title: Specialty-Specific Values Affecting the Management of Symptomatic Uterine Fibroids.
abstract: OBJECTIVE
  To better understand why interventional radiologists and gynecologists differ in their approaches to symptomatic uterine fibroids.
  
  
  METHODS
  Conversational interviews were conducted with 26 interventional radiologists and gynecologists about their professional roles, clinical reasoning, and practice variation within and outside their specialty. Interview transcripts were systematically analyzed using NVivo 10 software (QSR International, Burlington, Massachusetts) according to grounded theory and content analysis to identify key themes and compare themes across specialties and practice environments. Data were supplemented with retrospective analysis of 7,659 patients with symptomatic uterine fibroids treated at a large academic center over 11 years.
  
  
  RESULTS
  Interventional radiologists' shares of symptomatic uterine fibroid treatment and endovascular stent treatments have remained constant (P > .05) for 11 y at a large medical center, whereas minimally invasive gynecologic fibroid treatments and the percentage of interventional radiology (IR) procedures reimbursed by Medicaid/Medicare have increased significantly (r > .90, P < .001 and r = .93, P < .001). Interventional radiologists and gynecologists shared a commitment to do "the right thing" for patients, but each group possessed distinct professional values affecting how they viewed medical evidence, outcomes, and their colleagues. When differences were apparent and concerning, physicians tended to suspect ulterior motives not in patients' best interests.
  
  
  CONCLUSIONS
  Interventional radiologists and gynecologists demonstrated wide-ranging perspectives regarding their role in caring for patients with symptomatic uterine fibroids. To promote genuine collaboration and adoption of shared goals, stakeholders should seek and promote a deeper understanding of specialty-specific values and culture.
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611; Department of Medical Humanities & Bioethics Program, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Keller
authors.affiliation: Department of Medical Humanities & Bioethics Program, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611.
authors.forename: Megan
authors.initials: M
authors.lastname: Crowley-Matoka
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Collins
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611.
authors.forename: Howard B
authors.initials: HB
authors.lastname: Chrisman
authors.affiliation: Department of Obstetrics and Gynecology-Reproductive Endocrinology & Infertility, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611.
authors.forename: Magdy P
authors.initials: MP
authors.lastname: Milad
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611. Electronic address: vogelzang@northwestern.edu.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Vogelzang
mesh_terms: D000046:Academic Medical Centers; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D005260:Female; D006176:Gynecology / Q000639:trends; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007044:Hysterectomy; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D010535:Laparoscopy; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D010348:Patient Care Team; D010818:Practice Patterns, Physicians' / Q000639:trends; D000072177:Radiologists / Q000523:psychology / Q000639:trends; D015642:Radiology, Interventional / Q000639:trends; D012189:Retrospective Studies; D013038:Specialization / Q000639:trends; D066231:Surgeons / Q000523:psychology / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D055357:Uterine Artery Embolization; D063186:Uterine Myomectomy; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*