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Thursday, March 18, 2010

Her uterus is intact: An alternative to hysterectomy

Shelly is an Iowa native and a 42-year-old mother of two daughters. She trained to be a schoolteacher and later worked as a pharmaceutical representative. She is savvy and understands the business of health care. Her Ob-Gyn in a three-physician office practice in her hometown diagnosed uterine fibroids. The doctor told her that her only option was a laparoscopic hysterectomy.

Shelly describes what happened next. "I didn't want a hysterectomy, so I asked about less invasive methods that would leave my uterus intact and get rid of the fibroids. The doctor made fun of me, repeating 'less invasive methods' mockingly. Then she said, 'When that fibroid grows up over your belly button, you'll come running back!' I asked her whether my ovaries and cervix would remain, and she said, 'Well, I guess we could leave them." Shelly was indignant that anyone would remove perfectly healthy organs. She thought to herself, "my ovaries and cervix are perfectly fine!"

Not satisfied, Shelly saw another doctor in the practice who came to the same conclusion. Laparoscopic hysterectomy. So did the third doctor in the same practice.

"I wanted them to know that I'm not the average cabbage that fell out of the truck, so I asked for a copy of my medical records and the ultrasound so I could search for less drastic alternatives. They said, 'We only give records to our obstetric patients.' I was floored." Shelly knows that patients have a right to a copy of their medical records. When she called her insurance company to find out how the doctor's office could withhold her medical records, the company representative put her in touch with the state medical licensing board, which gives doctors their licenses to practice medicine. Shelly spoke to a representative of the licensing board. "I don't know what this person did," she says, "but within a day I had my records."

In the records she saw that the second doctor had written that she spent 45 minutes discussing treatment alternatives to laparoscopic hysterectomy. "That was a lie," Shelly says. "She spent 10 to 15 minutes with me and didn't tell me about my options. That's because it would be money out of their pocket if I chose an alternative treatment that these doctors didn't do. All they did was laparoscopic hysterectomies, so that's what they recommended. I think it's a conflict of interest for them to steer people toward certain procedures because that's what they know and that's how they make money."

Shelly thoroughly researched treatment options and found a less drastic alternative that she believed was best for her. Her uterus is intact, and she is pleased with the results. "It's not enough for patients to know treatment options and their risks and benefits," she says. "You have to understand the business of health care." Because Shelly had worked in health care, she understood that she was led down a treatment path that might be good for the doctor's business but not for her. When asked what happens to people who don't have the skills she has, she quips, "They will have everything ripped out."

Advice: Be aware of physicians' financial incentives.

Read a story about unnecessary treatment. Thanks to Rosemary Gibson for this story, reprinted from her excellent new book, co-authored with Janardan Prasad Singh: The Treatment Trap: how the overuse of medical care is wrecking your health and what you can do to prevent it.

1 comment:

Anonymous said...

I went through a very similar thing with the DRs at a local hospital here. They wanted to just take everything out. He said you are done having children, you don't need it!! If it were my wife I would do the same!
I requested my records, and I was told the DR's here will refuse to see if you do that. Well, yea! I want my Records, so I did manage to get them and went to a different DR. I did have to have one ovary/cyst removed. But, I did get to keep everything else. I am in my early 40's.