Unnecessary Medicine in ObGyn Many unnecessary medical procedures are performed in Egyptian hospitals, including screening, examinations, investigations, treatments, hospitalizations, and surgeries. This wastes resources and can harm patients. Some contributing factors include defensive medicine due to malpractice fears, a desire for profits, and incorrect diagnoses. Examples given include unnecessary pelvic exams, too frequent ultrasounds during pregnancy, cervical cancer screenings for low-risk groups, osteoporosis screening in young women, and medical treatments like antibiotics for minor issues. Reducing unnecessary care could benefit both patients and health systems in Egypt.

1. Unnecessary
Medicine
In
ObGyn
Muhammad M Al Hennawy
First Consultant Obstetrician & Gynacologist
Ras El Bar Central Hospital
Egypt - 01222503011
mmhennawy.site44.com
ekotob.site44.com
rebch.site44.com
www.drhennawy.8m.net
www.mmhennawy.20fr.com
www.ayolab.20m.com

2. Unnecessary Medicine
• Many unnecessary screening , examination , investigations , medical treatment , hospitalisation
, surgical procedures and surgical operations
• Are carried out in both private and governmental hospitals that may
• Cost our poor country a considerable cost ,
• Frequently causes more harm than good (where the risks exceeded the benefits) ,
• Painful ,
• Wasteful ,
• Useless or of
• Little potential value

3. • Do Egyptian gynaecologists
over-screen
over-investigate,
over-treat or
their patients
???!!!!

4. Why?!
• For fearing from legality (defensive medicine )
• For perform preventing medicine (screening )
• For getting more money
• An incorrect diagnosis
• Ignorance
• Negligence.

6. Practicing Defensive Medicine
(positive or negative )
Not good For Patients Or Physicians
• Defensive medicine occurs when doctors order
tests, procedures, or visits, or avoid high-risk
patients or procedures, primarily (but not
necessarily or solely) to reduce their exposure to
malpractice liability.
• When physicians do extra tests or procedures
primarily to reduce malpractice liability, they are
practicing positive defensive medicine.
• When they avoid certain patients or procedures,
they are practicing negative defensive medicine.

7. • It can be very harmful when a doctor negligently
diagnoses a patient with a condition that the
patient doesn't actually have.
• This is because patients sometimes rely on a
doctor's diagnosis when making decisions
regarding medical procedures.
• Thus, an incorrect diagnosis could lead to a
patient deciding to undergo a procedure or
surgery that they don't actually need.
• This can have serious consequences for patients,
as it can unnecessarily expose them to the risks
and pain that can go along with surgeries and
medical procedures

8. • It can be very harmful when a doctor negligently
diagnoses a patient with a condition that the
patient doesn't actually have.
• This is because patients sometimes rely on a
doctor's diagnosis when making decisions
regarding medical procedures.
• Thus, an incorrect diagnosis could lead to a
patient deciding to undergo a procedure or
surgery that they don't actually need.
• This can have serious consequences for patients,
as it can unnecessarily expose them to the risks
and pain that can go along with surgeries and
medical procedures

9. Examples
• Unnecessary screening
ovarian cancer
• Unnecessary examination
PV
• Unnecessary investigation
too frequent USS during pregnancy
electronic intrapartum fetal monitoring in low risk pregnancy
Mamography
DEXA screening for osteoporosis in women younger than 65
years
Imaging for lower back pain within 6 weeks of onset
Pap smears in women younger than 21 years or who have
had a hysterectomy for benign disease
cardiac screening (e.g. ECG) in low-risk patients
CT scans for head injuries in children
upper endoscopy in GERD
• Unnecessary prophylactic
medical treatment (overtreatment)
anti RH antibodies after delivery to RH negative mothers
• Unnecessary curative medical treatment
vaginal douche,
antibiotics for trivial indications,
too much vitamin prescriptions during pregnancy
calcium carbonate supply during pregnancy
creams for stretch marks
creams for scar treatment
antibiotics for uncomplicated sinusitis
antibiotics prescribed annually for viral infections
• Unnecessary Hospitalisation
Emesis gravidarum
• Unnecessary surgical procedures
urinary catheterisation
red cell transfusion
feeding tubes to old age
• Unnecessary surgical treatment
unnecessary cervical cerclage
unnecessary episiotomy
unnecessary caesarean sections
unnecessary female circumcision
unnecessary oopherectomy after ovarian tortion
unnecessary hysterectomy
unnecessary appendectomy
Unnecessary tonsillectomy
Unnecessary angioplasty
• Unnecessary radiological treatment

10. Unnecessary screening
• ovarian cancer

11. Ovarian Cancer
• Are There Any Good Tests for Ovarian Cancer?
• IS PELVIC ULTRASOUND A GOOD SCREENING TEST FOR
OVARIAN CANCER?
No
• IS CA-125 A GOOD SCREENING TEST FOR OVARIAN CANCER?
No
• Women without symptoms and of average risk do not need to be
screened for ovarian cancer.
• Due to the invasive nature of ovarian cancer screenings, the
harmful effects of testing are thought to outweigh the potential
benefits.
• For average-risk women with no symptoms, there is no need to
screen for ovarian cancer. In these women, the potential harms
of screening outweigh the potential benefits

12. Unnecessary Cervical Treatments
• Performing the human papillomavirus (HPV) test
twice with a short interval between tests would
reduce the number of women having unnecessary
treatment
• Mild dysplasia should not be treated if the condition
has been present for less than 2 years.
• Mild cervical dysplasia is associated with the
presence of HPV which generally clears on its own
within otherwise healthy women.

13. Frequent Colon Cancer
• Screening recent study found that having precancerous growths
spotted on colonoscopies removed cut the death rate from colon
cancer by 53 percent.
• Most major medical groups recommend that people over 50 get a
colonoscopy every 10 years.
• However, the key is moderation. According to the American
Gastroenterological Association, most adults who are at an average
risk of colon cancer and who get a clean bill of health from a
colonoscopy don't need another one for the next decade – good
news for health care pocketbooks, since the test costs an average of
$1,050.
• Eaton said the recommendation will probably be welcome news to
most patients.
• "Most people don't want one colonoscopy, let alone another sooner
than needed," Eaton said.

14. Unnecessary examination
• PV

15. Routine pelvic exam is unnecessary
for women without symptoms
• Certainly in women with symptoms, a pelvic examination is
indicated
• There is no any compelling reason to do it in asymptomatic
women, but it has been a part of standard practice.
• That awkward feet-in-the-stirrups moment when the doctor inserts two gloved fingers
into your vagina to feel your cervix, uterus and ovaries while pressing down with the
other hand on your abdomen may soon be a thing of the past.
• bimanual exam is not supported by medical evidence, increases the costs of medical
care and discourages some women, especially adolescents, from seeking needed
care.
• Moreover, the exam sometimes reveals benign conditions that lead to follow-up
procedures, including surgery, that do not improve a woman’s health but instead
cause anxiety, lost time from work, potential complications and unnecessary costs.
• “It is time,” she added, “to get asymptomatic women off the table

16. Unnecessary investigation
To Test Or Not To Test
• Clinical
• Laboratory
• Image ( x-ray – us – ct – mri)

17. • Too frequent USS during pregnancy
• Electronic intrapartum fetal monitoring in low risk pregnancy
• Mamography
• DEXA screening for osteoporosis in women younger than 65 years
• Imaging for lower back pain within 6 weeks of onset
• Pap smears in women younger than 21 years or who have had a
hysterectomy for benign disease
• Unnecessary Syndromic Diagnosis of Reproductive Tract Infections
• Cardiac screening (e.g. ECG) in low-risk patients
• CT scans for head injuries in children
• Upper endoscopy in GERD
• chest X-rays before outpatient surgery
• unnecessary coagulation testing in hypertensive disorders of pregnancy
• Preoperative Analysis
• Most People Who Take Blood Pressure Medication Possibly Shouldn’t
• Premarital Examination
• Virginity Examination

18. Cancer screening 'blights ten
lives for every one saved
'
• Thousands of women have had
unnecessary surgery, chemotherapy and
radiotherapy as a result of routine breast
cancer screening, doctors have warned.
• For each woman whose life is saved, ten
healthy ones needlessly receive
mastectomies and other treatment, a study
found

19. Too frequent USS during
pregnancy
• Ultrasound, sonograms, and dopplers use
high frequency sound waves to produce
an image of the baby on a viewing screen
or amplify the baby's heartbeat so it can
be heard more easily.
• NO STUDIES have been done which
prove the safety of these devices, and the
American Medical Association
recommends AGAINST unnecessary
exposure.

20. Fetal Monitoring
• Fetal monitoring and reliance on emergency cesarean section play a
key role in reducing the chances of cerebral palsy as the result of
birth injury.
• Recent studies, however, have shown no benefit of any kind that
“the rate of cerebral palsy has not decreased in developed countries
over the past 30 years, despite the widespread use of electronic
fetal heart rate monitoring and a five-fold increase in the cesarean
delivery rate over the same period of time.”
• Graham et al point out that “meta-analysis of the randomized
controlled trials comparing EFM [electronic fetal monitoring] with
auscultation have found an increased incidence of cesarean delivery
and decreased neonatal seizures but no effect on the incidence of
cerebral palsy or perinatal death.”

21. The New Mammography
Screening Recommendations
• * Routine screening for women aged 40 to 49 years is not
needed
(those in their 40s experience greater “harms” from screening, primarily in the
form of false-positive results, which can lead to unnecessary additional screening,
biopsies, and anxiety. )
• * Biannual screening for women aged 50 to 74 years
• * Current evidence is insufficient to assess benefits/harms
of screening women aged ≥75 years
• * Against clinicians teaching breast self-examination
• * Current evidence is insufficient to assess benefit of MRI
(magnetic resonance imaging) or digital mammography.

22. DEXA
• screening for osteoporosis in women younger than 65 years
• # Osteoporosis may affect up to half of women, and the prevalence of
pathologic fractures is expected to climb as life expectancy increases
worldwide.
• # Only one third of patients who experience a fracture related to
osteoporosis fully recover their physical function.
• # The Fracture Intervention Trial demonstrated that alendronate can
reduce the risk for fracture among women with osteoporosis.
• # The current analysis of the Fracture Intervention Trial finds that the
vast majority of women gain bone density during treatment with
alendronate.
• # Another analysis of this trial demonstrated that alendronate may
improve the risk for fracture even among women who lose bone
density during treatment.
• # Routine repeat DEXA testing among women within 3 years of the
initiation of treatment with a bisphosphonate appears unnecessary

23. Cardiac stress tests
• The American College of Cardiology, for
example, says stress tests are
unnecessary for otherwise healthy adults
without cardiac symptoms because they
rarely result in any meaningful change in
patient care.

24. Pap tests
• Routine annual Pap tests are not needed in women
aged 30 to 65. In average-risk women, an annual
screening offers no advantages over screening every
three years.
• Treatment is not needed in average-risk women who
have "mild dysplasia," which is associated with the
human papillomavirus (HPV), for a period of less than
two years
• in women younger than 21 years or who have had a hysterectomy
for benign disease
• "If you had your uterus and cervix removed (total hysterectomy) for a
noncancerous condition, you may be able to stop having Pap
smears."---Mayo Clinic
• stop routine Pap smear screening at age 70 if you've had three or
more normal Pap smears in a row and no abnormal Pap smears for
the past 10 years.

25. Unnecessary Syndromic Diagnosis
of Reproductive Tract Infections
• Leads to Substantial Unnecessary Treatment
• Current strategies to diagnose reproductive tract infections (RTIs) in
resource-poor settings by relying on presumptive diagnoses may be
leading to considerable overdiagnosis and overtreatment.
• According to a study of 600 clinic users in Hue, Vietnam, the
percentage of women with any RTI based on clinicians' presumptive
diagnosis reached 62%, whereas only 21% had an infection that
was etiologically confirmed.
• Five percent of the women had a confirmed sexually transmitted
infection (STI), and 1% a cervical infection.
• Applying the syndromic algorithm developed by the World Health
Organization (WHO) may reduce the amount of potential
overtreatment for vaginal infections,
• but the algorithm would need to be adapted to local epidemiologic
conditions to increase the accuracy of diagnoses of cervical infection

26. Upper endoscopy
• The treatment for GERD (GastroEsophagial
Reflux Disease ) -- which can include proton
pump inhibitors is the same whether patient
was diagnosed based on an endoscopy or
on her symptoms, like heartburn, sore throat,
and difficulty swallowing,"
• "Any invasive procedure carries the risk of
complications. In this case,
• The gastrointestinal tract could be perforated
during the exam

27. chest X-rays before outpatient
surgery
• The American College of Radiology
recommends against chest X-rays before
outpatient surgery for patients who have
normal physical exams and no previous
problems because the images do not
usually change patient care and have not
been shown to improve patient outcomes.

28. Unnecessary coagulation testing in
hypertensive disorders of pregnancy
• Substantial coagulation testing was done on gravidas
evaluated for a hypertensive disorder even though the
prevalence of clinically significant abnormalities was low.
• Laboratory evaluation of patients suspected of having
preeclampsia need not include a PT, aPTT, or fibrinogen
test when there is no evidence of bleeding or of a
condition that could produce coagulopathy and when the
platelet count and lactate dehydrogenase level are both
normal.

29. Preoperative Analysis
• Women scheduled for gynecologic surgery are very likely to undergo
unnecessary tests before their operation,
• While the tests (blood and urine tests, electrocardiograms, and chest
X-rays) aren’t harmful, they may be anxiety-producing and
inconvenient for patients, and they are certainly costly
• Recommendations for preoperative testing vary depending on the
patient and the procedure
• Patients should certainly have an informed discussion with their
physician about what tests they really need to have before surgery,
so they can come to an informed decision with their physician.”
• Anyone who has ever had surgery while in generally good health can
sympathize with the recommendation against multiple pre-op tests:
Ophthalmologists now advise against ECGs and blood glucose
measurements before eye surgery, except for patients with heart
disease or diabetes

30. Most People Who Take Blood
Pressure Medication Possibly
Shouldn’t
• An independent analysis finds no real benefit for people with
mild hypertension.
• Most of patients with high blood pressure have mild, or Stage 1,
hypertension, defined as a systolic (top number) value of 140-159 or
a diastolic (bottom number) value of 90-99.
• The new review suggests that many patients with hypertension are
overtreated—they are subjected to the possible harms of drug
treatment without any benefit.
•

31. Unnecessary prophylactic medical treatment
(overtreatment)
• Anti RH antibodies after delivery to RH
negative mothers
• Unnecessary Induction Of Delivery Before
39-week

32. The Unnecessary treatment of
RH negative mother
• Twelve percent of all American marriages pair
an Rh-negative woman with an Rh-positive man.
• Of the 3.3 million deliveries that take place in the
U.S. each year,
• 260,000 result in the birth of an Rh-positive baby
to an Rh-negative mother, and
• of these babies, at least 10% are likely to be
afflicted with some degree of Rh disease.
• The irony is that this threat is unnecessary.
Medicine has an effective weapon against Rh
disease.

33. Unnecessary Induction Of Delivery
Before 39-week
• Elective, non-medically indicated
inductions of labor or cesarean deliveries
should not be scheduled before 39 weeks'
gestation. Delivery prior to 39 weeks has
been shown to be associated with an
increased risk of learning disabilities and a
potential increase in illness and death.
• Elective, non-medically indicated inductions of labor
between 39 weeks' and 41 weeks' gestation should not
be scheduled unless the cervix is deemed favorable

34. Unnecessary curative medical treatment
• Unnecessary Drugs
• Vaginal douche,
• Too much vitamin prescriptions during pregnancy
• Unnecessary infertility treatment
• Unnecessary' IVF Doses
• unnecessary treatment for blood disorder in pregnancy
• Calcium carbonate supply during pregnancy
• Geriatricians and Antipsychotic
• Creams for stretch marks
• Creams for scar treatment
• Antibiotics for uncomplicated sinusitis
• Antibiotics prescribed annually for viral infections
• Antibiotics for trivial indications,
• Unnecessary TTT of Hirsutim
•

35. Unnecessary Drugs
• An unnecessary drug is any drug when used:
• (i) In excessive dose (including duplicate therapy); or
• (ii) For excessive duration; or
• (iii) Without adequate monitoring; or
• (iv) Without adequate indications for its use; or
• (v) In the presence of adverse consequences which
indicate the dose should be reduced or discontinued; or
• (vi) Any combinations of the reasons above.

36. Vaginal Douche Or Wash
To Douche or Not to Douche
• most doctors and other medical professionals recommend against the
practice.
• Its primary purpose, cleaning the vagina, is generally unnecessary as the
vagina has mechanisms for cleaning itself naturally. The mucous secreted by
the vagina helps to remove any unwanted substances, including all traces of
menstruation. Any unpleasant odors are usually the result of infection or other
underlying issues, and therefore should be treated medically, not by douching
• In addition to being considered unnecessary, douching may have negative
consequences as well. The vagina maintains a natural, healthy chemical and
bacterial balance on its own; introducing a douche may upset that balance,
leading to irritation and infections such as yeast infections and bacterial
vaginosis. Infections may also travel up to the uterus, Fallopian tubes, and
ovaries, leading to more serious issues like pelvic inflammatory disease. Due
to its potential damaging effects in the reproductive system, douching may
contribute to fertility problems and issues during pregnancy.

37. Too much vitamin prescriptions during pregnancy,
(To Take or Not To Take Prenatal Vitamins)
there was little scientific evidence to support taking iron or iodine supplements during or
ahead of pregnancy, while both were promoted as beneficial for mums-to-be.
women take (iron) supplements it does not change the outcome of their pregnancy, or the
development of the child, and it may even be related to an increase in behavioural
problems
pregnant woman recording low levels of iron was very common but this could be a
temporary adaption rather than a true iron deficiency’ as normal levels usually returned
post-birth
Folate is quite different (to iron and iodine), because we have actually done the studies
and we do know it does lower the risk of neural tube defects
This is particularly true with the fat-soluble vitamins that will be stored in the liver, like
vitamin A. They can eventually reach toxic levels and cause liver damage.
Even the water-soluble vitamin C can cause diarrhoea at levels of 2000mg a day, which is
lower than the amount some people take in the hope of staving off colds
a link between vitamin C supplements and an increased risk of hardening arteries in some
people with diabetes

38. Unnecessary Common infertility treatments
are unlikely to improve fertility
• Overall, 101 women became pregnant and had a live birth during the course
of the study.
• The researchers found that women who had no interventions had a live birth
rate of 17%, the group taking oral CC had a birth rate of 14%, and the group
having unstimulated IUI had a birth rate of 23%.
• They point out that to have a meaningful and significant improvement in the
live birth rate, the difference in live births between unstimulated IUI and no
intervention would have to be much higher than the 6% reported in this trial.
• Side effects for women including abdominal pain, bloating, hot flushes,
nausea and headaches were highest in women taking oral CC, affecting 10
% of women.
• Interestingly, women on active treatments (CC and IUI) were reassured by
the process of treatment while women who had no interventions were less
satisfied, despite it being equally effective.
• The researchers conclude: "These interventions, which have been in use for
many years, are unlikely to be more effective than no treatment. These
results challenge current practice, as endorsed by a national guideline in the
UK."

39. Unnecessary' IVF Doses
• there are a lot of couples out there who are
financially, emotionally and physically broke
from undergoing repeated IVF
• Many are being given high doses of hormones
and steroids to help them fall pregnant, but
some of these drugs are not needed and in
some cases may be harmful to both mother and
baby
• The use of hormones to produce large number
of eggs may lead to ovarian hyperstimulation
syndrome (OHSS), which is thought to affect up
to 6 per cent of patients.

40. unnecessary treatment for blood
disorder in pregnancy
all pregnant women have their blood tested at their
first antenatal visit. RhD negative women are
given one or two antiserum injections (anti-RhD
immunoglobulin, derived from blood products)
during the pregnancy.
about 38 per cent of RhD negative women are
carrying an RhD negative baby, so they receive
this treatment unnecessarily.
new test for predicting a baby's blood group by
"typing" its DNA in the plasma of RhD negative
pregnant women at or before the 28 week
antenatal visit.

41. Geriatricians and Antipsychotic
• The geriatricians' list goes on to warn against
the routine prescribing of antipsychotic
medications for dementia patients who become
aggressive or disruptive.
• Though drugs like Haldol, Risperdal and
Zyprexa remain widely used, "all of these have
been shown to increase the risk of stroke and
cardiovascular death

42. creams for stretch marks
• There were a couple of creams that
helped minimally but there was nothing on
the market that could do what today s
stretch mark removal creams can do.

43. Antibiotics for uncomplicated
sinusitis
• American Academy of Allergy, Asthma &
Immunology says that because most
cases of acute rhinosinusitis can be
diagnosed clinically and resolved without
treatment in two weeks, there is no need
for antibiotics or a sinus CT scan or other
imaging

44. Unnecessary TTT of Hirsutim
• When there is no cause
• Patient not complaint
• No ttt

45. Unnecessary Hospitalisation
• Hospitalisation of emesis gravidarum

46. Unnecessary surgical procedures
• Urinary catheterisation
• Red cell transfusion
• Feeding tubes to old age

47. Unnecessary Intrapartum procedures
• Catheterisation = bladder still virgin until catheterised
• reduce unnecessary urethral catheterisation and
promote continence through the implementation of
focused staff training Interventions.
• It is possible to use real-time ultrasound in estimation of
total bladder volumes of women in labour. The
implications are that all of those normally selected as
being in need of catheterisation could be detected, while
about a quarter of those women would avoid
unnecessary catheterisation.
• Some patients have urinary catheters inserted when they go under
anesthesia and then removed before they wake up so they are unaware
that they had a catheter unless they find out from their records or had
difficulty urinating or felt burning sensation as they urinated after they woke
up from surgery.
• This is very unethical

48. Geriatricians and Feeding Tubes
• Feeding tubes don't prevent aspiration
pneumonia or prolong dementia patients'
lives,
• but they do exacerbate bedsores and
cause such distress that people often try
to pull them out and wind up in restraints.
• The doctors recommended hand-feeding
dementia patients instead.

49. Unnecessary surgical treatment
• unnecessary surgerySurgery An instrumental procedure that is not needed
eg:
• Unnecessary Hospital Birth
• Unnecessary cervical cerclage
• Unnecessary episiotomy
• Unnecessary caesarean sections
• Unecessary DILATION & CURETTAGE
• Unnecessary Cosmetic Surgery
• Unnecessary female circumcision
• Unnecessary hysterectomy
• Unnecessary ovarian drilling
• unnecessary oopherectomy after ovarian tortion
• Unnecessary appendectomy
• Unnecessary tonsillectomy
• most double mastectomies are unnecessary
• Unnecessary Surgery for vaginismus
• Unnecessary angioplasty
• Unnecessary Low back surgery
• Unnecessary Heart burn surgery

50. Unnecessary Hospital Birth
• The use of technology such as the
epidural anesthesia and the electronic
fetal monitor correlate to a higher
incidence of cesarean section in hospital.
• Planned homebirth with good prenatal
care and a competent attendant is a safe
option for healthy women.

51. Majority of Prophylactic Cervical
Cerclages Found Unnecessary
• The majority of prophylactic cervical cerclages
• may not
• be
• necessary

52. Episiotomy
• It can sound so simple and efficient when an OB-GYN lays
out all the reasons why she performs episiotomy before
delivery. After all, it's logical that cutting or extending the
vaginal opening along the perineum (between the vagina and
anus) would reduce the risk of pelvic-tissue tears and ease
childbirth.
• But studies show that severing muscles in and around the
lower vaginal wall (it's more than just skin) causes as many or
more problems than it prevents. Pain, irritation, muscle tears,
and incontinence are all common after effects of episiotomy.
• the American College of Obstetricians and Gynecologists
released new guidelines that said that episiotomy should no
longer be performed routinely -- and the numbers have
dropped. Many doctors now reserve episiotomy for cases
when the baby is in distress.

53. Unnecessary CS =Unnecesarean
• “’If one went to the extreme of giving the patient the full details of
mortality and morbidity related to cesarean section, most of them
would get
up and go out and have their baby under a tree,’ [Dr. McDonald]
said.”
• Women are also frequently subjected to Caesarean sections they
don't really need.
• With an estimated 920,000 Cesarean births performed each year,
the Cesarean has become the "most common major surgery in
America" and it is four times more likely a woman will give birth via
cesarean section today than it was in 1970
• The cesarean section should not be used as an indicator of quality
of obstetrical care
We do not have a good definition of unnecesary c-section

54. DILATION & CURETTAGE
• If hormone therapy does not control the bleeding, a
dilation and curettage (D & C) (which is the dilation of the
cervix and scraping out of the uterus with a curette) or a
hysteroscopic procedure may be performed to check for
other problems.
• However, dilation and curettage (D&C) is no longer
acceptable as the single surgical treatment for
menorrhagia or dysfunctional uterine bleeding. It does
not correct abnormal bleeding unless intracavitary
lesions are totally removed. This procedure is inaccurate
due to missed diagnosis, incomplete removal of
intracavitary pathology, and a high false-negative rate.

55. Cosmetic Surgery
• Cosmetic Surgery Patient Dies, sent chills up my spine. Another vibrant and
attractive woman, this one in the prime of her life, left a grieving teen-aged
daughter. The victim follows a growing list of women who have made the
ultimate sacrifice. While seeking to turn back the clock, they stopped the
clock. And for what?
• My heart aches for the daughter who will never see her mother again. It also
aches for the millions of women who have bought the propaganda that their
breasts are too small, their stomachs are too flabby, their posteriors are too
large, their necks are too saggy and the lines in their faces are too
prominent.
• Plastic surgery is a growth industry, especially in South Florida, and I’m
often taken aback when I run into a friend who has surgically altered her
appearance. The surgery centers’ ads appeal to women’s insecurities about
their body image while offering payment plans and special offers; as if it’s as
simple and painless as buying a pair of shoes.

56. (FGM) Female Circumcision
• As African nations look to ban female
circumcision, a new report has indicated
that many women in the developed world
are in fact paying for such operations.
• BJOG reports that patients are ignoring
the risks to their health by undergoing
treatment for cosmetic reasons.

57. Surgery Women Don't Need
Hysterectomy
=
• There was a time when doctors didn't think much about
removing a woman's uterus, fallopian tubes, ovaries, cervix
and parts of the vagina,
• Particularly if a woman had already produced children or was
beyond childbearing age.
• Hysterectomies were standard treatments for everything from
anxiety (known back then as hysteria) to abnormal bleeding
• While hysterectomy can alleviate the pain, pressure and
bleeding caused by conditions of the uterus, and many
women are pleased with the result afterwards,
• the pros and cons of surgery must always be carefully
weighed. And there are many cases when surgery might be
completely unnecessary.

58. Appendectomy
• Two-thirds of appendix operations may be unnecessary
and could be treated simply by using antibiotics
• There is now good evidence that treating "uncomplicated"
cases of appendicitis with antibiotics tends to be better for the
patient than surgery.
• Uncomplicated appendicitis, where an inflammed appendix
has not led to other problems such as perforation of the organ
or a serious infection, account for 80 per cent of cases.
• The other 20 per cent are complicated cases, where surgery
really is the only option.
• Routine early appendectomy was based on the "dogma" that
"appendicitis is a progressive disease, from an uncomplicated
stage to one with complications of gangrene, perforation, or
peritonitis, and that any delay in treatment increases the risk
of complications

59. Tonsillectomy
• Tonsillectomy versus watchful waiting in
recurrent streptococcal pharyngitis in
adults

60. most double mastectomies
are unnecessary
• Women appear to be using worry over
cancer recurrence to choose contralateral
prophylactic mastectomy.
"This does not make sense, because
having a non-affected breast removed will
not reduce the risk of recurrence in the
affected breast.“

61. Unnecessary Surgery for
vaginismus
• nonoperation

62. Angioplasty
• Every year in the United States, surgeons perform 1.2 million
angioplasties, during which a cardiologist uses tiny balloons
and implanted wire cages known as stents to unclog arteries.
This Roto-Rooter-type approach is less invasive and has a
shorter recovery period than bypass, which is open-heart
surgery.
• The problem: A ground breaking study of more than 2,000
heart patients indicated that a completely nonsurgical method
-- heart medication -- was just as beneficial as angioplasty
and stents in keeping arteries open in many patients.
• The bottom line: Angioplasty did not appear to prevent heart
attacks or save lives among nonemergency heart subjects in
the study.
.

63. Lower-back surgery
• Since the 1980s, operations for lower-back pain and sciatica
have increased roughly 50 percent, from approximately
200,000 to more than 300,000 surgeries annually in the
United States. That rise is largely due to minimally invasive
advances that include endoscopic keyhole tools used in
tandem with magnified video output.
• To its credit, surgery (endoscopic or the traditional lumbar-
disc repair) does relieve lower-back pain in 85 to 90 percent
of cases, docs say. "Yet the relief is sometimes temporary,"
says Christopher Centeno, M.D., director of the brand new
Centeno-Schultz Pain Clinic near Denver, Colorado. And that
adds up to tens of thousands of frustrated patients who find
the promise of surgery was overwrought or short-lived

64. Heartburn surgery
• A whopping 60 million Americans experience heartburn at
least once a month; 16 million deal with it daily. So it's no
wonder that after suffering nasty symptoms (intense stomach-
acid backup or near-instant burning in the throat and chest
after just a few bites), patients badly want to believe surgery
can provide a quick fix. And, for some, it does.
• A procedure called nissen fundoplication can help control acid
reflux and its painful symptoms by restoring the open-and-
close valve function of the esophagus. But Jose Remes-
Troche, M.D., of the Institute of Science, Medicine, and
Nutrition in Mexico, reported in The American Journal of
Surgery that symptoms don't always go away after the
popular procedure, which involves wrapping a part of the
stomach around the weak part of the esophagus.
• "That may be because surgery doesn't directly affect healing
capacity or dietary or lifestyle choices, which in turn can lead
to recurrence in a hurry," he says

65. Conclusion
• Unnecessary medicine and surgery
• Are carried out in both private and governmental hospitals
that may
• Cost our poor country a considerable cost ,
• Frequently causes more harm than good (where the risks
exceeded the benefits) ,
• Painful ,
• Wasteful ,
• Useless or of
• Little potential value