Credentialing & Privileging

Professionalism or turfism? UAE makes the headlines

Credentialing Resource Center Connection, September 2, 2004

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Dear credentialing colleague:

Innovative interventional radiologists are taking a new clinical approach to uterine artery embolization (UAE), to treat uterine fibroids.

However, gynecologists are not of one mind concerning the use of UAE. In some medical centers, UAE is routinely offered to patients as an alternative to hysterectomy, while in other hospitals patients are more likely to learn of the procedure from a family physician or the Internet than from a gynecologist. 

An estimated 200,000 hysterectomies are performed in this country each year for the treatment of fibroids. For many of these patients, UAE (performed by an interventional radiologist) may have been a viable alternative. 

If history is any guide, credentials committees will begin to face requests for UAE privileges from gynecologists and others who have attended relatively short UAE training courses. The radiologists will suggest that full fellowships in interventional radiology should be the standard. Perhaps some will suggest working as a team to bring this approach to patients for whom it is appropriate. It is also likely that the issue will become a medical executive committee agenda item as discussions are held concerning the necessity of informing prospective hysterectomy patients of this alternative.

I asked Jonathan Burroughs, MD, FACEP, FAAFP, a consultant with The Greeley Company and medical staff president at Memorial Hospital in North Conway, NH, for his thoughts on this issue. "UAE is certainly a viable and even a preferred alternative for many women with symptomatic uterine fibroids," Burroughs said. "Unfortunately, many medical staffs do not have an interventional radiologist to both advise them of, and to perform this newer procedure that may remove the need for a traditional hysterectomy and save a woman a great deal of unnecessary morbidity. This creates a natural dilemma for many gynecologists: Do the procedure they are most familiar with or investigate what may be a better option for their patients."
 
"Today, the moral and ethical imperative is to do the right thing. To put it pragmatically: If a loved one of yours was to undergo treatment for symptomatic fibroids, would you want her to have access to the option(s) that would benefit her the most?" Burroughs said.
 
"Going back to the gynecologist's 'dilemma', I think that most patients would not only appreciate the gynecologist's commitment to their care, for offering all viable and beneficial options, but I think that the gynecologist will benefit from this 'selfless' service though increased patient trust and respect and ultimately larger numbers of referrals from satisfied and appreciative patients," Burroughs said.

My recommendation to medical services professionals is the following: Develop your privileging paper on UAE, obtain input from the gynecologists on your staff, request advice from the radiology department, contact the various specialty societies, and use the Google search engine to do clinical research on the procedure. Begin the debate over who should be performing this procedure in your facility in a professional and collegial manner. It will be beneficial for patients and, in the long run, for physicians as well.

That's it for today.

All the best,
Hugh Greeley
www.greeley.com/seminars/



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