Monday, March 22, 2010

How to scare a patient into agreeing for surgery

Fibroids are very common in infertile women. Most are intramural fibroids , which are present in the wall of the uterus) , and these do not need to be removed prior to IVF, as they do not affect embryo implantation. You can read more about this at It is only submucous fibroids ( those which are in the uterine cavity) need to be removed. These can be best removed with an operative hysteroscopy.

Unfortunately, most doctors have itchy fingers and are happy to operate at the drop of a hat.

The following combination of facts adds up to a trigger-happy situation

1. Fibroids are very common in infertile women
2. Infertile women are desperately seeking a reason for their infertility, so the doctor can "fix" the problem and help them to have a baby
3. Modern ultrasound scan machines with their zoom functions are excellent at picking up small asymptomatic fibroids which are of no clinical importance
4. Sonographers are happy to report these findings as abnormalities. Usually, the fibroids are measured in mm rather than cm, so they seem to be even bigger than they really are
5. No one bothers to explain to patients that fibroids are very common in fertile women; that most of them do not affect fertility; and that surgery can actually reduce their fertility
6. Gynecologists are trained to operate - and are very happy to do so ! This is far more profitable than reassuring the patient or advising watchful waiting ! Many will justify their advise for surgery by saying - If I do not operate, then someone else will, so I might as well do the surgery myself !
7. The surgery involved is a " simple " laparoscopy. which does not need the doctor to ut open the belly. This is "minor surgery" , which is done on a day-care basis, so why not just fix the problem since the solution is so simple !

In fact, many gynecologists actually end up scaring patients into saying yes for surgery. They take advantage of the patient's ignorance, and trot out a large ( and very creative list !) of reasons for why surgery is the best solution for them.

This includes the following reasons, none of which are the unalloyed truth.

The fibroid needs to be removed now, because ( choose one or more of the following) :

It will grow during pregnancy and become even larger
It will compress the baby; prevent the baby from growing; and will cause growth retardation
It will cause a miscarriage
It will cause preterm labour

The advise seems to be - removing the fibroid may not help your fertility, but it's still a good idea to do so, because some fibroids can cause problems during pregnancy, so why take a chance ? Most infertile women are very emotionally vulnerable, and are happy to do everything they can to prevent problems during their much-awaited pregnancy. This is why many happily sign up for "preventive surgery" - without reaslising the risk they are running !
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1 comment:

  1. Anonymous11:07 AM

    Dear Sir,
    This is such a fantastic and informative blog. I have to give my regards to you and I think more doctors should communicate this way.

    I was happy to read about fibroids as it is been affecting me. I am 27 years and first found out about it while I was 24. I had 2 intramural fibroids then which were around average dia of 3 and 8 cm each. It was shocking to discover it then. I had absolutely no symptoms.

    But over the last year i could feel a definite bulge on my stomach. Now i find that the 3 cm fibroid has become 11 cm and the other has just become 9 cm.

    Even though my doctor here in delhi had at that time advised me to wait and watch. She has asked me to consider myomectomy.
    I still have no major complaints other than little discomfort.

    Both these fibroids are still not said to affect any organ acc to my CT.

    I am single still and not likely to be married for the next 1.5 years.


    Thank you sir


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