The pain of “over-medication” in obstetrics and gynecology

Overmedication refers to diagnostic and therapeutic behaviors that exceed the actual needs of the disease, including excessive testing, excessive treatment (drugs, surgery, interventions) and excessive care. Excessive medical treatment cannot really improve the value of diagnosis and treatment for patients, but only increases the consumption of medical resources and is detrimental to patients’ diagnosis and treatment behaviors. The excessive medical treatment of minor diseases, major diseases and indiscriminate checkups will increase the pain and economic burden of patients and affect the quality of life or reproductive health; it can also cause serious waste of medical resources; mislead the training of young or junior doctors; and even violate medical principles and norms, medical ethics and ethics of doctors. This phenomenon is no exception in the clinical treatment process of obstetrics and gynecology. There is a wide range of excessive medical treatment in the clinical process of obstetrics and gynecology, such as the use of antibiotics and intravenous drip when there is pressure pain during gynecological examination; excessive diagnosis and treatment of cervical “erosion”; expanded use of cervical loop electrosurgery; excessive hysterectomy; unnecessary oophorectomy; abuse of cesarean section; irregular use of colposcopy; cervical cancer screening Disorders and related treatments in TORCH [refers to a group of pathogens: toxoplasmosis, others, rubella virus, cytomegalovirus, herpes simplex virus screening, etc. There are over-medication problems in the consultation and treatment process, which require the attention of obstetricians and gynecologists at all levels. The following is the focus of common obstetrics and gynecology over-medication 1, cervical “erosion” over-treatment Many units abuse LEEP treatment “cervical erosion” is a matter of great concern, so over-treatment can cause cervical adhesions, cervical secretion reduction, and This can cause cervical adhesions, reduced cervical secretions, endometriosis, cervical insufficiency, miscarriage and premature birth in future pregnancies or long-term non-healing of the cervical area, leukorrhea, and even loss of fallopian tube cilia. It is only right to use cytology, HPV testing and, if necessary, colposcopy for cervical screening to determine whether treatment is really needed for so-called “celiac disease”. Treating so-called “celiac disease” casually is against medical ethics. Cervical erosion itself does not become cancerous, but it is the process of the cervical ectropion of the columnar epithelium and the gradual formation of squamous cells underneath the reserve cells that are infected with HPV and the long-term persistence of high-risk HPV that may lead to precancerous lesions or cancer. Therefore, cervical “erosion” itself is not a precancerous or cancerous condition, but HPV is one of the real culprits. Therefore, it is important to treat “cervical erosion” correctly and to know that the term “cervical erosion” should be corrected as it has nothing to do with cervical cancer and that it is wrong to treat “cervical erosion”. It should not be over-treated. 2, to prevent excessive hysterectomy Many hospitals in China, including hospitals of different sizes, with the improvement of the level of treatment and the emergence of various auxiliary examination equipment, as well as the emergence of laparoscopy, etc., so that the diagnosis rate of the disease increased, the orientation of medical personnel (the mastery of surgical indications, understanding, qualifications, experience, etc.), young physicians surgical exercises, economic interests, domestic textbooks and the actual clinical work of the original uterus The hysterectomy is performed at 3 months of gestation, but now it can be performed at 2.5 months of gestation, which leads to excessive hysterectomy in different degrees. The impact on the ovarian function, sex hormone secretion, sexual function and psychology of women should be taken into consideration. 3, do not abuse LEEP LEEP has strict indications (indications), not as a means of treating cervicitis, cervical “erosion”, can not casually expand the indications, not to obtain economic benefits, regardless of the future reproductive health of women, in violation of medical principles and medical ethics. However, throughout our country, especially private and primary hospitals, and even larger or big hospitals still use LEEP widely for the treatment of cervicitis and cervical “erosion” (in reality, the above-mentioned is at most general physical therapy), which is a typical example of over-medication. Therefore, doctors should have sufficient knowledge of cervicitis and cervical “erosion” and should adhere to medical principles, strictly grasp the indications for LEEP, abide by medical ethics, and do not abuse LEEP for general cervical diseases. 4. Caesarean section without medical indication The reasons for the increase of caesarean section rate in China are complex, involving the influence of many factors such as system, society, media, medical personnel, pregnant women and their families, and economy, which will not be repeated, but it is undeniable that many of them are excessive medical practices, which are unfavorable to mother and child. To solve the problem of excessive medical treatment of cesarean delivery is a systematic project, and it is not only the responsibility of medical personnel. It is the responsibility of medical personnel to keep a strict eye on the problem, but it also requires the support of policy, society, administration, media, law, economy, pregnant women and their families, etc. Strict hospital management is also an essential part. 5. Irregular colposcopy and biopsy Nowadays, colposcopy is quite popular in China, and county hospitals basically have this equipment, but the level of development needs to be formalized and improved, and the quality of personnel is very important. A considerable number of hospitals are only keen to take color photos without formal description and diagnosis of colposcopy, thus informing patients that there are lesions in the cervix that need to be treated, i.e. physical therapy, LEEP or conization or even hysterectomy, without strict indications, resulting in over-medication or over-diagnosis or omission of cervical diseases, so that the disease (or cancer) is not properly treated and caused by the lack of strict formal operation. The consequences. There are even a few people with bad medical ethics who take color photos of the cervix and use them as a means to obtain economic benefits, which is a lack of professional ethics. 6.Related problems in cervical cancer screening Domestic cytology examination lacks nationwide consistent quality control procedures and norms, and cytology work is not paid attention to and lacks training, so leakage and misdiagnosis are more serious, and there is still a great distance compared with foreign countries. If clinicians are not familiar with the correlation between cervical cancer screening results (cytology, HPV-DNA, colposcopy), identification and further processing of the results, it also affects the quality of cervical cancer screening, resulting in over- or under-medication, which is detrimental to patients.