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Adenomyoma and the like From: Douglas Krell (sfth@roadrunner.com) Mon Jun 3 00:14:40 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: D. G. Huffman: "Toxic exposure to a pregnant patient" Previous message: OBDocRick@aol.com: "Re: GBS Patient education from the CDC" Dr. Helm wrote: I strongly feel that far two many > >"wallet biopsies" are being performed on women in this country Dr. Hill wrote: > I'm always dismayed at the referrals I get for women with small and > asymptomatic fibroids that are found on ultrasound, Many of these women have been > conditioned to think "hysterectomy" In my practice, the management of asymptomatic leiomyomata is always conservative and involves giving patients an ACOG pamphlet, drawing them a little picture of where I believe their fibroids are located, and estimating for them and for the chart, the size of the uterus. They are cautioned about abnormal bleeding or symptoms of pain and are followed on an annual basis. None of these women seem to ask for hysterectomy at this time. Some patients will then return at a future point and complain of pelvic pressure, dyspareunia, or abnormal bleeding. At that time, when the patient is motivated and they have an understanding of the possibility of hysterectomy as an answer to their suffering, do we offer the surgery. I've found only a handful of patients who have told me that they felt that their uteruses were removed unnecessarily. The majority felt that the operation was a solution to a problem whether real or perceived...and how are we to ever tell the diference? Perception is reality. The question is how can we change perception. Mostly through education. A few patients will begin to become symptomatic just knowing that they have fibroid tumors and will ask for surgery, but not many. Most people wait til the last minute. This is all just to say that I don't believe in my community, we are doing "wallet biopsies", and our patients seem to be informed enough to consider hysterectomy only when the symptoms warrant it. -- Douglas Krell MD sfth@roadrunner.com private practice Santa Fe, N.M. Next message: D. G. Huffman: "Toxic exposure to a pregnant patient" Previous message: OBDocRick@aol.com: "Re: GBS Patient education from the CDC"

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