HYSTERECTOMY: THE DECISION-MAKING PROCESS
Women consider having a hysterectomy for reasons such as chronic abdominal pain and excessive bleeding, and because of a doctor’s recommendation. Non-medical reasons may also influence the advice of medical practitioners, and of a woman’s family and friends. According to recent Australian and US studies, a doctor’s advice about hysterectomy may have more influence on a woman’s decision about surgery than her understanding of the reason(s) for the operation, its probable aftereffects, or the alternatives available. Presumably, a doctor’s recommendation for a non-surgical approach may be equally persuasive.
Dorothy’s ‘decision’ to have a hysterectomy followed her admission to hospital to have bladder repair surgery. The night before the operation her doctor visited her and, as he was leaving, said casually, ‘We might as well take your womb out while we’re in there, because you don’t have any need for it now.’ When asked how she felt about this, Dorothy said she accepted it without question because she believed her doctor knew what was best.
There is no doubt that some women prefer to leave decisions about their health care entirely to their doctors, even to the extent of preferring the doctor to decide whether or not they should have major surgery. But it is becoming increasingly common for doctors and women to work together, exchanging information and ideas and, in the end, coming to a mutual agreement about the best course of action.
Psychologists have identified five basic patterns of behaviour used by individuals when faced with choices about things like health investigations and treatments.
• Complacently continuing whatever has been familiar until then, which may involve discounting new and relevant information.
• Uncritically adopting whichever new course of action is most strongly recommended or is considered to be ‘the fashion’.
• Escaping the conflict by delaying decision making, shifting the responsibility to someone else, or making wishful excuses to bolster a particular alternative, meanwhile refusing to consider pertinent information.
• Searching frantically for a way out of the dilemma and impulsively seizing upon a hasty solution that seems to promise immediate relief. This type of decision making means that the full range of consequences of a particular choice are never considered.
• Searching painstakingly for relevant information, thinking carefully about it in as unbiased a way as possible, and weighing the alternatives carefully before making a choice.
Although the first two patterns may save time, effort and emotional turmoil, they often lead to decision making that is less than ideal and has unfortunate consequences. The third and fourth patterns likewise tend to be associated with undesirable results. The fifth pattern, termed the Vigilant approach’, usually leads to high-quality decision making. Its major features include identifying the feasible options; sorting out personal values, objectives, barriers to particular actions and incentives to others; assessing the consequences of a particular choice; planning how best to put the decision into effect; and anticipating what will happen as a result of that decision.
Today, many women are participating actively and responsibly in making decisions about their health and are having a major say about investigations and treatments. Your consent should always be sought before a procedure is carried out, except in the most unusual of circumstances, such as an emergency during major surgery when your life would be threatened if a particular action was not taken. In addition, your consent should always be sought for participation in medical research. Remember also that it is your right to withdraw from treatment by a particular practitioner at any time.
For most women, a decision for or against a hysterectomy involves the following considerations:
• an assessment of the impact of the existing medical condition and its symptoms on quality of life
• a comparison of physical risks and effectiveness of various forms of treatment
• a personal assessment of the importance of the uterus and of emotional reactions to the current situation and to removal of the uterus
• careful consideration of any relevant social and cultural factors
• the views of a doctor or doctors, a partner and close friends
• an assessment of the skill and care of medical personnel available to you.
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