Gynaecological problems should continue to be treated in primary care initially

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7047.1672c (Published 29 June 1996) Cite this as: BMJ 1996;312:1672
  1. Clare J Seamark,
  2. David A Seamark
  1. General practitioner General practitioner The Surgery, Marlpits Road, Honiton, Devon EX14 8DD

    EDITOR,—S K Smith's provocative editorial argues that a more medical approach is needed in gynaecology.1 We are general practitioners in a busy group practice. One of us (DS) has a diploma from the Faculty of Family Planning and Reproductive Health Care of the Royal College of Obstetricians and Gynaecologists; the other (CS) is a member of the same faculty, an instructing doctor in family planning, and a member of the British Menopause Society. We therefore have an interest in general practice gynaecology, which is a considerable part of our everyday work.

    We think that Smith should elaborate on one of the sentences in the editorial: “The gynaecologists' bias against medical treatments is unlikely to be reduced while general practitioners, understandably less knowledgeable as they are, embark on ineffective medical treatments before referring patients to specialists.” Is Smith suggesting that all patients with any sort of gynaecological problem should be referred to a consultant gynaecologist? We assume that this is not the case, unless the author is unaware of the sheer volume of this work that is dealt with in primary care. We would like some clarification of what these “ineffective medical treatments” are. All the medical treatments that we use are also used by our local consultant gynaecological colleagues. We are aware, in this age of evidence based medicine, that some medical treatments are hard to evaluate and may not have been scientifically proved in trials comparing them with the gold standard. We would appreciate comments on the effective medical treatments that Smith uses so that we can improve our practice.

    We see the future of gynaecology as starting within primary care, where appropriately trained and interested doctors can pursue the medical investigations and treatments with appropriate funding. The hospital specialist's domain could remain the surgical procedures and more complicated medical treatments. The focus of the editorial is also on women and their needs and wants. We suspect that many women are more comfortable being investigated and treated by their own general practitioners. For some, seeing a hospital gynaecologist is daunting.


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