Are You Cured? Only If You Say You Are

In gynecology (and all of medicine, but gals being our focus) the 'gold standard' of treatment is within the realm of "evidence based" data for diagnosis and therapies. And the way we define success is "cure." In some cases there is never cure, there is just control. Good gyno examples of conditions that we can control and not cure would be atrophic vaginitis and lichen sclerosus. For these conditions treatments render the patient free of disease, but stop the treatment and the disease returns. For other conditions cure is possible, for instance a urinary tract infection: if the appropriate antibiotic is used the urine can be shown to no long grow the bugs that were infecting it. But many conditions the treatments have to rely on the patient reports formally called "Patient-reported outcomes (PROs). Headaches are a good example of this type of condition no test of headache resolution, only efficacy based on patient symptom questionnaires. Hysterectomies are not performed as commonly as they once were. In fact they have declined by about 40% in the past decade, and there are many benefits to this fact. Hysterectomy is one of those types of conditions that may be able to cure the disease (no more fibroids), but have equal or worse out come in what the patient reports as her overall benefit. It's important to not forget the patient in the cure, and ideally you are only cured if you say you are. Although research trials have for years used effective ways to gather patient reported symptoms, this is not really a standard that is used. Many organizations are jumping into this field and trying to come up with standards as reported in a July 10th, 2013 JAMA on page 139. But for the average patient and her gyno, remember, regardless of test reports: you are not done with treatments until you say your complaints are controlled, and thus, again, gabbing with your gyno is an important step to overall health care success!

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