The Endangered Uterus

If your doctor has recommended a hysterectomy, don’t make a decision until you read this startling report on the real risks of surgery and the less-invasive alternatives your ob-gyn may not be mentioning.

If doctors should be moving beyond their comfort zone for the sake of better patient treatment, so should women. "No matter how much you love your ob-gyn, it’s time to rethink the idea that the doctor who delivered your babies in your 20s and 30s should be the same one who deals with your pelvic pain in your 40s and 50s," says Grace M. Janik, MD, president of AAGL’s fellowship board. "If you have a problem, you need to ask how many cases like yours the doctor has handled and who she knows who’s done more of them. Your own doctor may be able to treat you. But you must ask yourself, is she the best person out there for this job?"

That’s what Hope Waltman, 45, did when, in 2001, her longtime ob-gyn determined that fibroids were causing her painful periods and immediately proposed major surgery. "He really didn’t talk about any possibility except abdominal surgery," says Waltman, who lives in Carlisle, Pennsylvania.

Unnerved by the idea of a major operation, she researched fibroids and found a treatment that piqued her interest: uterine artery embolization. "I went back to my doctor and asked him about UAE. Only then did he pull out pamphlets about the procedure. He told me it was new, that his office didn’t do the procedure, and that he didn’t know of anyone he could refer me to. You could tell he wasn’t happy to even discuss alternatives," Waltman says. She eventually found another doctor, underwent UAE, and has been symptom-free ever since. "My ob-gyn had been my doctor for 15 years. I don’t know if it was that he was arrogant or that he didn’t want to lose business, but I couldn’t believe how unwilling he was to provide me with information. It just made me so blasted mad, I never went back."

Your Right to Know

If ob-gyns don’t develop skills that may inflict less pain on their patients, are they doing anything wrong? No, says bioethics professor Arthur Caplan, PhD, of the University of Pennsylvania. "A doctor takes an oath to offer treatment he can perform safely and that will relieve a patient’s symptoms." Open abdominal hysterectomy meets those criteria. However, when a doctor like Hope Waltman’s fails to inform the patient that other procedures exist, even if he prefers not to perform them, that omission violates a patient’s right to informed consent. This cornerstone of modern medical ethics requires physicians to inform patients of all reasonable treatment options, Caplan notes. The informed consent requirement is spelled out in ACOG’s code of ethics. But ACOG, which defines itself as a voluntary membership organization, "does not monitor its physicians" regarding their adherence to the code, according to a spokesperson.

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