COMMENTARY

December 2004: The Year in Review -- Ob/Gyn & Women's Health

Ursula Snyder, PhD

Disclosures

January 24, 2005

What's in Store for 2005 for Obstetrics and Gynecology?

By Medscape Ob/Gyn & Women's Health board member
Timothy R.B. Johnson, MD

I believe many of the issues that we have faced in 2004 will crystallize and that these areas will be the focus for Ob/Gyns in the coming year.

The acceptance and popularity of endoscopic techniques, advanced surgical laparoscopy, hysteroscopy, endometrial ablation, uterine artery embolization, transvaginal tapes, and other types of minimally invasive surgery will continue to advance in 2005. Technological advances in terms of new instruments, smaller instruments, and instruments that can do things in new and safer ways have been remarkable in 2004, and the residents in training programs are becoming increasingly adept with them. The ability to capture images with these new technologies and store them for patient records, transmittal to consultants, and teaching purposes is really remarkable, and I believe that it will take every effort of practitioners to stay at the cutting edge of these new techniques. Patients will certainly be reading and hearing about them in their newspapers, women's health journals, and visual media.

Energy Sources for Endoscopic Surgery

Appraisal of Surgical Techniques for Stress Urinary Incontinence

MRI-Guided Focused Ultrasound May Be Effective for Treatment of Uterine Leiomyomata

Diagnostic Imaging and Vascular Embolization for Uterine Leiomyomas

Uterine Artery Embolization: Where Does It Stand in the Management of Uterine Leiomyomas? Part 1

Uterine Artery Embolization: Where Does it Stand in the Management of Uterine Leiomyomas? Part 2

Uterine Artery Embolization: An Expert Interview With Jacob Cynamon, MD

Minilaparotomy Appears to Be a Safe, Effective Approach to Myomectomy

Use of Bladeless Trocars Improves Outcomes in Laparoscopic Gynecologic Procedures

Low-Dose Excimer Laser Effective for Oral Lichen Planus

Cesarean section rates will no doubt continue to rise, with an increase in primary cesarean sections and increasing demand for elective cesarean sections. (See Medscape Newsmaker Interview with Eugene DeClercq, MD

and Medscape Medical News CME story.) I think we will also witness a reduction in vaginal birth after cesarean section. The recent article in The New England Journal of Medicine[188] highlights the increasing focus on potential short- and long-term risks associated with vaginal delivery and patient convenience. Patient demand will sustain the increase in cesarean sections, which are becoming safer because of ever improving surgical and anesthetic capacities. Nonetheless, I think we must avoid excess in this "march toward progress." Ob/Gyns have been fooled by the lure of progress recently and should pay close attention to the lessons of fetal heart monitoring and menopausal HT.

It is clear that increasing malpractice rates are having a real effect on obstetric practice. Because of the increasing malpractice burden, Ob/Gyns are leaving the practice of obstetrics, obstetricians are leaving high-premium states, young physicians are avoiding high-premium states to start their practice, and medical students are avoiding the specialty of obstetrics and gynecology. (See Medical Liability Survey Reaffirms More Ob-Gyns Are Quitting Obstetrics.) While I think many of us baby boomers have witnessed cycles of high malpractice premiums in the past, I do believe that what we are experiencing now is something new and very different that reflects both the extraordinarily high and unjustifiable awards being made in many cases but also what are increasingly recognized as predatory rate-setting practices by insurance companies. Over the past several years, companies who write for physician malpractice lines have seen marked increases in their profits, so it seems hard to justify the rapid increase in their rates. It is clear that some type of government intervention or relief will be required, and I believe it will most appropriately come at the state level to ensure patients can have access to quality physicians.

Medical Liability Reforms Move Forward in Three States

Do You Have the Right Malpractice Insurance Policy?

Are Damage Caps Regressive? A Study of Malpractice Jury Verdicts in California

In Focus - Impatient Doctors Use New Weapons to Battle Malpractice Costs

Law and Medicine - The Medical Malpractice Crisis: Tip of the "Litigation, Inc." Iceberg

Malpractice Reform: A Newsmaker Interview With Stewart B. Dunsker, MD

Field Notes in Obstetrics and Maternal-Fetal Medicine - Shoulder Dystocia -- Reducing the Legal Risk

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