Listen: Physicians

Dr. William A. Nolen discusses problems in potentially unnecessary surgeries, specifically hysterectomies performed on women.

Nolen is author of the book “The Making of a Surgeon.”


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ROSEMARY DILLON: Nolen has cornered the market for books about doctors and medical training. First, with The Making of a Surgeon and just recently with A Surgeon's World. But Nolan says that's the end. He doesn't have anything more to write about.

After his speech Monday night, I talked with Nolen about another author Herbert Denenberg, who wrote A Shopper's Guide to Surgery. Denenberg claims 2 million Americans undergo unneeded operations every year. He lists 14 rules to avoid becoming a victim. Like transplant surgeon John Najarian, Nolen questioned Denenberg's figures. But he said peer review breaks down when surgeons are hesitant about reporting on each other.

WILLIAM A. NOLEN: If I see somebody doing an operation that I don't think is necessary, I'm very reluctant to go to that man and say, cancel that case. You shouldn't be doing it because you see them in a position where first of all, his patient wants him to do the operation. He'll say it's just jealousy on your part. It's a matter of opinion whether that operation should be done. That's why I think peer review is fine except that it's not good enough.

We have to have people who are not involved in it at all. We have to have laymen and laywomen on the board who can say, look, how come this guy is doing so many hysterectomies, and how come so many of those uteruses are normal? Now that's what we need.

ROSEMARY DILLON: He makes the comment that the disadvantaged persons are more likely to suffer from unneeded operations. For example, the poor people who don't have access to the medical care system. And he also includes females as an underprivileged minority.

He says the hysterectomy has become the equivalent of a tonsillectomy. You mentioned that. Do you want to comment further on that?

WILLIAM A. NOLEN: Well, women have uteruses and men don't. And most surgeons are very careful about taking off testicles. But they're not so careful about removing ovaries or taking out uteruses.

The odd thing about the uterus is that you can't feel it, if you're a woman. And you can't see it. You have to take the doctor's word for the fact that there is something the matter with it.

If you have gallstones, you can hold up the X-ray and say there are your gallstones. See them? Or if you have a cancer of the bowel, you can hold up the X-ray and say, see that tumor in the bowel. That's pretty good evidence that there's something the matter with it.

But a woman comes in, and she has a pelvic examination done. And the doctor says, you have a fibroid, and you should have it removed. Now she doesn't even know she's got that fibroid It may not be causing any symptoms at all. And she's very wary of this particular opinion.

It's a very strange organ, really. And you can live without it, of course. And I think that there is a tendency in surgeons to get a little bit knife happy and do hysterectomies unnecessarily.

I'll tell you, let me give you an example. I got a call, I was in Boston last week, from a woman who had gone to a-- she was from Maine, as a matter of fact. And she called me up in a state of panic.

She'd gone to her internist, and her internist had said, look, routine examination. You have fibroids in your uterus. They weren't bothering her at all.

He said, you don't need surgery. But I'm going to send you to a gynecologist anyway, because I like him to check it, in case you have trouble later. So the gynecologist examined her and said, oh, boy. You've got fibroids in your uterus. You'd better have your uterus out.

And she said the internist still doesn't think she needs a hysterectomy. But the gynecologist's philosophy is that if it doesn't belong there, if it's not normal, it should be removed. And she called me to help her decide.

And I said, well now, look. If I were you, I would get another opinion. Ask somebody else.

She said, I wouldn't do that. She said, I don't want to hurt his feelings. He's a very nice man.

And I said, well now, look. It's your uterus. You don't want an unnecessary operation.

You're unsure about it. Go. By all means, go.

Well, I don't-- whatever happened to that woman. But it's really pitiful that she has to call me because she was concerned about it. And she was afraid that the gynecologist would get furious.

And the fact is he probably would have gotten furious. Some doctors are like that. They can't stand to have their opinions questioned.

ROSEMARY DILLON: But what's going to happen to that poor woman? If another doctor recommended no surgery, there she is with two conflicting experts, what does she do now? Continue shopping around for another opinion?

WILLIAM A. NOLEN: You see, that's up to her. This is one of the things that was brought up in, what's his name's, article. There's a point.

There are times when you don't need a consultation, obviously, like the gallstones. There are other times when the treatment can be medical or surgical, for example with an ulcer or a hysterectomy. Some point, she has to have some faith in the person. I think if she finds somebody in whom she has confidence, she ought to take his word for it. This stuff is very iffy, anyway.

ROSEMARY DILLON: Nolen writes about medical problems each month in McCall's magazine. He told me his next book will be a children's book, and he hopes to have it ready by August. This is Rosemary Dillon.


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