After a short statement on unnecessary surgery, the background of the ripple effect of the McCarthy report of 1974 was briefly summarized. A review of the vaginal hysterectomies on my service for 1971 through 1976 revealed that hysterectomies for functional diagnoses comprised 46percnt; of the total and that hysterectomy for sterilization is now the third major category. Many patients had anatomic lesions such as fibroids, adenosis, or relaxation, but indications for hysterectomy, as agreed on by patient and physician, were functional. The operations should be consistent with the preoperative diagnoses. Second opinions are only a second physician's opinion, but they can be very helpful in controversial problems. Hysterectomy per se can offer more to the ldquo;quality of liferdquo; than any other single operation.
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