16 The Independent Professionals


	Camille: Something tells me you're not really a doctor.
	Lister: What gave me away? The fact that I've gone fully ten seconds 	 	without patronising you?
	Red Dwarf by Rob Grant and Doug Naylor

At the Independent Professional Review I found that the independent professionals were both quite old and seemed quite amiable. They saw me for an hour in the morning and then saw Miss Godly and the nurse who had been sitting in on the consultation two years ago.
In the afternoon I was told that the only ultrasound available in the Royal University Hospital was no better than that of the local Hospital, Helton, and could not have distinguished an ovarian lump from a womb lump, so it would have been no good doing another scan. Of course the situation was much improved now that the gynaecology department had moved to the Women's Hospital and women were now getting better scans. I felt frankly incredulous.
Also magnetic resonance imaging was only for research purposes and would never have been used to scan masses in female organs. I must admit I didn't seriously think that something as new, and expensive, as MRI would be wasted on mere diagnosis of a lumpy female but at the time I was desperately fishing around, trying to think of some diagnostic test which would have identified the mass and at least have assured me that I was not carrying a highly malignant ovarian cancer. It was two years later that I realised I had already had that test. Dr Fewins had good reason to be sure that the mass was NOT ovarian. When I had been first scanned at Helton the radiographer spent a long time scanning the area just above my pubic bone, very low in the abdomen. When Dr Rimmer had done the scanning a year later and went to answered the telephone, leaving her radiographer to find the ovaries, it dawned on me that it was the ovaries that were in this area, one on each side in their normal position. As this scan showed, the mass arose from the top of the womb, mainly outside of the womb and sitting on top of it. Only thinking of it after the Review did I understand that not only was the lump a single, compact, hard and centrally situated mass but it was too far away from the ovaries to be part of them.
Later I realised something else that had been staring me in the face for over 20 months. On 20 July 1992 - on the same day that he requested a copy of the scan - Dr Curry wrote to Dr Amicable saying that it was impossible to be certain of the diagnosis of the lump and though it was probably fibroid(s) "a ovarian neoplasm cannot be completely excluded even despite the ultrasound report". In other words without even seeing the scan, knowing nothing about either its content or its author's experience and qualification from the RCOG, he had decided that it could not determine whether the mass was from the ovaries or the womb!
Not only was Dr Fewins certain of her identification of normal ovaries but she had been asked for an identification only of the mass, and in ten years of ultrasound experience had never been asked for more than this basic information. She never said that she could not possibly have provided more details if requested and she made no assertions at all on the numbers, or even probable numbers, of fibroids present.
The referral letter from Dr Amicable stated that the ultrasound scan "confirmed the mass to be a large fibroid uterus". Mrs Languid's letter had stated that I "indeed" had a large fibroid womb and my ovaries appeared normal. But Dr Curry had written that the lump was merely "probably" a fibroid mass and had decided that it was also probably multiple fibroids. And Miss Godly, without even examining me, had just accepted his ideas that the ultrasound scan was inconclusive and that there were many, if any, fibroids.
Miss Godly's opinion that I should have a hysterectomy was allegedly based on the false premise that I had multiple fibroids - well multiple probable fibroids. That, and my heavy bleeding - which had, in fact, stabilised over two years ago and was not getting worse at all - in her view condemned me to mutilation. However, as Jeffcoate's Principles of Gynaecology says that it is "relatively easy to enucleate 10-30 fibroids" it occurs to me that the number of fibroids is irrelevant. Having multiple fibroids is no justification for consigning a womb to destruction, though Miss Godly used this as an excuse anyway, without making the slightest attempt to find out if the excuse was true.
I was asked about laparoscopy. I am fairly sure that at Helton I was told that laparoscopy was not possible because the mass was rising above my umbilicus. How true this was I do not know but I have since read a paper by Nezhat et al on the laparoscopic removal of 347 fibroids from 154 women. The largest pedunculated, subseral and intramural fibroids removed were 15 cms in size. And the oldest patient was 51! You can have conservative surgery with minimal trauma even on large fibroids, and no matter how old you are - as long as you can pay for it. But such levels of sophisticated equipment and expertise are not found in the NHS, which appears to resent spending even an extra penny on conserving wombs it can simply excise.
Miss Godly did not mention laparoscopy. Or hysterosalpingography. Or endoscopy. She merely knocked back any investigation I suggested. Ultrasound was inconclusive. CAT scanning was no better. MRI was not for boring fibroid females. As G H Whitehouse observes in Gynaecological Radiology, published in 1981, in 44-48% of cases fibroids press on the ureters and produce water swellings in the kidneys. He wrote that "as in all cases of large pelvic masses a preoperative assessment of the urinary tract is important when there is a large fibroid uterus". Miss Godly attempted no such urinary assessment. But how could she? When equipment at the Royal University Hospital could not even provide a definite diagnosis of a large mass with the distinctive whorled appearance of fibroids how could she have investigated the fine structure of the kidneys, which the professor later found to be suffering pressure effects from the mass.
I would bet that few fibroid women have their urinary systems investigated in this way. Old wombs get the minimum of investigation and expensive tests, or even fairly cheap tests, are rarely wasted on them. There's no point when all the textbooks declare that every womb over the age of 40, and many under, should be despatched for destruction. Why bother wasting resources finding out what effect a fibroid mass is having on the kidneys when it will soon be swept away, along with its container?
I never got so much as a blood test at the Royal University Hospital and nobody even attempted an internal examination of my organs and the lump.
It was said that I had seen Miss Godly for an hour but I didn't remember it being so long. It seems that the reviewers had been told that Miss Godly had seen me for over a quarter of an hour before seeing me with the nurse. This was patently false. And I had already given them a copy of my December 1992 letter to Dr Amicable, in which I described being left to "stew in isolation" in an empty room for twenty five minutes before Miss Godly appeared with the nurse. Then when she came in she shook hands with me - not something she would have done if she had seen me only a few minutes previously.
Mr Reviewer said I had terminated the consultation prematurely. (After an hour, or was it only half an hour?) It seemed that Miss Godly was just going over the options and she had expected me to stay and tell her how I felt. How I felt? Dr Amicable's letter admitted that I was "reluctant" to accept mutilation and wanted other treatment. Dr Curry noted that I was "disappointed" with Mrs Languid's suggestion of butchery and talked to me of the conservative surgery of Professor Donnez using Zoldadex, laser myolysis and myomectomy. I'd indicated how I felt in SEVEN A4 pages. Had Miss Godly even glanced at them? Or had they been ignored, as all patient input is ignored? As Dr Harrison observed in A Woman in Residence, "In medicine there is the belief that if a patient doesn't do what the doctor has suggested, then the doctor just hasn't explained the matter enough." The professionals were sure that all they had to do was keep saying, like deadly parrots, that hysterectomy was best for me and I would believe them - no proof necessary.
I hadn't realised that it was some kind of game. Miss Godly had made her play. Now I was supposed to perform, to say something. But what? She had said that she could do no tests to establish anything at all about the mass. Even the certainty of its diagnosis was taken from me. What impression did she think it made on me to be told not only that she could tell me nothing about the details of the lump, and that she could do nothing - no investigations or tests whatsoever to produce the slightest information on it - but that she wasn't even certain of its diagnosis. She knew no more about the lump than I did. But she was sure that I should be cut open. Did she deliberately try to confuse me by cancelling the definite diagnosis? Did she think I would be so disheartened that I would agree to anything she suggested?
And that was the best that the NHS could do?
Miss Godly made it perfectly plain that she didn't approve of myomectomy and I wasn't having a hysterectomy unless it was essential for my survival. When I said that I could cope with the bleeding, indicating that I wasn't going to be operated on, Miss Godly merely tried to chivvy me into an operation with threats to my future health. Having failed to bring me to heel she tried to put the frighteners on by stating that I would need to continue iron treatment and that this was "not in the best interests" of my health. And she made no attempt to treat my bleeding medically though, as the reviewers noted, Dr Curry had already mentioned progesterone briefly on my first appointment. If I wasn't accepting surgery then I wasn't getting anything. Neither she nor Dr Amicable ever attempted any medical treatment for my bleeding.
Miss Fobb, the administrator, later wrote that it was Miss Godly's opinion that I should have a hysterectomy, not a myomectomy, and it would not be ETHICAL for Miss Godly to perform an operation she didn't think the patient should have. So Miss Godly had only been pretending that she would do a myomectomy. How could she have performed such an operation on me? It would not have been ETHICAL for her to have done so. It was no wonder she gave no impression that she would actually do conservative surgery, and her attitude was so negative that I could not have trusted her even if she had reluctantly said, "well I'll remove just the fibroids if you really insist".
And considering that even after four Zoladex injections, causing the shrinking of the mass to only a third of its previous size, my womb was still noted as being "very vascular" at operation I think preoperative treatment was highly desirable. One has great doubts of getting it from Miss Godly. Indeed how could she have justified fibroid-shrinking Zoladex treatment at ?126.40 a shot when she couldn't even be certain that I had fibroids? I have the nasty suspicion that had I gone into a theatre with her whatever it said on the consent form I would come out with no womb, and possibly no ovaries either.
Mr Reviewer chunnered over the price of Zoladex. I could almost see his distress at the squandering of over ?500 worth of the drug on a geriatric female organ that could have been quickly excised; should have been excised, for it was ridiculous allowing a woman over 40 to keep her womb and have to have smear tests - more unnecessary expense - and maybe getting cancer in the damn thing and causing even more expense having it taken out later when a quick hysterectomy would have fixed it good style now. Bloody stupid women. They don't appreciate that they're better off without their reproductive systems. Zoldadex should be kept for important complaints, like prostate cancer, and important patients - men.
Mr Reviewer suggested that had I stayed longer Miss Godly might have done something - like actually examine the lump in question. She had been wittering away for an hour (or maybe just half) impressing on me the fact that I was going to learn absolutely nothing about the lump from her, talking only of surgery, not investigation (of which, I was told, none was possible) on the unknown mass. And then after going through the surgical options (or was that option?) she was actually going to examine me? Wasn't that putting the horse after the cart? Isn't it supposed to be diagnosis and examination first, treatment suggestions afterwards?
It would have been interesting to have known if, like the professor, Miss Godly had the clinical skill, which Mrs Languid obviously did not, to determine that there were no more than two masses. Would it have made any difference if she had known that removing the lump alone would be as quick as a routine butchery? Perhaps her ethics would have allowed her to do a myomectomy if she had realised that it would at least be a "technically uncomplicated" procedure.
Although I did not say so at the Review I am now almost certain that Dr Amicable sent me to Miss Godly to be told that I should be fixed. I find the expressions, "we are really asking for a second opinion" and "hysterectomy was suggested to Miss Nomark but she is very reluctant to accept this", and that Dr Amicable had explained that "hysterectomy is possibly the only option available, but she would still like to have a second opinion", all deeply suspicious. Especially when I read in Weinstein, Kase and Gershensen's book Principles and Practice of Clinical Gynecology that myomectomy is almost ALWAYS possible regardless of the size, number or position of fibroids - that is hysterectomy is virtually NEVER the only option, merely the option favoured by the medical profession. The overall impression from Amicable's referral letter is that she is saying "just see this stupid woman and tell her she can't have a myomectomy and she should be fixed".
It was interesting that Mr Reviewer said that I had probably got a referral to the professor for an opinion only because if his opinion had been that I should have a hysterectomy then the local health authority would have insisted that I get fixed locally, as they would not have sanctioned payment for an operation out of the district when it could be done locally. This would surely mean that after insisting that I should have a hysterectomy Miss Godly wouldn't have done the operation herself, because the local hack was perfectly capable of doing a routine mutilation. It looked like my conclusion was correct. "We are really asking for a second opinion" really meant "we are really only asking for you to confirm Mrs Languid's opinion so this woman can be sent back to the local hospital to get fixed by her". And in fact Dr Amicable had finished by asking Miss Godly to "see and advise" - only?
Although I was to be referred to the professor for an opinion only I had already made it quite clear in my original enquiry to the RCOG that I was not interested in mutilation and the professor's letter of 31 March 1993, a copy of which I had sent to the practice, stated concisely that "If the fibroid or fibroids are causing you any symptoms then it or they can be removed from the uterus and not with the uterus". It couldn't be clearer that the professor could certainly do a myomectomy and as I refused to consider a hysterectomy there would have been no point in seeing him if he would not have done so. But I was still being referred for an opinion only, at Dr Amicable's suggestion.
I was told that Miss Godly had worked in Africa, where it is often a great social stigma for black African women to be hysterectomised, though they are especially susceptible to fibroids, and she had lots of experience of myomectomies. Why she had actually done two this year and one woman was all of 42! And she had women referred to her from outside her district for myomectomy! I wondered just how many myomectomies she had done on the dark continent. And how many Africans had lost their wombs to her. A damn sight more than she had saved I was prepared to bet. If she was aware from her African experience that some women loathe being mutilated she took little notice of my abhorence of the medical "operation of choice". But what, I wondered, had been the white doctor's experience of fibroid women in the large, prestigious South African hospital. Did she see only black women with such severe symptoms that they would have accepted any treatment of their condition? Did she expect them to be as joyful at amputation as their white mistresses, who all realise that they are much better off without their female organs?
I was not surprised that Miss Godly had done some myomectomies, probably in women where she could justify it on breeding grounds, but that she had actually conserved the womb of a woman over 40 was surprising. Perhaps this female was for some reason madly desperate for children. 
Dr Godly's insistence that she "could not be certain without doing a laparotomy whether the mass was ovarian or uterine", leaving me with a mass her associate had labelled as possibly malignant, and if so probably fatal, I can only regard as either yet another attempt to frighten me into surgery (agree to get cut open or you may die of cancer) or either moronically thoughtless or frighteningly callous behaviour.
The male reviewer tried to play down the note from Dr Bravado etched in my GP medical record - the one which stated that "in view of age" a myomectomy was not suitable. That was just brief notes the GP had made, presumably from a telephone conversation. But this note had been the impression Miss Godly had made upon another medical professional and if it was not both correct and significant what was Dr Bravado doing writing it in my medical notes? It confirmed my assessment of December 1992 that Miss Godly might just as well have given an opinion by post. In fact I don't think that she had an opinion to give at all. She had merely accepted a brief from Dr Amicable to hassle me into hysterectomy.
She failed, and her letter to Dr Amicable ended with "I have, therefore, not arranged to see her again", which sounded to me like she had given up the attempt and had no intention of ever seeing me again. But Mr Reviewer insisted that she had not just dumped me with an unresolved, and possibly highly malignant, mass. She had expected to hear from me again. In the practice notes my GP made no mention of Dr Curry's letter of 20 July, and the reference to Miss Godly's letter is dated 19.9.92. I thought that the month had been misdated but the entry also refers to the request I made
to be referred to the homeopath. Dr Amicable made no mention of Miss Godly in the notes. Nor did she ever mention Miss Godly again to me and when I saw her in January and wanted another ultrasound to see if the lump had increased in size (I did not know that the original scan was for diagnosis only and that NO measurements had been made) she suggested I go back to see that nice Mrs Languid - the one who "would not feel very happy" at the thought of attempting a myomectomy, though she would love to have her registrar bludgeon me into having a hysterectomy.
At least the registrar was quite honest about the "surgery" he was talking about. He wrote directly that "Mrs Nomark refuses hysterectomy". No pretence there that any old crone should be allowed to retain her geriatric organs. He sneered at raddled female parts with "Why would you want a fibroid womb?" and curtly dismissed myomectomy, saying that, "They (fibroids) only come back".
And I don't believe Mrs Languid had ANY intention of seeing me herself on my second appointment. She had given me an early appointment time, (1.30) marked "permission for time" on my card, only a week after my first consultation, and she practically walked past me to her little office and then saw somebody else, and I was called in to the "capable and caring" (according to his boss) person I subsequently named "Jack Ketch".
No doubt Jack is today capably and caringly removing wombs by the score with never a hint of conservative surgery to sully his performance.
I didn't like the way the male reviewer kept insisting that hysterectomy was a perfectly valid treatment for fibroids (the perfect treatment for fibroids in his view?) and I would have to spew up lots of good reasons for not accepting it, humbly and gratefully, of course, as all patients are expected to accept their doctors' decrees. It sounded like he was an avid hysterectomist. Does a Jehovah's Witness have to repeatedly justify his distaste of blood products? Transfusion is repugnant to him so he doesn't have it - no matter how inconvenient it is to the medical profession. Hysterectomy is repulsive to me. So I didn't have it.
Finally I was told that I was supposed to have been seen by Miss Godly herself on my first appointment yet when I got the date - TWO MONTHS after the referral letter so they weren't rushing - it was for a day when Miss Godly was on vacation, thus ensuring that whoever I was seen by it would most certainly not be she.
Just a little administrative cock-up there. No conspiracy at all to rob you of your womb. No more than the national, routine attempt to routinely dispose of all female organs in the most efficient, cheapest way possible.
It's true that many women do survive hysterectomy without obvious, severe difficulties (which isn't to say they are not damaged by it) but given my attitudes could anybody with the minimum of intelligence or human feeling really say it would be ideal surgery for me? Even if necessary as a life-saver I should loathe it. For it to be done because a hack with a low opinion of female organs, which she can't be bothered making even the slightest effort to investigate, decides that it would not be ETHICAL for her to consider conservative surgery is really obscene. And then for her to have the gaul to say that she is only thinking of my best interests - well it just takes my breath away. Thank God it didn't take my womb away.
I felt quite sure that the reviewers would conclude that the cock-up was all the patient's fault - as usual. If I hadn't have left without her permission her Ineffableness would have realised (belatedly) that I was not going to accept a hysterectomy and I could have been put down on her operating list for a myomectomy.
Then perhaps during the operation on my large fibroid in my extremely vascular womb it might have been observed that I was bleeding so much that Miss Godly would have been obliged to perform a hysterectomy, to the great satisfaction of both her Ethics and the National Hysterectomy Service.

At the beginning of October I received a letter from the chief executive of the Women's hospital where Miss Godly now worked which said:-

Dear Miss Nomark

I have received the report of the Independent Professional Review conducted at....

One of your complaints was that at the time of the consultation with Miss Godly, you did not wish to have surgery of any kind and specifically did not wish to consider or discuss hysterectomy procedures. The independent consultants found that Miss Godly, however, considered that it was her professional responsibility to counsel you regarding all treatment options available. This she did in a clear and concise manner1. The consultants are also satisfied that Miss Godly was skilled in the technical procedures required for a myomectomy which was the operation you might have considered but which Miss Godly thought to be inappropriate in your case.
You also complained that neither Miss Godly nor her senior registrar conducted a proper examination of the abdominal mass. The senior registrar had conducted an abdominal examination at your first visit to the gynaecological clinic. An ultrasound report was available of the examination which had been carried out at Helton Hospital before you were referred to Miss Godly as a second opinion. The senior registrar arranged for you to see Miss Godly when she was next available at the outpatient clinic. The independent consultants found this allegation difficult to answer as you terminated the consultation before Miss Godly considered it had been concluded satisfactorily. They consider it was not possible to say whether or not Miss Godly would have performed a clinical examination or arranged further special investigations at that time.
The independent consultants commentated on delays in response to your complaint. In part this was due to the transition of the gynaecological services from the Royal University Hospital to the Obstetric & Gynaecology Services Trust. The consultants considered that if the opportunity for a further consultation with Miss Godly has been arranged or a speedier response made by the administration then your complaints may have been resolved without the need for the Independent Review. I do therefore apologise for any delays in dealing with your complaint at the time.
I hope that you feel that your complaints have been thoroughly and satisfactorily investigated.

PR HERRING
Chief Executive

This confirmed what I had long suspected, that Miss Godly had irrevocably made up her mind that my reproductive system was dog-meat long before she saw me - merely because I had a large lump and was over 40. However, as I suspected, the fellow professionals found a getout in my leaving without agreeing to her butchery. They made no comment on the fact that Miss Godly had decided on treatment before examination2 or that having decided on mutilation she could never have performed a myomectomy as that would have been contrary to her "ethics".
In fact Miss Godly had never told me that it was her opinion that mutilation was "best" for me and refused to communicate with me at all when I wrote to her. Though she found time to complain to my GP's practice about me - apparently telling them that myomectomy was not suitable "in view of age", since that was what they wrote in my records. Yet what more could she have had to say to me, if she had already spent an hour trying to hassle me into mutilation?
On 19 October 1994 I wrote to the chief executive:-

Dear Mr (Red?) Herring

Thank you for your letter of the 5 October, informing me that you have received a copy of the Independent Professional Whitewash.
I am sorry to disappoint you by not feeling in the slightest that my complaints have really been taken seriously. I enclose a copy of my version of the review, which I composed soon after the event. In fact I sent copies to Miss McD of the CHC and Miss Reviewer in September.
As far as administration is concerned, it is very convenient to blame moving records but this does not explain why I was THREE times told, twice by Mrs Thomas and once by Mrs Mercer, that a copy of the ultrasound was NOT received by the Royal, in spite of the fact that Miss Godly wrote that it was. Nor why I was told to apply to Weston hospital if I wanted a copy of the letter that accompanied the scan report. One naturally wonders why the Royal should fail to give me copies of these documents which should not only have been in my records but contained the only, very brief, results of the superficial scan done at Helton. Considering that her letter revealed that Mrs Languid "would not be very happy" at even the thought of performing a myomectomy and knew little about GnRH-a treatment it naturally made me think that she had tried to hustle me into hysterectomy because that was the limit of her competence. And suggested to me that the Royal deliberately withheld the letter because they did not want me to become acquainted with these facts.

After commenting about Miss Fobb I continued:-

You make no mention of what the reviewers said about Mr Curry informing me that I had a possibly highly malignant lump, since he thought it might be ovarian, not uterine, in origin, and Miss Godly asserting that she could do nothing to establish which it was, leaving me with an alarming lack of diagnosis. Or did they ignore this fact?

After comments about MIss Godly I finished :_

Although Miss Godly acknowledged that other options to hysterectomy were possible the letter I received from Miss Fobb (a copy of which I gave to the reviewers) makes it perfectly plain that Miss Godly had decided that I should be mutilated and was not seriously entertaining the possibility of any other procedure. As Miss Fobb says it would not have been ETHICAL for Miss Godly to have considered any operation MISS GODLY did not consider in the patient's interest, no matter how much the patient detested HER selection. I am only thankful that I realised how determined Miss Godly was on mutilation, a decision based not scientific facts or investigation but on medical prejudice against female organs, and went where doctors sometimes listen to what the patient says instead of dishing out convenient, routine mutilations because the profession likes doing them.
I also enclose a copy of the foreword, written by Professor Stuart Campbell, to Felicity Smart's book on fibroids. As you will note it says that my attitude to my body should be respected and that I am entitled to the treatment I feel right for me, not what somebody else chooses to dish out. Miss Godly not only entirely failed to respect my attitudes and feelings but launched into her hysterectomy campaign without even attempting to establish the basic medical facts. She also rubbished the ultrasound scan, leaving me uncertain as to whether the mass was fibroids or a malignant ovarian growth. I should like to think that she is a solitary medical dinosaur but I have the uneasy feeling that in medicine in general, and gynaecology in particular, it is very much a case of "REPTILES RULE OK".

Yours sincerely
Pamela Nomark

In fact I had not only sent copies of my write-up of the Independent Review to Miss McD and Miss Reviewer but to the nurse who had been sitting in on my interview with Miss Godly, asking for comment upon it.
They did not reply but some six weeks later the nurse did. She wrote that she had now retired from the NHS and didn't want to be involved. Strangely enough the reply was typed on headed paper from hospital at which she no longer worked.
Mr Herring wrote within a week of my letter. He said that he was sorry that I felt the review had not fully dealt with my concerns, but regreted that he could "undertake no further investigation or action given its outcome". And he suggested that if I wished to pursue the "administrative aspects" of my complaint I had the right to to contact the Health Ombudsman.
So on the 17 December 1994 I wrote a 3 page letter to the Ombudsman, reminding him of my original complaint, telling him of my further communication with the Royal and enclosing a copy of the letter from Chief executive's precis which stated that, "An ultrasound report was available of the examination which had been carried out at Helton Hospital before you were referred to Miss Godly as a second opinion" - directly contracting the legal eagle and the chief of nursing who had both written that no such report was received. Just for good measure I also moaned about Miss Fobb, quoted the irreverent Mr Fisher and finished with:-

So is there really any point in my complaining again. It seems that NHS bureaucrats may do as they damn well please and damn the punters.
I would be interested to know if you feel that I have been well served by the NHS, especially as an article in the Echo states that you feel "it is an indictment of the service if patients and relatives are not being treated with respect". Personally I feel that I have had the run around - that is when I have not been totally ignored as an unimportant ratbag.

Yours sincerely
P Nomark

The rely was dated 22 February 1995 and said that:-

I am replying in the Commissioner's tempory absence from the Office3 and I apologise for the delay in doing so, which has been caused by an inexpected surge in the number of complaints received in recent moonths.
Your initial complaint to the Commissioner centred on the alleged failure of the Royal University Hospital to provide you with certain documents when you requested a copy of your medical records in October 1992 under the Access to Health Records Act 1990 (the Act). Having carefully considered your complaint, the Commissioner wrote to you on November 1993 and explained that he could not help in his capacity as Health Service Commissioner or as Parliamentary Commissioner for Administration...
Although it is not entirely clear from your letter which matters you are now asking the Commissioner to consider, it might be helpful if I first explain that he could not take up any complaint about the Trust's delay in providing a copy of Mrs Languid's letter following your application under the act because , once again, a legal remedy is available to you...

Yours sincerely
R A OSWALD
Deputy Health Service Commissioner

And he sent me yet another copy of his incomprehensible booklet. 
As far as I can see Mr Fisher is correct and the Ombudsman is virtually useless. If you want the rights you allegedly have under the Patient's Charter you will have to be able to afford to go to court to enforce them.

I found lots of evidence of the awful sexual, hormonal and mental carnage that hysterectomy can produce. I was telephoned by a wreck suffering from all the above effects who told me that her entire reproductive system was gutted because she had a fibroid womb only the size of an eight week pregnancy(!) and an ovarian cyst. As her GP kept hassling her to have surgery she now feels that she was butchered because the local hospital needed to drum up customers to save it from being closed down!
I didn't know what to say to her. She wants a change in the law to refer every suggested hysterectomy victim to a special female medical review body to ensure that surgery is really necessary. She is apparently unaware that in conforming to the medical system the vast majority of medical females act like honourary men. Of this I have had personal experience.
My sister's friend was also told that because she had fibroids and was 35, i.e. over the hill, she must be mutilated too. At 16 weeks size her lump was much smaller than mine was but she was told that she must have a hysterectomy and that myomectomy was not possible because of bleeding. As Bonney operated before the advent of modern surgery, antibiotics, blood transfusions or fibroid shrinking agents I regard this as rubbish. When she eventually had an ultrascan it was found that she didn't have fibroids at all. She had an ovarian, dermoid cyst.
So much for doctors' ability to diagnose!
And she was told that this could be removed by keyhole surgery with minimal trauma. What, I wondered, would have happened if she had immediately agreed to surgery? Would she have been opened up, her normal womb removed as they had a warrant for its execution, the ovary with the cyst removed as "any other procedure necessary" and the remaining ovary extirpated as not worth preserving on its own as it might develop a cyst later - or cancer even. She might have woken up completely gutted.
Hysterectomy, as Professor Campbell and many of the mutilated say, should be a last resort. Its continued, frequent, and frequently inappropriate, use is an indictment of man's inhumanity to woman.


1 Don't they all?
2 decided purely on my date of birth since she knew nothing of the mass itself
3 For 2 months?