Editor's choice

Politically incorrect surgery

The surgeon cuts through the skin and uterus of a pregnant woman to deliver a baby who might otherwise not be born alive. What could be nobler? Unfortunately, it's not so simple. Caesarean section competes with lobotomy and circumcision to be the most politically fraught of operations.

José Belizán and others have measured caesarean section rates in Latin America and found that 12 countries have rates higher than the 15% that the World Health Organisation defines, arbitrarily, as correct (p 1397). Some populations with access to private care may have rates approaching 100%. The authors estimate that 850 000 unnecessary caesarean sections may be performed each year in Latin America. They find that the operation is commoner in richer countries and those with more doctors and higher proportions of city dwellers and institutional deliveries. They regret that "caesarean section is now culturally accepted as a normal way of giving birth."

Arachu Castro raises the possibility that unnecessary caesarean sections may be violence against women (p 1401). Hilda Bastian quotes anthropological work from Brazil showing that obstetricians appropriate "women's fear of labour pain, body disfigurement, and concern for sexual performance to justify the profession's own preference for surgical birth"in order perhaps to pay the school bills and get on to the golf course before dark (p 1402). Elaine Showalter and Anne Griffin argue that the most important issue is providing women with access to good services rather than making assumptions about the proper form of labour and delivery (p 1401).

Equally contentious is the argument over whether to call patients something differentconsumers, clients, users, customers, citizens, or whatever. Evidence from Australia suggests that patients themselves mostly want to be known as patients (p 1436), while a hospital in Toronto has already adopted "client" (p 1436). Roger Stevens thinks laterally and suggests that patients should be known as "Neubergers" after (Rabbi) Julia Neuberger, who argued against the word patient in the original article (p 1437). "The word," says Dr Stevens, "is euro-friendly, is refreshingly free from any taint of political correctness, and does not have any of the associations of its predecessors." He looks forward to his receptionist telling him he has a surgery full of Neubergers.

Finally, we have a gift for all those who moan that the BMJ is no use for hospital doctorsan article on how to get a distinction award (the supplement paid to some NHS consultants for excellence) (Career focus; www.bmj.com). You can now nominate yourself, but the important thing is to get support from as many different parts of the medical forest as possible.

Footnotes

To receive Editor's choice by email each week subscribe via our website: www.bmj.com/cgi/customalert