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Joel C. Pittard, MD
Lee Obstetrics & Gynecology, PA Opelika, Ala

JAMA. 1981;246(20):2321.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

The article "Physicians Measure Up: A Study of 13 Surgical Procedures" by Elliott et al (1981;245:595) points out the difficulty in determining if surgery is necessary. The Colorado Professional Standards Review Organization was unable to select adequately consistent criteria for the gynecologic procedures studied, ie, dilation and curettage (D&C) and abdominal and vaginal hysterectomy.

For example, one criterion given for hysterectomy was "continued severe bleeding with several menstrual periods and two nondiagnostic dilation and curettages." However, the criteria for uterine D&C do not include treatment (nondiagnosis) of bleeding disorders. This implies that although D&C is not an indicated method of treatment for severe bleeding, it must be performed twice (unnecessarily?) before resorting to hysterectomy as a cure—a definite Catch-22 situation.

Additionally, the listed indications for abdominal and vaginal hysterectomy are mutually exclusive with the exception of "malignant lesions of the uterine cervix" and the previously mentioned bleeding . . . [Full Text PDF of this Article]

Footnotes
Edited by John D. Archer, MD, Senior Editor.

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