LETTERS

B-Lynch suture technique, HMO comments questioned

I am always disappointed when respected clinicians say or do foolish things. First, in “B-Lynch suture: a new approach to intractable postpartum hemorrhage” [September], Giancarlo Mari, MD, et al advocated performing the procedure through a Pfannenstiel incision! Since this technique should only be performed in cases of life-threatening hemorrhage, it should be done through a vertical midline incision. There is simply no clinical justification for wasting time with a Pfannenstiel incision in such cases.

And then, in his vaginal hysterectomy pearls [September], Robert L. Shirley, MD, bemoaned the possibility that health maintenance organizations (HMOs) may eventually “decide that patients should be discharged directly from the recovery room.” Too many physicians have forgotten that we alone are responsible for making such decisions, not the HMOs. These organizations don’t discharge patients early; frightened doctors do. Such passive acquiescence to potential HMO abuse by a veteran surgeon sets a very bad example for those physicians who still place their patient’s safety above all else. Please tell me he was only joking.