Consumer advocacy, elective surgery, and the "golden era of medicine"

Article Abstract:

In the 1960s and 1970s minimum standards of medical practice were developed in an effort to improve the services available to the public. With the creation of quality assurance, the medical profession has become consumer-oriented. Many physicians believe this consumer advocacy movement means an end to the 'golden age of medicine,' while others see it as a logical conclusion. Although most physicians remain dedicated to improving the quality of life and relieving suffering, the fact remains that physicians sell services to customers for money. Consumers must be protected from ineffective, unsafe or expensive medical practices as they are with other consumer goods and services. Surgical procedures should receive evaluations similar to the extensive drug trials required to test safety and efficacy of drugs. Many surgical techniques are incorporated into practice without controlled investigations and with only the passage of time as a monitor of effectiveness. For example, hysterectomy for sterilization was performed routinely until it was found that the operation was not cost-effective. Similarly, hysterectomy for the prevention of incontinence was performed routinely until the procedure was found not to improve the cure rate. Conservative surgery for certain types of infertility was found not to improve pregnancy rates. Standardization and testing for procedures, indications and surgical outcomes are desperately needed. The appropriateness of surgical procedures can be evaluated by using the mnemonic PREPARE: Procedure (what is being done), Reason or specific indication, Expectation (desired outcome), Probability that the outcome will be achieved, Alternative and nonsurgical options, Risks and side effects of the procedure, and Expense. (Consumer Summary produced by Reliance Medical Information, Inc.)

Standards, Evaluation, Consumer protection, Surgery, Surgery, Unnecessary, Unnecessary surgery, editorial

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Demographic and historic variables in women with idiopathic chronic pelvic pain

Article Abstract:

Idiopathic chronic pelvic pain (pelvalgia) in women is characterized by pain lasting longer than six months that has no identifiable cause. Some have suggested that psychological factors, particularly an experience with sexual trauma or depression, may play a role in pelvalgia. To clarify this issue, demographic data and reproductive histories were compared for 106 women with chronic pelvic pain and 92 women without such pain attending a US naval hospital. The women were similar with respect to race, number of previous pregnancies, deliveries and abortions. Spontaneous abortion was more common in the women who experienced chronic pelvic pain. Women in this study with idiopathic pelvic pain were more likely to have been involved in active military service, to have had previous nongynecological surgery, to have used more prescription medications and to have had a history of psychologically-based physical complaints. Multiple sexual partners and psychosexual trauma (molestation, incest and rape) were more common among women with chronic pelvic pain. Since it appears that there is a psychological basis for chronic pelvic pain, women experiencing pelvic pain of unknown etiology may benefit from psychological evaluation and therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Causes of, Diseases, Intractable pain, Pelvis, Pelvic pain

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