Medical decision making and elective surgery: the case of hysterectomy.

Review and analyses of three sources of data are presented indicating that 25% of hysterectomies are elective. Annual mortality associated with elective hysterectomy is estimated to be 319, or about 12,122 woman years. Cost-benefit analyses of mortality, life expectancy, morbidity, psychological sequelae, as well as dollar expenditures, reveal high costs and relatively limited benefits. Explanations for this apparent anomaly in decision making are explored and include economic incentives, system structure, sexism, and cancer prophylaxis. Principles of risk perception are discussed in terms of potential biases associated with the cancer prophylaxis motive. It is suggested that physicians' judgements of risk may be more salient to the decision process than those of prospective patients.