The praxeology of the office dilatation and curettage

Studies establishing the validity, safety, acceptability, and cost-effectiveness of dilatation and curettage (D&C) performed in the office have been published for 60 years. Major obstacles to office D&Cs have been third-party payers, congressional action and governmental regulations, social mores, medicolegal practices, and specialization. Analysis of 310 offices D&Cs in a private gynecologic practice reveals a 300% reduction of patient short-term disability, 90% patient acceptability, 98% diagnostic accuracy, 450% improved physician time, approximately 450% cost reduction, and improved cost savings and income to patient and physician. The gynecologist has the substantial role in medical care decision-making. However, we must not lose sight of the fact that these very personal and individualized decisions must involve the patient as well. In order to maintain the most beneficial perspective and medical care decision-making, a hierarchy of values is presented: quality medical care, patient and physician satisfaction, economies of cost, and replicability. It is suggested that this praxeologic approach to the office D&C can be applied to other medical care decisions.