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Endometriosis: laparoscopy and the doctor's point of view ENDOMETRIOSIS: LAPAROSCOPY AND THE DOCTOR'S POINT OF VIEW
Typically, a gynecologist knows that a laparoscopy is indicated when his patient's complaints of pelvic pain persist for at least six months and he finds that she is not responding to conservative treatment, such as painkillers, or to a regimen of antibiotics (if he found signs of infection). He will need to reevaluate her case at this point: did she have endometriosis at the time of her first visit to his office? Let's assume that the doctor isn't sure and now she is back at his office, having followed all his instructions. She is not better, but worse, valiantly struggling with her pain and seeking relief her doctor suggests laparoscopy, since it may be endometriosis that's causing her symptoms. He assures her that even if it is not, the procedure may help reveal any of several other conditions, such as acute ovarian cysts or even an ectopic pregnancy.
Good diagnostician should be about 95 percent sure that his patient has endometriosis just by taking a very detailed medical history and listening to her progression of symptoms. A follow-up laparoscopy, when indicated, could then confirm the diagnosis. We have discovered, however, that there is another side to the issue: many women have had unfortunate experiences not only with misdiagnosis at the time of their initial visit but with laparoscopy as well. As the patient, you should be aware of what steps your doctor is taking before he recommends a laparoscopy:
• If the doctor believes you have an infection, he should have taken a culture to prove that point,
• If the doctor suggests mat you have a pelvic cyst or tumor, it should have been confirmed first with a pelvic ultrasound.
• If you are not responding to any treatment the doctor prescribes based on this findings, you should then be free and able to openly discuss with him (1) how you feel and (2) what other diagnostic and therapeutic steps could be taken.
• If he first retests you for infections, cysts, and tumors and all the tests are negative once again, a laparoscopy might then be called for.
What happens when a woman willingly undergoes this procedure again and again and is either diagnosed correctly or incorrectly, and either way, the disease is mismanaged?
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