Surgery in the absence of pathology the relationship of patients' presentation to gynecologists' decisions for hysterectomy.
OBJECTIVE
To test predictions from a theory about patients' influence over doctors' treatment decisions when physical symptoms are presented in the absence of physical pathology.


METHODS
We audiotaped 88 gynecological consultations of consecutive patients who presented menstrual symptoms without pathology. Each consultation was coded according to a scheme, developed from previous qualitative research, which identified specific strategies of patients and gynecologists. The occurrence of each strategy was compared between consultations in which hysterectomy was decided upon (N=15) and those leading to conservative treatment.


RESULTS
Consultations were more likely to lead to hysterectomy if patients deployed specific strategies, including reporting social effects of symptoms, catastrophization, requesting surgery and citing clinical or lay authority in support. Each strategy could account statistically for gynecologists' perceptions that decisions for hysterectomy reflected patients', rather than gynecologists', influence.


CONCLUSIONS
The findings are consistent with the theory that, in the absence of physical pathology, patients deploy specific strategies that influence gynecologists to offer surgery.
Salmon
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Department of Clinical Psychology, University of Liverpool, PO Box 147, Whelan Building, Brownlow Hill, L69 3GB, Liverpool, UK. psalmon@liv.ac.uk
Marchant-Haycox
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D000328:Adult; D005260:Female; D005831:Genital Diseases, Female / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D006304:Health Status; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D011602:Psychophysiologic Disorders / Q000175:diagnosis* / Q000523:psychology*; D016896:Treatment Outcome