Surgery as a means of saving lives and alleviating suffering has been performed for centuries, but has historically always been considered as painful and dangerous and only used as a last resort. With the advent of anaesthesia and pain relief, the understanding of the nature of infection and it's prevention and treatment, and the ability to manage blood loss, surgical treatment for many diseases became the norm. Improvements in surgical techniques, equipment and aftercare have lead to the impression amongst doctors and patients that operations are always safe and effective. They are not!
All operations have risks. All operations have potential short and long term consequences. Not all operations achieve the result that the patient expects. The difficulties are quantifying the risks, identifying the consequences, and developing real expectations.
Most of medicine involves balancing the risks against the benefits, and considering the alternatives. In some areas this can be very difficult. Hormone Replacement Therapy, for instance, requires the patient to balance a risk to Duration of life ( which is still not quantified), against the benefits to Quality of life (which may be miraculous) considering the alternatives (often ineffective) Most surgeons readily appraise their patients of the virtues of proposed surgery, and will inform of the known risks, but often have limited experience with the alternatives.
In gynaecology, some areas that were traditionally managed surgically can now often be managed conservatively. Improvements in availability and delivery of hormonal treatments has improved menstrual control (Mirena). Better diagnostic services have allowed us to avoid exploratory operations and operations for benign processes (3D Ultrasound). Some old fashioned treatments have been revamped and improved (e.g. (Pessaries) for prolapse control).
Colin Pearse
