Cries and whispers. Presidental address.
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Biomedical subjects
Publications and source records attributed to K P Russell.
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The mere presence of uterine fibroids is not, since qua non, an indication for their surgical removal. Knowing when not to operate is probably more important for the physician than knowing when to operate. It is easy to fall into diagnostic and therapeutic traps when uterine fibroids are known to be present, especially when they occur concomitantly with a condition such as irregular uterine bleeding, infertility, or pregnancy. The contributions of such conditions to problems in diagnosing and managing fibroids must be kept in mind by the prudent physician; a decision in favor of medical rather than surgical management is often best.
The regionalization and consolidation of obstetric-gynecologic services, especially maternity services, is a significant current trend in our specialty. The concepts of consolidation and regional organization are interdependent and interrelated, and the movement has received impetus from economic considerations as well as the needs for organizational efficiency. Regionalization and consolidation of services are also consistent with the stated goals of The American College of Obstetricans and Gynecologists which call for the assurance that adequate obstetric-gynecologic care is available to all women, through (1) solutions to the problems of maldistribution of personnel and facilities, and (2) reductions in health-care costs by the more efficient utilization of personnel and facilities. Activities in this field have been enhanced by the interests of such health-related entities as the National Foundation-March of Dimes and the Robert Wood Johnson Foundation in these studies. It is mandatory that progress in this activity be dictated by practical as well as theoretical considerations. A conceptual model for the organization of these developments will be presented with considerations of patient care and services, medical education (both continuing and residency), and research (including basic and clinical) as they apply to the model.
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Although the availability of oral contraceptives and the development of improved intrauterine contraceptive devices have greatly increased the general utilization of family planning services, there are still great segments of our population which are not yet reached, especially in the economically deprived areas. Since over 98 percent of all obstetrical deliveries now occur in hospitals, it seems logical that it is on hospital maternity services that these deficiencies might often be best overcome. Although this is primarily a medical problem, the use of paramedical personnel can greatly augment the physician's practice in these areas. Family planning services should be an integral part of comprehensive maternity care, not alone in the physician's office but also in the hospital setting.