the Grim - a well-known omen of death - in Harry Potter's cup. This visibly disturbed the class, who went rather shaken to Transfiguration with Professor McGonagall.
- "My dear, you have the Grim."
- —Sybill Trelawney seeing Harry's Grim in the tea leaves.
After Neville broke two teacups, Lavender's rabbit Binky was killed, and Hermione Granger, after being greatly insulted by Professor Trelawney, stormed out of a lesson, Lavender and Parvati and Padma Patil[15] became great supporters of Trelawney.
During Christmas, Trelawney was late for dinner. But upon noticing the small party in the Great Hall , she tried refusing, claiming that if she joins, they will become a party of the unlucky number thirteen and the first to rise will be the first to die. An impatient McGonagall states that they'll risk it. Two hours later, both Harry and Ron bolted up from their seats, causing Trelawney to shriek, asking which one of them got up first. McGonagall joked that unless there was a mad axe-man waiting in the Entrance Hall to slaughter the first person he sees, it makes little difference.
- "It will happen tonight. The Dark Lord lies alone and friendless, abandoned by his followers. His servant has been chained these twelve years. Tonight, before midnight... the servant will break free and set out to rejoin his master. The Dark Lord will rise again with his servant's aid, greater and more terrible than ever he was. Tonight... before midnight... the servant... will set out... to rejoin... his master..."
- —Professor Trelawney's prophecy.[src]
While doing the third year exams with the Gryffindors, Professor Trelawney, while invigilating Harry Potter, entered a trance and made a prediction that the Voldemort's servant would be freed, returning to him that night. When she returned to normal seconds later, she could not remember anything happening.
Harry later told this to Professor Dumbledore, who said that he should offer her a pay raise for making a total of two real prophecies.
1994-1995 school yearEdit
- "You are preoccupied, my dear. My Inner Eye sees past your brave face to the troubled soul within. And I regret to say that your worries are not baseless. I see difficult times ahead for you, alas... most difficult... I fear the thing you dread will indeed come to pass... and perhaps sooner than you think..."
- —Professor Trelawney to Harry Potter.[src]
The following year, the Triwizard Tournament took place at Hogwarts and Harry Potter was one of the champions. Trelawney continued to annoy him with her predictions of his death. She guessed that Harry had lost his parents because he was born during the winter. However, Harry told her he was born in July.
Furthermore, when Ronald Weasley asked Lavender Brown to show him Uranus, Professor Trelawney gave them much more homework.
Once, Rita Skeeter, in the form of a beetle, eavesdropped upon Harry during Trelawney's lesson, when Harry had a crisis. Trelawney believed that it had to do with Harry's scar.
At the end of the year, Trelawney learned about the death of Cedric Diggory and the return of Lord Voldemort. The Second Wizarding War had begun.
1995-1996 school yearEdit
- "Professor Trelawney was standing in the middle of the entrance hall with her wand in one hand and an empty sherry bottle in the other, looking utterly mad. Her hair was sticking up on end, her glasses were lopsided so that one eye was magnified more than the other; her innumerable shawls and scarves were trailing haphazardly from her shoulders, giving the impression that she was falling apart at the seems. Two large trunks lay on the floor beside her, one of them upside-down; it looked very much as though it had been thrown down the stairs after her."
- —Sybill Trelawney while she is being sacked by Dolores Umbridge[src]
Early on in the 1995–1996 school year, Dolores Umbridge was made Hogwarts High Inquisitor by Ministry edict, and appeared in Trelawney's classroom with a clipboard, making notes. Trelawney saw this as an intrusion, and was most upset and angered by it. Umbridge asked Trelawney to justify her teaching techniques and required a prediction from her; but was unimpressed with the results.
During free time that year, Professor Trelawney was visited in her tower by Parvati and Padma Patil, who had additional sessions of Divination with her[15].
- Parvati Patil: "Professor? Professor, is there anything – er – wrong?"
- Professor Trelawney: "Wrong! Certainly not! I have been insulted, certainly... insinuations have been made against me... unfounded accusations levelled... but no, there is nothing wrong, certainly not! I say nothing of sixteen years of devoted service... it has passed, apparently, unnoticed... but I shall not be insulted, no, I shall not!"
- — Trelawney and Parvati Patil after being put on probation.[src]
Umbridge later put Professor Trelawney on probation, which greatly distressed and insulted her. She became uncharacteristically brisk and started drinking a large amount of cooking sherry, which she hid in the Room of Requirement[7]. Harry Potter noted that Trelawney became more harassed and bedraggled in appearance.
After Harry Potter stood up to Professor Umbridge by giving an interview to The Quibbler, edited by Xenophilius Lovegood, Trelawney broke her usual pattern of predicting horrible death for Harry, instead predicting long life, many children, and election as Minister of Magic.
- Sybill Trelawney: "No! NO! This cannot be happening...It cannot...I refuse to accept it!"
- Dolores Umbridge: "You didn't realise this was coming? Incapable though you are of predicting even tomorrow's weather, you must surely have realised that your pitiful performance during my inspections, and lack of any improvement, would make it inevitable you would be sacked?"
- — Dolores Umbrige, soundly callously amused, insulting Trelawney while she sacks her[src]
Eventually, Trelawney was dismissed by Umbridge, who, in her great dislike for Trelawney, almost threw her bodily from the castle, ignoring the fact that Trelawney was in paroxysms of grief over her dismissal. Before she could be chased off the premises, Dumbledore came to her aid and insisted that she stay at Hogwarts, as Umbridge had no authority to banish her from the school grounds; this was partially to protect her from Voldemort due to her prophetic ability. McGonagall, despite not having much respect for Trelawney, also came to her aid, and Filius Flitwick and Pomona Sprout helped her get back to her tower.
- Professor Dumbledore: "It is my wish that Professor Trelawney continue to live at Hogwarts."
- Professor Trelawney: "No – no, I'll g – go, Dumbledore! I sh – shall leave Hogwarts and s – seek my fortune elsewhere -"
- Professor Dumbledore: "No. It is my wish that you remain, Sybill."
- — Dumbledore demanding that Trelawney stays at Hogwarts.[src]
Trelawney was replaced by the centaur Firenze, appointed by Dumbledore (much to Umbridge's shock and fury, due to both Firenze being a "half-breed" which she hated but also Dumbledore appointing someone before she could) who taught in Classroom 11 rather than North Tower, where Trelawney remained living.
She was finally reinstated to her teaching position after Umbridge was suspended. This meant that, since Dumbledore could not ask him to return to the herd that tried to kill him, she would have to share classes with Professor Firenze.
1996-1997 school yearEdit
- "'He and Professor Trelawney are dividing classes between them this year. The sixth year is being taken by Professor Trelawney.'"
- —McGonagall talking to Parvati Patil.[src]
That year, she continued drinking, due to her humiliation of working with a "horse", as she referred to Firenze. She hid her cooking sherry in the Room of Requirement.
At Horace Slughorn's Christmas party, Trelawney was morosely drunk. She spent the night listening to Luna Lovegood's speeches on the "Rotfang Conspiracy" and that Rufus Scrimgeour was a vampire. She seemed rather interested.
In mid-March, Professor Trelawney demanded, quite unsuccessfully, that Professor Dumbledore fire Firenze. Their meeting was cut short when Harry Potter arrived for one of his private lessons with the headmaster.
Later, Trelawney attempted to enter the Room of Requirement, but was thrown out by Draco Malfoy, who apparently used Peruvian Instant Darkness Powder to conceal his identity. Harry Potter found her sprawled on the floor, and helped her up. He asked her to accompany him to Dumbledore's office, to tell Dumbledore what she had heard. On the way, she started talking about the day she was hired. When Trelawney mentioned that the eavesdropper had been Severus Snape, Harry left her standing in the corridor and ran off to confront Dumbledore with this information.
1997-1998 school yearEdit
During the 1997–1998 school year, Voldemort had taken over Hogwarts and made Snape headmaster, while Alecto Carrow replaced the murdered Muggle Studies teacher, Charity Burbage, and Amycus Carrow took Snape's position as Defence Against the Dark Arts teacher, which became simply Dark Arts. It is possible that Professor Trelawney, like all of the other staff members, tried to protect the students from the Death Eaters. Professor Trelawney, being either half-blood or pure-blood, was permitted to remain teaching at the school. It is unknown why Voldemort did not attempt to capture her, which was presumably why Dumbledore wished her to remain at the school in 1996. It is possible that since Voldemort had since turned his attention to finding the Elder Wand to kill Harry Potter, he believed that any prophecy concerning him and Harry would be rendered irrelevant upon its retrieval.Like the rest of the school, Professor Trelawney participated in the Battle of Hogwarts. She fought by dropping crystal balls on enemies' heads, successfully knocking out Fenrir Greyback in this manner and possibly saving Lavender Brown's life. She then continued using her wand to throw crystal balls onto the heads of Death Eaters with a "tennis like serve." Eventually, the Death Eaters were all defeated, along with Voldemort.
Later lifeEdit
Providing Professor Trelawney survived the end of the Second Wizarding War, she presumably continued teaching at Hogwarts under Minerva McGonagall.
It is possible that Trelawney continued her career without Firenze, as he was welcomed back into the Forbidden Forest Centaur colony[12].
Physical descriptionEdit
- "Harry's immediate impression was of a large, glittering insect. Professor Trelawney moved into the firelight, and they saw that she was very thin; her large glasses magnified her eyes to several times their natural size, and she was draped in gauzy, spangled shawl. Innumerable chains and beads hung around her spindly neck, and her arms and hands were encrusted with bangles and rings"
- —Harry's impression of Trelawney[src]
Professor Trelawney is described as being a thin woman, usually draped gauzy shawls, and cloaks and bangles all covered with shining sequins and glittering strings of beads.
She had thick glasses, which hugely magnified her eyes and caused them to appear about ten times their normal size. She spoke in a soft, misty, ethereal voice, which sometimes turned into a brisk, snappy voice when she was angry or upset.
- "She looked as odd as ever, glittering with beads and trailing shawls, her eyes magnified to enormous size by her spectacles."
- —Trelawney at the 1996 Start-of-Term Feast.[src]
She had brown hair. She also had dark green eyes and somewhat pale skin.
Personality and traitsEdit
- "Welcome. How nice to see you in the physical world at last. Welcome to Divination. My name is Professor Trelawney. You may not have seen me before. I find that descending too often into the hustle and bustle of the main school clouds my Inner Eye"
- —Professor Trelawney greets her third-year students[src]
Trelawney was extremely eccentric; she had a theatrical presence and frequently spoke in misty, ethereal tones. She saw herself as being a great Seer, although her predictions rarely came true. Much like Gilderoy Lockhart, Trelawney was sometimes unable to understand who liked and who disliked her, as she did with Harry Potter in 1997.
According to Professor McGonagall, seeing death omens is a favourite way for Trelawney to greet her class, something that annoyed Harry for his three years with her. She could also be angered when she believed that the students were not interested in her subject, such as Ronald Weasley.
Trelawney was implied to have had a mild drinking problem; a number of times, Harry detected the smell of old sherry around her and at one point, she was seen stowing away empty alcohol bottles in the Room of Requirement. She was also very sensitive, as she cried when Dolores Umbridge sacked her and sobbed angrily when she was insulted by Umbridge putting her on probation. Trelawney was, however, loyal to Hogwarts and defended it during the Battle of Hogwarts, apparently saving the life of her student and friend Lavender Brown.
Magical abilities and skillsEdit
- Professor Trelawney: "I was saying that Saturn was surely in a position of power in the heavens at the moment of your birth...your dark hair...your mean stature...tragic losses so young in life...I think I am right in saying, my dear, that you were born in midwinter?"
- Harry Potter: "No, I was born in July"
- — Harry and Trelawney[src]
- Divination: Professor Trelawney is generally thought of as a charlatan, however, this is not true. Almost every prediction she made throughout the series (including the ones not made under the influence of Second Sight) came true. The only possible exceptions to this were the ones where she continually foreshadowed Harry's death (though he did technically die in 1998, anyway) and the ones she blatantly fabricated for the Quibbler interview simply to annoy Umbridge. Her most notable non-second sight prediction was probably her foretelling of the death of Albus Dumbledore and the Battle of the Astronomy Tower via Tarot cards. As noted prior, she did also possess the Second Sight, which was also possessed by her ancestor, Cassandra. This enabled her to go into a trance, where she would prophesise something, before returning to normal and having no memory of her prediction. Therefore, (all things considered) Professor Trelawney appeared to be a rather potent Seer in spite of her reputation.
- Non-verbal spellcasting: Trelawney was able to cast spells and charms without incantations. She showed this during the Battle of Hogwarts, when she launched crystal balls at enemies using her wand.
- Duelling: Professor Trelawney is known to have a fair amount of skill in duelling since she fought and survived the Battle of Hogwarts.
- "That brings her total of real predictions to two. I should offer her a pay rise."
- —Albus Dumbledore on Trelawney's second prediction.[src]
The Chosen OneEdit
The first prediction was made in the presence of Albus Dumbledore at the Hog's Head inn[17]. Trelawney was in the middle of an interview for a teaching job at Hogwarts when it happened. Dumbledore reported that he had decided not to give Trelawney the job, but changed his mind when he heard the prophecy. Trelawney herself is not aware that she made the prophecy, merely remembering that she came over faint, which she attributed to not having eaten that day.
Sybill Trelawney's first prophecy was the following:
- "The one with the power to vanquish the Dark Lord approaches.…born to those who have thrice defied him, born as the seventh month dies…and the Dark Lord will mark him as his equal, but he will have power the Dark Lord knows not.…and either must die at the hand of the other for neither can live while the other survives.…the one with the power to vanquish the Dark Lord will be born as the seventh month dies…"
This prediction is believed to refer to Voldemort ("the Dark Lord") and Harry Potter, who was born on 31 July. At the time of its prophesying the identity of the approaching one could not be known as he had not been born. The time of year the prophecy was made is unknown, but it was described as 'dark and stormy', so it is possible that the prediction was made at the time of conception of the child foretold, at around Halloween.
It later became apparent that the prophecy could have applied either to Harry, or to Neville Longbottom, who was also born at the end of the seventh month on 30 July. Part of the prediction came to pass on the night of 31 October, 1981, when Lord Voldemort's body was destroyed after Harry survived an attack from him, reputedly using the killing curse, Avada Kedavra. The attack left Harry with an ability to speak Parseltongue, a lightning-shaped scar on his forehead, and a mental connection to Voldemort. It was Dumbledore's view that it was Voldemort's choice of Harry as his target from the two possible boys which made Harry the one foretold. Had Voldemort chosen Neville, who was also born at the end of July, then he would have had a different adversary. Both boys had parents who had defied the dark lord thrice.
The prophecy as interpreted by Dumbledore to Harry in June 1996 would read: "Someone (Harry or Neville) with the power to vanquish Voldemort is coming...born to those who have defied Voldemort three times (the Potters or the Longbottoms), born at the end of July...and Voldemort will attempt to kill Harry, but Harry will unexpectedly survive...either Harry or Voldemort must be killed by the other because one of them must die...Harry will be born at the end of July..."
When Harry and the others arrive in the Hall of Prophecy in the Department of Mysteries, Ron found a record of the prophecy that had a tag which read:
- S.P.T. to A.P.W.B.D.
- Dark Lord
- and (?) Harry Potter
S.P.T. stands for Sybill Patricia Trelawney and A.P.W.B.D. stands for Albus Percival Wulfric Brian Dumbledore. The question mark before the Harry Potter is because at the time it was unclear who the prophecy was written about, but when Voldemort sought to murder Harry the prophecy record was changed to include his name.
The Servant Rejoins His MasterEdit
- "It will happen tonight. The Dark Lord lies alone and friendless, abandoned by his followers. His servant has been chained these twelve years. Tonight, before midnight... the servant will break free and set out to rejoin his master. The Dark Lord will rise again with his servant's aid, greater and more terrible than ever he was. Tonight... before midnight...the servant...will set out...to rejoin...his master...."
- —Sybill Trelawney[src]
Professor Trelawney prophecised this occurrence subconsciously to Harry Potter in 1994, in her classroom. This prophecy came to pass when Peter Pettigrew's true identity was revealed and he escaped to help bring Lord Voldemort back to health.
Other predictionsEdit
Professor Trelawney has made other predictions, too, some of which happened, though they may coincidental. It is unknown if the rest of them are true.
- She told Neville Longbottom to take a blue cup after breaking his first one, because she likes the pink ones. Neville immediately took a cup, broke it, and then later broke his second cup too.
- She also asked Neville about his grandmother, saying she may have been ill.
- And that he will be late for his next divination class.
- She told Parvati Patil to beware of a red-headed man. Parvati immediately suspected Ron. At the Yule Ball, Harry and Ron, Parvati's and her sister, Padma's dates, ignored her and her sister. Two years later, Ron started going out with Parvati's best friend Lavender Brown, who started to ignore Parvati.
- She predicted a bout of flu in February, and that she would lose her voice.
- She predicted that the thing Lavender was dreading would happen on 16 October. On that day, Lavender got a letter that her pet rabbit, Binky, had been killed by a fox. Hermione was sceptical, indicating that Lavender could hardly have dreaded her new rabbit dying, and that the death could not have happened on the day the news arrived. (Though this can be argued as Lavender was dreading something horrible on that day.)
- On the beginning of 1993–1994 school year, she told in the whole class that, near Easter, one of their number will leave them forever. It seems that her prediction was fulfilled, when Hermione quit the class in disgust near Easter holidays.
- At the Christmas lunch, Trelawney at first refused to join the table, since when thirteen dine together, the first to rise will be the first to die. Harry Potter and Ron Weasley got up from the table first together, but Albus Dumbledore was the first among those at the table to die. Also, she did not take into account of Peter Pettigrew, who was at the time disguised as Scabbers the rat, which would in fact count as fourteen people. However, she was right: before getting seated, there were thirteen people at the table (counting Scabbers) and Albus Dumbledore rose to greet her, which confirms that he was the first person to die.
- In 1995, thirteen members of the order dined together, and the first to rise was Sirius, who later died.
- When she and McGonagall were arguing, Dumbledore raised his voice, and out of the people dining he was the first to die.
- Also, after the Battle of the Seven Potters, thirteen people (Mr. and Mrs. Weasley, Bill, Fleur, Fred, George, Ron, Ginny, Harry, Hermione, Lupin, Tonks and Hagrid) gathered in The Burrow to mourn the death of Alastor Moody. Afterwards, Lupin stood up and offered to look for Moody's dead body. Later in the Battle of Hogwarts, Lupin was killed by Antonin Dolohov. Fred and Tonks were also killed, but as the time of Lupin's death is unknown, it is possible he was first.
- When Dolores Umbridge was appointed Hogwarts High Inquisitor during Harry's fifth year, she insisted that Trelawney demonstrate her abilities by prophesying something. Trelawney replied that she saw dark events ahead for Umbridge, which Umbridge immediately dismissed as nonsense. Later, Umbridge was dragged off and imprisoned by centaurs in the Forbidden Forest.
- In Harry's sixth year he saw Trelawney coming, and hid from her. As she passed, he saw that she was examining a pack of cards and muttered, "A dark young man, possibly troubled, one who dislikes the questioner." She dismissed her own words as nonsense, unaware of Harry's presence or his dislike of her. Later in the year, Harry saw Draco arguing with Snape when he questioned Draco on the progress of his mission for Voldemort. Later Trelawney again met Harry in the corridors, and this time complains that Dumbledore had been repeatedly dismissing her warnings of impending disaster. She looked at some Tarot cards and saw, "... the lightning-struck tower... Calamity. Disaster. Coming nearer all the time...". This seems to predict the events of Dumbledore's death on the Astronomy Tower. The Lightning-Struck Tower tarot card (The Tower) is generally considered representative of disaster or life-altering change.
- According to Professor McGonagall, Trelawney had predicted the death of one student a year since her arrival at Hogwarts (which was in 1980.) As of 1993, not a single one of those had yet died.[18] In 1996, however, she retracted her prediction regarding Harry Potter as a means of attempting to annoy Dolores Umbridge, stating that he would live to a ripe, old age, become Minister for Magic and have twelve children.[19]
- Wand: Sybill Trelawney possessed a wand made of an unknown core and wood. She wielded it in the Battle of Hogwarts, launching crystal balls at Death Eaters in a tennis-serve motion. She presumably purchased it prior to her magical education.
- Crystal balls: As one of the Divination teachers, Professor Trelawney owned several crystal balls. She used them as weapons during the Battle of Hogwarts, and used one to knock out the werewolf and Snatcher Fenrir Greyback.
- Pet cat: Professor Trelawney owned a pet cat who lived in the Divination Classroom at the top of the North Tower. It was sat on a chair when Trelawney made her second prophecy.
Lavender Brown and Parvati PatilEdit
- "She says I've got all the makings of a true Seer. I saw loads of stuff..."
- —Parvati Patil on Professor Trelawney.[src]
Lavender Brown and Parvati Patil seemed to have an exceptionally close relationship with Sybill Trelawney; they had an unwavering faith in the reliability of Trelawney's predictions, and were often seen comforting her and seeking out her company. The two girls often spent lunch periods in the North Tower with Trelawney, returning to the other Gryffindors with smug looks as though they knew something the others did not. Both of them even became offended on the Professor's behalf when Hermione made clear her disdain for Trelawney and the subject she taught in 1993. When she was temporarily sacked by Dolores Umbridge, Lavender and Parvati brought Trelawney some daffodils to cheer her up.
On her part, Trelawney seemed to return their genuine affection for her with equal fervour. For instance, she told Parvati that she had the makings of a true Seer[9], and helped to save Lavender from Fenrir Greyback by dropping a crystal ball on his head during the Battle of Hogwarts.
Dolores UmbridgeEdit
- Dolores Umbridge: "I'd like you to make a prediction for me"
- Sybill Trelawney: "The Inner Eye does not See upon command!"
- Dolores Umbridge: "I see"
- Sybill Trelawney: "I--but--but--wait! I...I think I do see something...something that concerns you...Why, I sense something...something dark...some grave peril...I am afraid...I am afraid that you are in grave danger!"
- Dolores Umbridge: "Right. Well, if that's really the best you can do..."
- — Professor Trelawney performing poorly in Umbridge's inspection[src]
Umbridge, a sadistic woman who tortured students, interfered in Trelawney's lessons and soon put the Divination teacher on probation. After receiving this news, Trelawney sobbed and furiously proclaimed dramatically that she had been insulted by the establishment, those whose eyes were clouded by the Mundane and did not possess the Inner Eye, and that it was alas the fate of all Seers to be feared by society and persecuted. Trelawney, very distressed, then began to drink copious amounts of cooking sherry, be somewhat brisk in her lessons, looked very bedraggled and harassed much of the time, and would sob uncontrollably while teaching. It is known that Umbridge and Hermione share something- they both think she's an old fraud.
- Parvati Patil: "Professor? Professor, is there anything--er--wrong?"
- Sybill Trelawney: "Wrong? Certainly not! I have been insulted, certainly....Insinuations have been made against me....Unfounded accusations levelled...but no, there is nothing wrong, certainly not....I say nothing of sixteen years' devoted service....It has passed, apparently, unnoticed...But I shall not be insulted, no, I shall not!"
- Parvati Patil: "But Professor, who's insulting you?"
- Sybill Trelawney: "The establishment! Yes, those with eyes too clouded by the Mundane to See as I See, to Know as I Know...Of course, we Seers have always been feared, always persecuted....It is--alas--our fate...."
- Parvati Patil: "Professor, do you mean...is it something to do with Professor Umbridge...?"
- Sybill Trelawney: "Do not speak to me about that woman! Kindly continue with your work!"
- — Parvati Patil talking to Sybill Trelawney after the Divination teacher receives the results of her inspection[src]
Umbridge believed that Trelawney was a fraud and, true to her duties of High Inquisitor to weed out any unsatisfactory teachers, eventually she sacked her. When Dumbledore defended Trelawney and let her stay at Hogwarts, much to Umbridge's chagrin, and Umbridge was even more furious with Dumbledore because he had already picked out a replacement teacher, Firenze a centaur, who Umbridge was prejudiced against because of her hate of "half-breeds". Umbridge left Hogwarts in 1996 after the Skirmish in the Forbidden Forest at the end of the school year, and Trelawney resumed teaching Divination but had to share the teaching of the class with Firenze, who could not go back to his herd in the Forest as they had banished him for working with humans. Trelawney viewed this as a great insult.
Minerva McGonagallEdit
- Professor Trelawney: "I dare not, Headmaster! If I join the table, we shall be thirteen! Nothing could be more unlucky! Never forget that when thirteen dine together, the first to rise will be the first to die!"
- Minerva McGonagall: "We'll risk it, Sybill. Do sit down, the turkey's getting stone cold."
- — Trelawney and McGonagall at Christmas.[src]
Professor Trelawney and Minerva McGonagall were colleagues as professors at Hogwarts School of Witchcraft and Wizardry, though Minerva did not believe in the legitimacy of her subject. Minerva had no use for Sybill's subject, Divination, politely describing it as an 'imprecise' branch of magic, and believed that Trelawney was a fraud[9].
Despite her distaste for Trelawney and her teachings, however, Minerva and Sybill would grow to understand one another through their shared hatred of Dolores Umbridge during the woman's tenure as Defence Against the Dark Arts Professor. When Dolores sacked Trelawney, Minerva comforted her and spoke out against Umbridge's behaviour [8].
In many ways, McGonagall's relationship with Trelawney was similar to Hermione Granger's relationship with Luna Lovegood.
Albus DumbledoreEdit
- "I cannot ask Firenze to return to the Forest, where he is now an outcast, nor can I ask Sybill Trelawney to leave. Between ourselves, she has no idea of the danger she would be in outside the castle. She does not know - and I think it would be unwise to enlighten her - that she made the prophecy about you and Voldemort, you see."
- —Professor Dumbledore to Harry Potter on Professor Trelawney.[src]
Upon their first meeting, Albus Dumbledore initially believed that she was a fraud, but when he heard her prophecy about Harry Potter and Voldemort, he hired her, as he wanted to protect her from the Dark Lord and his Death Eaters.
During 1997, Trelawney predicted Dumbledore's death at the Astronomy Tower several times without realising it. When Dolores Umbridge fired Trelawney, Dumbledore insisted that she remain in the castle, fearing that she could be endangered by Lord Voldemort.
However, in 1996, Trelawney was angry with Dumbledore, as he allowed Firenze to continue teaching Divination alongside her following her reinstation. This made Trelawney think that Dumbledore disliked her, as she asked him several times to fire her.
- Professor Trelawney: "Good evening, my dear. I haven't seen you in my classes lately..."
- Luna Lovegood: "No, I've got Firenze this year."
- Professor Trelawney: "Oh, of course. Or Dobbin, as I prefer to think of him. You would have thought, would you not, that now I am returned to the school Professor Dumbledore might have got rid of the horse? But no... we share classes... it's an insult, frankly, an insult."
- — Trelawney speaking about Firenze to Luna Lovegood.[src]
After Professor Trelawney was dismissed, Dumbledore hired the centaur Firenze to replace the vacant spot of Divination teacher. After Umbridge left Hogwarts and Trelawney was reinstated, Dumbledore refused to fire Firenze, as his herd had once tried to kill him. This greatly angered Trelawney.
Co-teaching with him, she called him names, such as "the Nag," "Dobbin", and others. She believed that the headmaster preferred Firenze to herself. However, after the Second Wizarding War, she might have changed her opinion.
Hogwarts staffEdit
Charms Master Filius Flitwick and Herbology teacher Pomona Sprout were kind enough to escort Professor Trelawney back to the North Tower after her dismissal, with Flitwick magically carrying her trunks and possessions.
She disliked the Potions master and former-Death Eater Severus Snape, most likely because he rudely eavesdropped on her job interview with Albus Dumbledore in the Hog's Head.
Professor Trelawney appeared to be friendly with a colleague of hers, who taught either Study of Ancient Runes, Earth Magic, Ghoul Studies, Music, Muggle Music, Art, Muggle Art, Ancient Studies, Advanced Arithmancy Studies, or some other elective subject. She tended to her during the Battle of Hogwarts, but unfortunatly, she did not survive the battle. Just before Voldemort summoned his troops back to the Forbidden Forest, the Professor's body was brought to the Great Hall. There were no signs of external damage so they believed she was taken by the Killing Curse.
Both her name and her surname are related to her future telling ability. "Sibyl" was a priestess in ancient Greek mythology. A sibyl (one "l") is a woman who could look into the future. A sibyl also can be any female prophet. The name is from the Latin sibylla, seer. While "Trelawney" may come from the oculist and seer Dr. Trelawney, from Anthony Powell's A Dance to the Music of Time. Alternatively, it may be derived from a famous cry of defiance from the south-west of England, where Rowling grew up, often shouted at football matches:
"And shall Trelawney live? And shall Trelawney die? Here's ten thousand Cornishmen who ask the reason why!"
The cry is a line from The Song of the Western Men, written in 1833 by the poet and parson Robert Stephens Hawker and the unofficial Cornish national anthem. It concerns the march to London in 1688 in protest at the incarceration in the Tower of Jonathan Trelawny, Bishop of Bristol. This could be a reference to Trelawney predicting the death of one of her students every year. It is also interesting to note that Bishop Trelawny also was released and went on to live for another thirty-three years, just as Professor Trelawney's famous death predictions rarely came true.
The name "Trelawney" comes from the Cornish phrase tre-lonow, homestead of groves, or tre-launow, farm in clearing.
Author's commentsEdit
J. K. Rowling has stated that she does not believe in magic, and does not intend that her readers should believe in it either. She has hinted that the portrayal of Trelawney (a mystic and fortune-teller, perhaps the kind of "magic" that children are most likely to come across) as something of an ineffectual old fraud may be related to this. However, her name and the reference to a grandmother named Cassandra somewhat contradicts this. In Greek mythology, Cassandra was a Trojan seer who recieved the gift of prophecy from Apollo, but when she spurned his romantic advances, the god in his wrath cursed her that she would be ever correct but never believed. This suggests that perhaps some of Trelawney's pronouncements may be more accurate than is often believed.
Behind the scenesEdit
- In Harry Potter and the Order of the Phoenix, Trelawney's first name is misspelled as Sybil.
- Sybill could possibly be derived from the name of a group ancient Roman oracles known as the Sybilline oracles, which is appropriate considering her ability to tell the future and make accurate prophecies.
- Trelawney is portrayed by Emma Thompson in the film adaptations of Harry Potter and the Prisoner of Azkaban, Order of the Phoenix and Deathly Hallows: Part 2. Thompson does not appear in Harry Potter and the Half-Blood Prince because she was filming for Nanny McPhee and the Big Bang, despite the fact that Harry Potter co-star Maggie Smith also appears in the film (although, as supporting cast, so they do not have as many scenes as Thompson did).
- Emma Thompson was married for several years to Kenneth Branagh (Gilderoy Lockhart) who directed and starred alongside her in Henry V, Dead Again, Peter's Friends, and Much Ado About Nothing. Interestingly enough, Branagh was offered the chance to direct Prisoner of Azkaban, which marks the first appearance of Professor Trelawney in the series, before Alfonso Cuaron got the job.
- Even more interesting, is that Branagh had broken up with Thompson after falling for Helena Bonham Carter (Bellatrix Lestrange), whom he had met while directing Mary Shelley's Frankenstein.
- Trelawney predicting the prophecy and Snape overhearing it are not included in the films. Indeed, Trelawney plays a far smaller part in Harry's destiny in the films than in the books.
- Trelawney told Lavender Brown that the worst thing for her would come true on Friday, 16 October. However, 16 October, 1993 was a Saturday.
- Emma Thompson had originally stated that she would not return as Trelawney in the last films.[20] However, she has since confirmed that she will reprise her role as Trelawney and has already filmed her scenes.[21]
- Emma Thompson has appeared in several films with Imelda Staunton; Much Ado About Nothing, Peters Friends, Sense and Sensibility and Nanny McPhee. Alan Rickman, Robert Hardy, Gemma Jones and Elizabeth Spriggs also starred in Sense and Sensibility. Maggie Smith and Ralph Fiennes also appear in Nanny McPhee and the Big Bang.
- Professor Trelawney was also referenced in the video game adaptation of Harry Potter and the Philosopher's Stone by a locked door on the seventh floor that states if Harry tries to open it "Do not disturb, crystal gazing".
- Oddly enough, many of the predictions made by Trelawney and others during the third year come true. Ron does in fact go through trials and suffering during the hunt for the Horcruxes, and ends up happy from the experience since he becomes closer to Hermione. Harry does come into a great sum of unexpected gold; his prize money for winning the Triwizard Tournament (though later it was transferred to the Weasley twins), and his inheritance from Sirius after his death. Harry also ends up working for the Ministry of Magic, although it is unknown if he ever became Minister. Though Trelawney seems to have been making it up at the time, seeing a death omen in Harry's cup, Harry did face his own death in 1998, although he did not actually die. However, the fact the death omen was in the shape of a dog may have been misinterpretted and may have truly been symbolizing Sirius entering his life as an animagus.
- In Harry Potter and the Deathly Hallows: Part 2, Trelawney appears for only a fleeting moment, respectfully covering one of the fallen battle casualties. She can also be seen from behind battling Death Eaters in the courtyard; look for her curly hair and distinctive green sparkling coat right after Hermione runs between the legs of the troll on the way to the boathouse. You can also hear a Crucio said in her voice.
- In Harry Potter and the Prisoner of Azkaban, Sybill incorrectly states Harry Potter's date of as being during the winter. Interestingly enough, Voldemort's birthday is 31 December and Harry was later revealed to be one of Voldemort's Horcruxes. So she may have determined Voldemort's birthday using the piece of his soul within Harry.
- In book's Finnish edition Sybill's name is Sibylla Punurmio.
- In the film version of Harry Potter and the Order of the Phoenix, there is a deleted scene that portrays Trelawney dinning in the Great Hall at the opening feast of 1995, where she clumsily eats and makes a mess of her food.
- A collector character wand has been made for Trelawney. However, her name is mispelled as Sybil on the box.[22]
- In the Harry Potter Glossary on the Bloomsbury Harry Potter website, her middle name is incorrectly given as "Phyllis."[23]
- Harry Potter and the Prisoner of Azkaban (First appearance)
- Harry Potter and the Prisoner of Azkaban (film)
- Harry Potter and the Goblet of Fire
- Harry Potter and the Order of the Phoenix
- Harry Potter and the Order of the Phoenix (film)
- Harry Potter and the Order of the Phoenix (video game)
- Harry Potter and the Half-Blood Prince
- Harry Potter and the Half-Blood Prince (video game) (Mentioned only)
- Harry Potter and the Deathly Hallows
- Harry Potter and the Deathly Hallows: Part 2
- LEGO Harry Potter: Building the Magical World
- LEGO Harry Potter: Characters of the Magical World
- LEGO Harry Potter: Years 1-4
- LEGO Harry Potter: Years 5-7
- Harry Potter LEGO Sets
- The Making of Harry Potter
- Harry Potter Film Wizardry
- Pottermore
Notes and referencesEdit
- ↑ 1.0 1.1 Trelawney applied for a teaching post in 1980, implying that she was of age by then.
- ↑ 2.0 2.1 As Trelawney is descended from a famous witch, she must be from a wizarding family, meaning that she is pure or half-blood.
- ↑ 3.0 3.1 LEGO Harry Potter: Years 1-4
- ↑ 4.0 4.1 Trelawney attended the Slug Club Christmas party, implying she may have been a member. Being descended from Cassandra Trelawney, Horace Slughorn would have presumably liked to "collect" her as well.
- ↑ 4 March, 2004 World Book Day Chat
- ↑ Pottermore Twitter
- ↑ 7.0 7.1 7.2 7.3 Harry Potter and the Half-Blood Prince
- ↑ 8.0 8.1 8.2 Harry Potter and the Order of the Phoenix
- ↑ 9.0 9.1 9.2 9.3 9.4 Harry Potter and the Prisoner of Azkaban
- ↑ Harry Potter and the Deathly Hallows
- ↑ Harry Potter and the Deathly Hallows: Part 2
- ↑ 12.0 12.1 J.K. Rowling and the Live Chat, Bloomsbury.com, 30 July, 2007
- ↑ Harry Potter and the Philosopher's Stone (video game)
- ↑ Harry Potter and the Chamber of Secrets
- ↑ 15.0 15.1 Harry Potter and the Order of the Phoenix (video game)
- ↑ Luna Lovegood mentioned to Trelawney that she had Firenze instead of her during the Slug Club Christmas party.
- ↑ Harry Potter and the Order of the Phoenix, Chapter, "The Lost Prophecy".
- ↑ Harry Potter and the Prisoner of Azkaban, Chapter 6 - (Talons and Tea Leaves)
- ↑ Harry Potter and the Order of the Phoenix, Chapter 26 - (Seen and Unforeseen)
- ↑ Thompson will not return for Deathly Hallows
- ↑ Emma Thompson confirms she filmed scenes for Deathly Hallows
- ↑ A collector wand has been created for Trelawney by The Noble Collection
- ↑ Bloomsbury Harry Potter Glossary - T
|Professors: Sybill Trelawney · Firenze
|Known Seers: Calchas · Cassandra Vablatsky · Cassandra Trelawney · Inigo Imago · Mopsus · Professor Mopsus · Unidentified female Seer · Unidentified male Seer
|Textbooks: The Dream Oracle · Unfogging the Future
|Methods: Astrology · Cartomancy · Tarot cards · Crystal-gazing · Crystal ball · Dream interpretation · Fire-omens · Heptomology · Palmistry · Ornithomancy · Tessomancy
|Divination at Hogwarts: Divination (class) · Divination Classroom · Divination staircase · Sybill Trelawney's office · Classroom 11


text:
Dell and Red Hat have coengineered a set of enterprise-grade private cloud solutions based on OpenStack.
Known rather cleverly as the "Dell Red Hat Cloud Solution", this is a RHEL OpenStack platform for elastic and dynamic IT services to support and host non-business critical applications — including mobile, social, and analytics — and dev/test environments.
These solutions include "rapid on-ramps" to OpenStack private clouds for Proof of Concept Configuration — designed for customers looking to explore OpenStack capabilities; and Pilot Configuration — designed for testing cloud applications, and for customers beginning a production environment.
The pilot configuration is capable of supporting cloud scale applications across six OpenStack computes and three storage nodes. The pilot configuration can be expanded with pre-configured compute, storage, and infrastructure blocks.
For customers seeking massive scale-out designs, Dell Cloud Services will engage with customers to design and architect OpenStack-based clouds.
Red Hat's OpenShift PaaS offering provides Linux Container-based multi-tenancy via Red Hat Enterprise Linux Gears. Dell and Red Hat say they will now work together within the OpenShift community to build OpenShift solutions that provide support for developers looking for ways to make their current and future data and applications more portable and accessible.
Dell VP Sam Greenblatt explains that OpenShift integration is a necessary step toward Dell and Red Hat coengineering next-generation Linux Container enhancements from Docker. "This PaaS platform from Red Hat, and solutions to be coengineered by Dell and Red Hat, will aim to enable compatibility for PaaS offerings within enterprise environments, and developers to write applications to be portable across public, private, and hybrid cloud environments, compatible with any operating system and using any language."
The OpenShift-based solution will provide support for customers to use within their frameworks and databases, through the use of Docker cartridges, with the goal of enabling integration with any other platform that supports Docker, including public clouds. This capability is hoped to give developers the freedom to choose their application development language to build a portable application that can exist in any cloud environment.
As pointed out by Clayton Coleman on OpenShift.com blogs, "For those who aren't yet familiar with Docker, it takes the power of Linux containers (the ability to isolate software on a Linux system so that it can't see other software), pairs them with an efficient file system abstraction for delivering the exact libraries you need to any server, and then makes it all ridiculously easy to use."
Dell will integrate these capabilities across its hardware and software offerings to enable a complete PaaS solution from Linux to OpenStack to OpenShift, including platform management.
Red Hat's Paul Cormier says that cloud innovation is happening first in open source. "What we're seeing from global customers is growing demand for open hybrid cloud solutions that meet a wide variety of requirements. Whether it is enterprise-grade private cloud solutions, or DevOps solutions to build applications for both public and private clouds, through our expanded work with Dell, we're focused on delivering the flexible solutions that meet these varied needs."

subset: commoncrawl


text: Thursday, May 17, 2012 Arthritis Foundation Releases Physical Activity Report Physical activity is an important but underused intervention for adults with arthritis, says a report released yesterday by the Arthritis Foundation at a Capitol Hill briefing cosponsored by APTA. Physical activity, the report contends, decreases pain; delays the onset of disability; improves physical functioning, mood and independence; and enhances quality of life, aerobic capacity, and muscle strength. Reps Anna Eshoo (D-CA) Sue Myrick (R-NC), cochairs of the Congressional Arthritis Caucus, also sponsored the briefing. Myrick attended the briefing, which included speakers Jack Klippel, MD, president and CEO of the Arthritis Foundation; Wayne Giles, MD, MS, director of the Division of Population Health, National Center for Chronic Disease Promotion and Health Prevention, Centers for Disease Control and Prevention; Mary Wu, who told her story from a patient perspective; and Zarnaaz Bashir, MPH, director of Strategic Health Initiatives, National Recreation and Parks Association. Despite the documented benefits of physical activity, adults with arthritis have higher rates of physical inactivity than those without arthritis. Furthermore, the highest rates of physical inactivity are among adults with arthritis and heart disease, arthritis and diabetes, and arthritis and obesity, when compared with adults with none of these conditions. The new APTA-sponsored report, titled Environmental and Policy Strategies to Increase Physical Activity Among Adults With Arthritis, aims to motivate health agencies, business, recreational facilities, and others as partners in providing physical activity opportunities that meet the needs of people with arthritis. The report also answers the call of the National Public Health Agenda for Osteoarthritis and the Institute of Medicine's recent report Living Well with Chronic Illness: A Call for Public Action. It outlines an initiative that calls on the nation to address barriers and promote physical activity in a way that is safe, accessible, convenient, and inclusive of adults with arthritis in 6 key sectors—park, recreation, fitness, and sports; business and industry; community and public health; health care; transportation, land use, and community design; and mass media.


text:
After reading this my heart is tight.
Honestly! I haDa weird feeling in my heart.
I hope to God it's a lie:
I truly believe is a great and if he dated fans and was accepting applications I would totally sign in...
.... if he wasn't SOOOOO out of my league!
He's strong and I believe in him. I truly do, so... GO Jim!
Maybe it's time for some twitter love messages!


text: Friday, November 30, 2012 CMS to Host Conference Call on Functional Limitation Reporting Requirements on December 12 Physical therapists are encouraged to attend a conference call hosted by the Centers for Medicare and Medicaid Services (CMS) on December 12, 1:30 pm ET, that will cover the new functional reporting requirements for outpatient physical therapy, occupational therapy, and speech language pathology services, effective January 1, 2013. Participants will learn how to report patient functional limitation information on claims using the 42 new nonpayable functional G-codes and 7 new severity/complexity modifiers on claims for physical therapy, occupational therapy, and speech language pathology services. These G-codes and modifiers will be required on selected claims for all outpatient therapy services. In addition, the G-codes and severity modifiers used in the functional reporting are required to be documented in the patient's medical record of therapy services. To ensure a smooth transition, CMS sets forth a testing period from January 1, 2013, until July 1, 2013. After July 1, 2013, claims submitted without the appropriate G-codes and modifiers would be returned unpaid. The call will include an overview of the new functional reporting requirement, including effective dates, and information on: professionals and providers affected nonpayable G-codes used to report functional limitations modifiers used to report the severity of functional limitations when reporting is required documentation requirements A question and answer session also will be held. The speaker for this call is Pamela R. West, PT, DPT, MPH. The presentation for the call will be posted at least 1 day in advance of the call on the FFS National Provider Calls webpage. In addition, the link to the slide presentation will be e-mailed to all registrants on the day of the call. Registration will close at 12:00 pm ET on the day of the call, or when available space has been filled. Comments where can we purchase book on documentation on functional limitation Posted by monsuru bello on 11/30/2012 4:17 PM Where can we purchase a book on documentation on functional limitations. Posted by Hafiz on 12/1/2012 12:43 PM Where can we obtain answers to our comments? I would also like written information..ie book..on new codes and and documentation requirements. Posted by Diane Koch on 12/2/2012 12:51 PM If I cannot attend the live conference when can I listen to the recording? Posted by Patricia Becker on 12/2/2012 1:33 PM Please send course information to the above e-mail thank you. Thank you. Elaine 909-519-9985 Posted by ELAINE Trei on 12/2/2012 1:37 PM APTA's webpage, www.apta.org/Payment/Medicare/CodingBilling/FunctionalLimitation/, provides information and resources, including a comprehensive FAQ document, to help physical therapists meet the new functional limitation reporting requirement. Additional resources will be added to the webpage in the coming months. Check back soon for a webinar update on Medicare 2013, podcasts on functional limitation reporting and case examples, and more. This call is being hosted by the Centers for Medicare and Medicaid (CMS). If you are not able to attend the live call, go to http://www.cms.gov/Outreach-and-Education/Outreach/NPC/index.html?redirect=/NPC/20_CEC_Notification.asp for information about how to access National Provider Call training materials, such as written transcripts, audio recordings, podcasts, and video slideshow presentations, on CMS' website. Posted by News Now staff on 12/2/2012 3:51 PM How long is the audioconference? Posted by Darin McCarthy on 12/4/2012 1:56 PM Does this apply to hospital based outpatient PT as well? Thank you for your time. Posted by Leslie Johnson on 12/4/2012 1:57 PM Is this the same thing as the PQRS program? And if not, how can we get access to the recording or course information? Posted by Christy Page on 12/4/2012 4:24 PM I would like to register for this webinar. I am an APTA and Orthopedic Sections Member Joseph Posted by Joseph Mathews on 12/9/2012 10:49 AM Please registar me Posted by Anita Frumson on 12/9/2012 8:12 PM Once again: This call is being hosted by the Centers for Medicare and Medicaid (CMS). If you are not able to attend the live call, go to http://www.cms.gov/Outreach-and-Education/Outreach/NPC/index.html?redirect=/NPC/20_CEC_Notification.asp for information about how to access National Provider Call training materials, such as written transcripts, audio recordings, podcasts, and video slideshow presentations, on CMS' website. APTA is not responsible for registration for this event. Posted by News Now staff on 12/12/2012 8:26 AM I haven't received a confirmation email with information on how to call in on the conference call. Where do I find this. Posted by DeeAnn Hinkle on 12/12/2012 1:22 PM I did not receive the link to the slides from today's call. Can you send a link please? thanks, Marjean Posted by Marjean Heisler on 12/12/2012 5:28 PM Could you provide me with a summary of the discussion and learning points from the 12-12-12 conference call? Posted by gina new on 1/9/2013 7:34 AM I missed the 12/12/12 webinar. Can I obtain audio recording,or print out of this webinar? Thank you Anita Simons OTR Posted by anita simons OTR on 3/2/2013 7:37 AM Can I get a audio recording , or a print out of the webinar? Thanks Posted by cherri sanders on 5/14/2013 11:48 AM The webinar being referred to in this article was hosted by CMS (not APTA). APTA does offer resources on the functional limitations reporting. Please go to http://www.apta.org/FunctionalLimitationReporting/ (copy and paste this url into your web browser) to review these resources. Posted by APTA Staff on 5/14/2013 6:55 PM Hello, Can you please tell me how I can either obtain the material from the audio conference or get the material that was presented? Thanks Posted by cherri sanders on 5/24/2013 2:33 PM


text: Friday, January 11, 2013 Federal Government Affairs Leadership Award and APTA Public Service Award Nominations Due February 11, 2013 Do you know of an APTA member who in 2012 went above and beyond to advocate on behalf of the physical therapy profession at the federal level? Is there a legislator, staffer, or public figure who championed physical therapy causes in 2012? Nominate them for the Federal Government Affairs Leadership Award or the APTA Public Service Award. The Federal Government Affairs Leadership Award is presented annually to an active APTA member who has made significant contributions to APTA's federal government affairs efforts and has shown exemplary leadership in furthering the association's objectives in the federal arena. The APTA Public Service Award is presented annually to individuals who have demonstrated distinctive support for the physical therapy profession at a national level. Individuals from the following categories are eligible for nomination of this award: members of Congress, congressional staff members, members of a state legislature, federal agency officials, health and legislative association staff, and celebrities or other public figures. APTA's Board of Directors will select award recipients during its March 2013 conference call. Awards will be presented at the Federal Advocacy Forum to be held April 14-16, in Washington, DC. Please submit your nominations by Monday, February 11, to Stephanie Sadowski at email@example.com or fax to 703/706–8536. If you have questions, call Stephanie Sadowski at 800/999-2782, ext 3127.


text:
Monday, August 15, 2011
Being a difficult patient
In some sense I've succeeded. As a mother, I don't call the pediatrician's office after hours more than once or twice a year. Aside from making appointments, I only called my OB's office once: while in labor. But I also feel like I should advocate for myself a little bit as a patient, and I worry that sometimes might cause me to be perceived as annoying.
For example:
At my last visit to the OB/GYN, it was noted that I had my last pap smear six months ago. As such, the doctor told me I'd need to come back in six months for my next annual pap.
Now don't get me wrong, I love getting paps. I love having to pay for them out of pocket due to my deductible, I love waiting an hour to get in to see the doctor, and the exam itself is pure enjoyment. I wish I could get them every week. But in actuality, the guidelines from the ACOG say:
Women age 30 and older who have had three consecutive negative cervical cytology test results may be screened once every three years
And actually, the last doctor I saw before I moved a couple of years ago was a primary care physician who confirmed that I only needed to get this delightful test every three years.
So now I have two choices: I can either get an inconvenient and expensive test I don't need, or I can be that patient who shows up with the ACOG guidelines in my hand and explains why I'm refusing the exam.
50 comments:
Or you could start innocently by asking 'But I thought it was only needed once every three years? Why do I need it every year?'ReplyDelete
I don't think you're being difficult at all - there is probably a rude and annoying way of talking to your doc about this, but if you can do it tactfully and with respect (I bet you can!), then you are doing everyone a favor. You don't have to get an uncomfortable and expensive exam and the doctor can be kindly reminded that times have changed. I think it is important to resist overutilization of unnecessary care.ReplyDelete
I feel like this ob/gyn office is all about doing unnecessary tests. I already refused one test they wanted me to do because I felt it was unnecessary, so I feel like if I question them again, I'm definitely going to be marked as a "difficult patient."ReplyDelete
To be blunt: then why do you go there?ReplyDelete
Slightly longer:
If a patient shows up and points at accepted guidelines such as ACOGs, it's only right that we as their doctors explain why we want to act in discord with those guidelines. Hell, we HAVE to, the patient has to give informed consent to that pap smear or whatever, and we better be able to provide them with an explanation of why we're doing it.
I can see the 'difficult patient' scenario, but I also think it applies to truly difficult patients. You know, the one who would look at ACOG guidelines and wail "But I WANT a yearly pap smear and since I pay you, YOU'LL DO IT!" Or, alternatively, the one who would look at ACOG guidelines and yell "But I had a pap smear 16 years ago and it was FINE and this here is just big pharma crap so you can STEAL MY MONEY!"
Guidelines are there for a reason, but they are just that, guildelines. If your Ob/Gyn has a good reason to screen you more often, I'd say go for it. But he better give you that good reason first.
It kinda sucks that pointing out governing guidelines is "difficult." I'm a lawyer and if one of my clients pointed out a new case or law or whatever that was now the standard, they wouldn't be "difficult" by asking that I follow it. If that's all I have to do to be labeled a "difficult" patient, shoot me now.ReplyDelete
Snarky: I guess I just assume that if the gyn says I need the test, she believes it. And if I show her any guidelines, which I presume she must already know, it's not going to convince her otherwise, it will just be annoying. But I honestly can't believe I need it. I'm over 30, monogamous for many years, and never had a positive pap.ReplyDelete
- AnonymousAugust 15, 2011 at 12:53 PM
Be that patient.ReplyDelete
If your doc is worth her practice, she'll be fine with it. We all develop habits in medicine that we sometimes stick to without thinking hard enough -- I would hope I'm aware enough as a physician to not take challenges to little things like this personally.
I think it is reasonable to politely disagree with the guidelines as back-up. If you aren't comfortable speaking up about it (especially as a physician), then maybe you need to find a different OB/GYN. All of the GOOD doctors that we've worked with for my daughter's care (and there have been a great many), would be fine with this sort of polite discussion.ReplyDelete
I always phrase that sort of conflict as a money issue - oh, my insurance deductible is so high, maybe paps every 3 years would be enough?ReplyDelete
That usually seems to go over ok.
Of course I'm a poor med student, that might not work as well for an attending ; )
To clarify something I said earlier, the reason I'm more hesitant about this is because I refused to do the full testing for gestational diabetes, and I got treated like the biggest troublemaker in the world (by a covering OB/GYN, not mine). I even cited literature supporting my decision and the doctor made me cry.ReplyDelete
I try not to worry about being "that" patient or for that matter, "that" mother. What does that even mean? The informed one? The one who actually cares?ReplyDelete
For my last pregnancy, I could have been regarded as "that" patient. I needed some extra intervention in order to carry the pregnancy. Yet I declined all prenatal testing beyond the level II ultrasound and in general, tried to have the least amount of intervention possible, beyond what was necessary. It was like threading a needle, but my care providers were right there threading along with me or I would have been miserable.
Since your bad interaction was with a covering OB/GYN, not yours, I would try to let this go, while sticking to your guns about the PAP. I'm not a doctor, but I'm sure most docs sometimes have to be covered by other docs that they are not fully simpatico with. Maybe try to avoid the covering OB/GYN in the future while giving yours the benefit of the doubt, at least for now?
"I even cited literature supporting my decision and the doctor made me cry."ReplyDelete
That's terrible :(
Do they automatically schedule you in for an appointment? If they don't, I would just politely never get back to them about an appointment and in the meantime, find a better OB doc.
You can't worry about being "that" patient. This is your care we're talking about here. Of course be sweet.... with the caveat that we all know it doesn't really matter if you're sweet. Many doctors don't like to be challenged by anyone. Ever.ReplyDelete
You could also offer a compromise -- offer to be tested for HPV, and if it comes back negative, then you get to forgo the pap for the next 3 years. Also, you might want to provide your new ob with your old pap results so that she doesn't just think you're bs-ing her. Just a thought.
Fizzy, have you or will you write about your experience with gestational diabetes testing? I have a friend who refused testing for personal reasons (she is a very strict vegan and had read that the drink is not vegan-friendly...did you know white sugar isn't? I had no idea until I met her) and her doctor was so obnoxious and rude to her that she ended up leaving his practice mid-pregnancy and now plans on delivering at home with a midwife bc she feels she was denied her right to refuse care. He totally ruined her trust in every truly having a doctor on her side.ReplyDelete
As far as this goes, I can't see why she would consider you "difficult" if you brought up the guidelines. It's silly to pay money for something that you don't need. Ask her if there's a reason and if she can't give a good one then decline. Excess testing and excess treatment is no better than too little testing or treatment. Just talk to her!
OMDG: You hit the nail on the head... doctors do not like to be questioned. I suppose I could provide my last two paps for her, which would not be incredibly easy considering that practice was in another state, but I feel like she ought to believe me. When I told my PCP that I got my flu shot at work, they didn't require me to give proof of that.ReplyDelete
Danielle: I didn't write the story of my GD test here, but I wrote it up somewhere else. Since it seems to be of interest, maybe I'll try to find it and reprint it here. It was a really crappy situation and while I didn't abandon the practice, it gave me a bad feeling about them.
Fizzy, if she really believes you need the test, as you believe and I certainly hope, then it should take all of two minutes for you to ask, her to clarify and you to agree. Case closed, smear done, everyone happy.ReplyDelete
But if she doesn't have a reason, it'll probably get pretty obvious pretty fast. And if she doesn't, there's no reason for you to feel bad about it, when she should be the one feeling bad for pushing something on you that is in no way needed.
I'd be curious to hear a PCP or GYN reader weigh in on what conceivable reason the doctor might have for recommending the pap in the face of those ACOG guidelines?ReplyDelete
I admit I am a bit puzzled, if you had a normal pap six months ago, it makes no sense to do your "annual pap" in six months. Was HPV testing done? Was it positive? Am I missing something here? However, if you have not had a normal pap with your current provider (or any pap) it is certainly reasonable to bring copies of your most recent tests to your physician's attention. Could it be that your physican was referring to your annual exam casually as your "annual pap?" I find a lot of patients don't want to show up for an annual exam *unless* they think they are having a pap.ReplyDelete
While it is true, over the age of 30 with negative pap/negative HPV, you only need a pap smear every 3 years. As for the expense of the test, if it is done at the annual, it should be covered with the annual exam fee, should you need to have one done. Talk to your physician about your concerns! Usually I'm the one having to convince patients that they don't need a pap this year! You still need an annual breast exam and pelvic every year, though, so don't forget to do that! :)
Dr. Whoo: I did have a negative pap with this doctor six months ago so she had this on record. Never had HPV testing. It's possible I imagined the word "pap" when she just said "annual exam" but it's still confusing to me. She had just performed a breast exam that day as well as a pelvic exam, so why would I need to come back in 6 months for an "annual"?ReplyDelete
Also, is there evidence behind doing an annual pelvic exam? My PCP didn't do it.ReplyDelete
Oops! Reading comprehension! Also saw the part about your deductible, I sympathize! :) So you probably had your PP check, right? Which is a breast and pelvic exam to see how you are healing PP and included in your global fee, therefore, not technically, an annual exam, where preventative care is discussed etc. etc. If you wanted to push your annual out until 1 year from your PP check, that is well within reason, and then discuss the pap issue at that time. No difficulty involved. :)ReplyDelete
Annual pelvic is our best way to screen for ovarian CA, evidence based. PCPs don't like to do them. GYNs are the only ones who "go there." We also screen for skin abnormalities of the vulva and vagina. I've diagnosed a melanoma a time or two. Also diagnosed a colon cancer on pelvic exam. We don't just do a pap when we are doing pelvics!ReplyDelete
"If you wanted to push your annual out until 1 year from your PP check, that is well within reason"ReplyDelete
I wish she had said that to me.
Also, regarding the pelvic exam issue, when I was reading about it, I did see some articles saying that it may not be needed (http://www.liebertonline.com/doi/pdfplus/10.1089/jwh.2010.2349), although this is definitely a case where I don't know all the evidence. To play devil's advocate though: you've probably done hundreds of thousands of pelvic exams but it sounds like you only detected cancer a handful times. I don't think that's an example of a high utility test.
I agree with Dr. Whoo.ReplyDelete
I know that sometimes "pap" and "annual" are used synonymously by patients and providers, when they are 2 separate issues.
RH+: And what about the pelvic exam being needed yearly? Did you see the article I annoyingly brought to your office? :)ReplyDelete
Ha! I *am* a difficult patient.
Fizzy, far be it for me to browbeat you into showing up for an annual exam. If you don't want to do it, don't do it. If you are healthy and not having any issues then you are probably just fine to skip it. It's what is recommended as preventative health maintenance for women in our age group. You know, ounce of prevention worth a pound of cure and all that jazz. Do with that what you will. ;)ReplyDelete
I had the same question regarding this and my OB said that I need an annual pap and exam because I'm on estrogen/progesterone therapy (aka: birth control) as it can cause epithelial cell changes on the cervix hence necessitating pap smears yearly. But I didn't look it up, so it might be a "made up answer" (now reading your post makes me question it, am I a "difficult" patient then? lol)ReplyDelete
That said, I seem to have the most trouble with my OB (and not my PCP) when it comes to questions or explanations for what he wants to do and more importantly why. But although he gets squirmy about explanations I still ask only because I DO agree with his medical judgement and although I wait 1.5 hours for each prenatal appointment, I still like how he practices medicine. Sounds strange, I know. He has gotten used to me and we have been getting along. :) (although it was a learning curve). Maybe it's the OB profession in general, since they ONLY work with women and tend to try to minimize talking/explaining/complaints? otherwise they'd be there all day? or maybe some issues discussed are trivial in their minds since they consider themselves surgeons... I don't know...
Gyne resident here. Fizzy, I've totally been that patient. After having 5 UTIs in 6 months I went to student health for prophylactic (or self-treating)antibiotics. I was informed that "no, we don't do that here". I armed myself with the SOGC guidelines on treatment of recurrent UTIs in women and went back to my family doctor. He too, didn't want to prescribe. I felt badly being "one of those" patients who we all find frustrating, but I was tired of sitting in ERs in random places while on vacation.ReplyDelete
I think it's ok to be your own advocate when need be. A care plan should be agreed upon by both parties, and sometimes this means having an open mind as a physician.
As for the pap stuff, I can't see any good reason why your OB would insist. Is there perhaps a fear of litigation driving this? In canada the guidelines will be moving away from such frequent paps sometime in the near future.
Hmm, if this makes you qualify as a difficult patient, god knows what I am!! I've had a number of complications in my 2nd pregnancy, most significantly a spontaneous (non-traumatic) abruption, resulting in my now being on bedrest (4 weeks and counting; a topic for another day). And I am a nervous wreck.ReplyDelete
So now, instead of being a normal MD who plays everything down and acts in an evidence-based way, I am regularly calling my other MD friends to calm me down/give me reality checks. (Am I leaking amniotic fluid? Are these contractions close enough for me to go in? Do you think I'm having a silent re-abruption? etc)
So don't worry too much. Craziness is relative ;). I wish I could follow some guidelines right now!
I'm guessing she recommended the Pap because she hasn't done your last 3 Paps to be able to confirm that they are normal, has about 15 mins to see you, learn about your history of sexual partners/risk factors for HPV, and do your breast exam and Pap and whatever else. The reality is that it's just far easier for her to repeat the Pap than to track all those records down or ask you to do it and then follow up on whether you did it. My guess is that if you simply walked in with the path reports in your hand from the last 3 yrs, and therefore make it easy for her, she'd be delighted to skip the Paps and pick up a few mins in those visits to keep chugging through a busy day!ReplyDelete
- AnonymousAugust 16, 2011 at 3:47 AM
How much $ does the pap add?ReplyDelete
I think you may have your reason there, especially if usually women are obedient and insurance is paying.
- AnonymousAugust 16, 2011 at 6:59 AM
if they really make you feel bad, you should switch doctors. but just because i recommend something different than a patient ultimately does, doesn't mean i think they are difficult. ask any questions, explain your reasons if you still feel the same way, and then move on. he/she will too. if they don't, definitely time for a new doctor. i don't think i get the pelvic / pap distinction fully , as an aside.ReplyDelete
As a patient with a extremely complex (aka rare) disorder) believe me I worry about being difficult quite often to - some drs I know dont mind the questions, others I dont know how to read and still other drs I think avoid me and are plain afraid of my knowledge. (that sounds like I think I know it all which I dont but I have become very aware of the recommendations for my disorder and I am involved in my care and decisions which some providers just dont like) I am gladthat drs to feel these concerns because we as patients sometimes feel like some of our drs are extremely distant, cold and heartless to! Doctors who we see for years on end and quite ofen (I for instance receive a weekly enzyme replacemet infusion every monday and my rx;ing dr there will talk to the other pts there but will never come within 10ft of me bc these other patients (who I am friends with) dont quesiton his 'advice' while I do question it because of what other providers have told me.ReplyDelete
Anyway thanks for writing this!
Erica - MPS I
Regarding your comment about the utility of doing pelvic exams - while it is true that problems are picked up rarely, it is a low cost and low adverse event frequency test, which is ideal even if the incidence of whatever it is we are trying to pick up is very low.ReplyDelete
Even if we think ovarian cancer is rare (although it is among the top 10 cancers and top 5 cancer killers in women in the US, so in reality, it is not entirely rare) and even if the pelvic exam picks up only a few of them, it is still worth doing because it is inexpensive, low-tech, carries negligible risk of injury or harm, and yet can save a life.
Jess: Thanks for your input. It might be litigation driving it. Hopefully it's not income.ReplyDelete
Tempeh: It seems ridiculous to me to repeat a somewhat expensive test rather than tracking down the results. If we're trying to control health care costs, this seems really excessive. Besides, like I said, the doctor doesn't repeat my flu shot if I don't bring in documentation to show I got it. Isn't my own knowledge of my previous health interventions worth something?
White Coat Dreamer: I think there *are* costs and harms to doing the pelvic exam (w/o pap):
--The actual cost to the patient/insurance of the exam, which is not negligible
--There are many women who may avoid their ob/gyn due to not wanting yearly pelvics and thus not get other more useful primary preventions such as a breast exam
--False negatives picked up with this exam may lead to excessive testing for nothing
Dear Fizzy, we will have to agree to disagree on that issue, because if we apply your criteria, then virtually all preventive screenings can be dismissed in the same way, including the breast exams which you are encouraging.ReplyDelete
Unfortunately, this is one of many challenges we face on the public health front. I hope that with more of us having training and experience in public health (this is where MDs with an MPH, and/or added public health exposure in medical school and beyond are invaluable) we will be able to allay some of this skepticism towards and mistrust of public health research and initiatives.
The foundations of the recommendations for the annual breast exams, tri-annual Pap smears and annual pelvic exams are the same (i.e., public health research), so it seems a little odd to pick and choose which recommendations we follow based on nothing but subjective feelings.
It is hard to gauge how tone is perceived via written notes, so I just want to make it clear that nothing I have said is meant as a personal affront to or criticism of you or your position. Everything I have written is meant very cordially and in a collegial spirit. You have made it clear that you are seeking reasonable evidence and discussion on this topic, and that is certainly something I also aspire to do when in doubt.
White Coat Dreamer: I absolutely appreciate your intelligent thoughts on the matter and didn't take it as anything other than an interesting discussion. This is my response:ReplyDelete
A good screening exam is one that increases survival and in which the cost is justified. Obviously, we DO have to pick and choose which screenings we do, but it should be based on evidence, not subjective feelings. There are reasons why, for example, we don't do yearly X-rays to screen for lung cancer.
I don't know as much about this as some of the ladies on this blog, but I did cite that recent (2011) review in which multiple articles were cited that said pelvic exams were not useful for picking up ovarian cancer. Anecdotally, if a very skilled gyn like Dr. Whoo has picked up a couple of cancers in her career, does that justify the cost as well as all the distress from the test and false positives? It's all about numbers, and based on that article, the numbers don't support it. If you have to do 100,000 pelvic exams to pick up one actual case of ovarian cancer with god knows how many false positives, then that's not really worthwhile. And I'd suspect that at the point an ovarian cancer is big enough to be picked up by pelvic exam, it's probably advanced enough that this exam does not increase survival. (But like I said, I'm not an ob/gyn. I'm basing this on one review article.)
As for the breast exams, it's my understanding that this has more utility and less cost. But I don't know for sure.
It's also worth mentioning that most PCPs don't perform an annual pelvic exam, but do perform a breast exam. So are they setting themselves up for a lawsuit?ReplyDelete
You realize you gave me the warm fuzzies with all that epidemiologic evidence you just cited. Wish I had time to read them, but I have to finish writing my quals!
Fizzy, you are absolutely right, we do have to choose what screening programs we implement, and those programs change as the evidence changes. I am not an Ob/Gyn, though I did some Ob/Gyn preventive medicine research as a graduate student (before going to med school), and my data is likely outdated. I will try to look through what you have cited, and indeed if we don't lose valuable preventive benefits by not being poked and prodded every year, I am quite happy about that. ;)ReplyDelete
- Jacqui AustraliaAugust 17, 2011 at 12:07 AM
Um, has anyone on here even considered that this is a VOLUNTARY SCREENING tool, nothing more, nothing less? False positives anyone? Unneeded colposcopy/LEEP/Cone biopsies as a result of false positives? If you don't want a smear, calmly state to your doctor that you are there for whatever it is that you are there for, ask them to mark on your file you have made an informed decision NOT to have a pap and can you please now get on with the reason you are there. Do you see men getting harrassed to be checked for prostate or penile cancer like women are for cervical cancer? Never mind that prostate and penile/testicular cancer are MUCH, MUCH more common. Oh no, men just say "no thanks" and end of story. Check Dr. Andela Raffle's statistics and facts about this testing. 1000 women would have to test for 35 years to "save" one woman from cervical cancer. I am assuming all you guys know about the high rate of false positives for women under 30 etc, and the fact that virgins, women in long term mutual relationships, women with non cancerous reasons for having hysterectomies don't need to be tested.ReplyDelete
- AnonymousAugust 17, 2011 at 8:55 AM
A "good" screening test is informed by either individual or societal values. Apart from this, which makes any decision potentially gray, a good screening test needs to pick up people who would develop or progress to life-threatening or function-threatening illness (thus improving survival or a patient-important outcome) for which the course of the condition can be altered by early intervention or therapy. If there are too many false negatives, this is obviously problematic. If there are too many false positives , and either the screening test, subsequent workup for a positive result, or treatment has enough risk of harm, it may outweigh the potential benefits. But as all of this gets interpreted through the lens of values, you can arrive at different conclusions with the same data.ReplyDelete
- AnonymousAugust 17, 2011 at 3:29 PM
Bring up guidelines, say this, or say that, worry what the doctor will think . . . . No Means NO!ReplyDelete
I never worry about being a "difficult" patient. My body, my choice, or I'll be more than happy to introduce my doctor to my lawyer.
- AnonymousAugust 18, 2011 at 8:53 AM
I'm coming in late to the discussion, but I'm wondering - Is this a new thing?ReplyDelete
I'm still in my first trimester and went for my first prenatal appointment at 8 weeks. They told me at the time that I would need a Pap, despite a negative pap and HPV test 8 months ago and three prior negative annual Paps. When I told them that that wasn't the recommendation and that, indeed, I wasn't due for another Pap until 2013 bc of the negative Pap and negative HPV (according to current screening guidelines), the excuse I got was "Well, things can go sort of wild in pregnancy, so we need to do it anyway to make sure that you don't have something."
I've not been able to turn up anything on specific testing of pregnant women who've met the criteria for reduced screening. I submitted to the test because this practice is the best / most convenient option for me and I didn't want them to refuse to see me. I just wish they'd practice on guidelines instead of trying to CYA instead.
I do think it's worth mentioning that all of this went down before anyone sat down and took or had me fill out a sexual history to determine my "risk." This didn't happen during my first pregnancy (in fact, I went almost 18 months without a Pap that time!).
Anon @ 8:53: That's interesting you say that, because I did get paps during both pregnancies, even though I wasn't due for one. I didn't ask about it because I was already at the office and it wasn't a big deal. But it does seem like everyone I know has gotten a pap during pregnancy, like it's a standard thing. I don't know what the guidelines are on pregnancy and paps.ReplyDelete
It is standard of care to have a pap (perhaps more importantly swabs are taken for chlamydia/gonorrhea during this as well) as a part of your prenatal care.ReplyDelete
Makes me wonder if the Obs were just using the word "pap" in place of GC/Chlamydia screening since "pap" is less emotionally laden, and the procedure is similar.ReplyDelete
Jess: So if I had a negative pap in May and got pregnant in April, would I need another? If so, why?ReplyDelete
- AnonymousAugust 20, 2011 at 11:24 AM
I think Old MD Girl hit the nail on the head with that one. I had a friend who was very upset that they did a bunch of STD testing on her for her first pregnancy as her and her husband had only ever been with each other sexually. As cynical as I am, it's one of the few cases where I actually believe that is true. I told her that even knowing her and her husband as well as I do, I'd have done the testing if I was in her doctors position, because too many partners have trouble being honest w/ each other or their doctors about sexual activity and my obligation would be to protect the safety of the child first and foremost. I told her about the number of positive pregnancy test my lab has done on people who 'had never had sex'.ReplyDelete
It can be a very sensitive issue.
- AnonymousSeptember 1, 2011 at 6:06 AM
According to the CDC, there is no reliable, cost-effective, non-invasive method of screening for ovarian cancer. That includes pelvic exams. Look it up. The blog Science Based Medicine included an article re: whether the pelvic exam should be abolished from the annual exam because it's useless in asymptomatic women.ReplyDelete
Just another reason not to see an OB/GYN for routine primary care.


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