An overview of hospital gynecologic practice

Table 1 presents an overview of current gynecologic practice in hospitals as illustrated by three New England states. We believe the balance of diagnoses and operations displayed are reasonably typical of practice elsewhere in the United States. However, since operative rates are lower in New England than in other parts of the country, the proportions of women undergoing hysterectomy or a sterilization procedure will be somewhat higher elsewhere. The general issue of variation in rates of diagnoses and operations is presented; professional uncertainty is a fact which may account for the variation. Further controlled studies are urgently needed to decrease this element of uncertainty and to distinguish too much diagnosis and treatment from too little. Ultimately, nothing less will meet the standards of the best care for patients or satisfy health insurance or government programs that premiums or taxes are supporting an appropriate level of health care.