Editobs' Note: Each year thousands of lives
are saved by America's dedicated surgeons using
remarkable techniques that were hardly dreamed
of a few decades ago.
But despite these advances, recent studies of
hospital records indicate a "substantial amount"
of unnecessary surgery is being performed. For
example, one-third of the hysterectomies (re
moval of the uterus) were considered needless
when reviewed by medical authorities.
How can you be sure that when a doctor rec
ommends an operation, it is really essential? To
get the facts, Family Weekly assigned veteran
medical writer Theodore Irwin to interview
Dr. F. J. L. Blasingame, a prominent surgeon
and Executive Vice President of the American
Medical Association. Here are the highlights
of that interview, which was conducted at the
A.M.A. headquarters in Chicago.
Q. How can it be determined if an operation
was unjustified. Dr. Blasingame?
A. All accredited hospitals have tissue com
mittees to review and evaluate cases. When the
hospital's pathologist reports that normal tis
sue was removed without a sound clinical rea
son, it is obvious the patient could have been
spared the operation.
Q. Are most of the "needless" operations '
performed on women?
A. Perhaps. Women's symptoms frequently
are more difficult to evaluate than those of men.
For instance, a woman's pelvic organs are a
source of a great variety of symptoms, and there
is often fear of cancer in the ovary or uterus.
When a woman patient insists she wants "some
thing done," some doctors may yield and operate
unnecessarily. For this reason, conscientious
physicians, the A.M.A., and the specialist so
cieties stress the importance of a doctor becom
ing aware of the many pitfalls in diagnosing
pelvic conditions.
Q. What can be the consequences of an avoid
able operation?
A. Host surgery can expose a patient to the
risk of infection, hemorrhage, residual pain, or
scarring both physical and emotional and,
of course, there's also the waste of money
and time.
Q. Is more surgery being performed today
than in the past?
A. In certain categories, yes. With antibiotics
and other improved supportive measures, the
hazards of surgery are less and people can
tolerate procedures which they couldn't before.
For instance, 10 years ago many present heart
operations would have been considered useless.
On the other hand, mastoid operations are
practically a thing of the past.
Q. What impels a doctor to undertake an
operation that proves unwarranted?
A. Reasons vary with the disease, the doctor,
and the hospital situation. When any one of a
dozen things could be wrong, even the ablest
doctors may have difficulty in diagnosing. Some
times an absolute diagnosis is impossible. Even
after lab tests, the correct answer may not be
forthcoming. The doctor does the best he can.
IS THAT
OPERATION
NECESSARY?
By THEODORE IRWIN
There's a lot of talk about
needless surgery; to get the
facts, this veteran reporter
interviewed a respected leader
of the medical profession
k 4
Q. Have tonsillectomies been overdone?
A. Not at all. On the contrary, I'd say that
since the advent of antibiotics, tonsillectomies
have been on the wane.
Q. How about the vogue for gall-bladder
operations?
A. Gall-bladder surgery should not be taken
lightly by either the patient or surgeon. It can -be
a hazardous procedure because of the rich
blood supply and complicated anatomy in the
area and because of the postoperative risks. In
doubtful cases, a patient is entitled to have all
the tests done for him.
Q. And Caesarean sections in pregnancy?
A. Here, an unnecessary operation can often
be attributed to the patient's demand for it be
cause she wants to avoid the ordeal of having
her baby through the birth canal. Some ob
stetricians may encourage Caesarean sections,
but hospital staffs usually keep an eye on the
rate. The need depends on the size of the pelvis
and the baby. Unless indications for surgery
are obvious, a good obstetrician will often first
give his patient a test of labor before suggest
ing a Caesarean.
Q. How can I make sure that an operation
is really essential?
A. You should depend on professional judg
ment, not the advice of friends or neighbors. If
there's any doubt in your mind, tell your doctor
and ask to be examined by another physician
(one who is experienced and well trained) to
obtain an Additional opinion.'
Q. How can I check on the surgeon selected?
A. Call your county medical society and find
out if he is on the staff of a good hospital.
Q. Couldn't I look up the surgeon in a medi
cal directory?
A. You could learn something about him from
the list of his affiliations, but the average lay
man will find it hard to interpret the informa
tion in a medical directory. A doctor can pass
every exam, yet his "batting average" may not
be high. There's much more to a doctor than
may appear on the printed page.
Q. Suppose I don't want to use the surgeon
recommended to me?
A. Assert yourself. We have freedom of medi
cal choice in this country.
Q. How can a patient tell if a surgical fee is
reasonable?
A. You could compare it with those charged
friends or relatives for a similar operation. If
you believe it's too high, discuss it with the
surgeon or change to another competent man
who can do the job within your means.
Q. Does a patient have any recourse if he
strongly suspects his operation was unjustified?
A. You can make a complaint to the grievance
committee of the hospital or your county medi
cal society. Give them the full details. Re
member, you must be willing to confront the
doctor personally with your charges.
Q. What results can be expected?
A. When a doctor is proved habitually dis
honest or grossly incompetent, he can be dis
ciplined and have his hospital privileges re
voked. If you still are not satisfied, you can sue
for malpractice.
Q. And your final advice to patients?
A. Select your regular doctor carefully and
get to know him long before illness strikes.
Look upon him as a friend and confidant. De
velop a good rapport with him so that you can
depend upon his integrity and judgment if you
should ever have to undergo surgery.
COVER:
Beryl Simpson of Quincy, Mats., photo
graphed by Arthur Schatz, is part of an
exciting scientific project she dyes sea
Hulls! For the reason why, turn to page H.
Family
Weekly
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