Letter: Under the knife

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Sir: Jeremy Laurance ("Can we trust doctors when they put us under the knife?", 1 September) sees no problem with Bupa curbing a gynaecologist's freedom to perform a hysterectomy. He misses several points.

Bupa cannot prevent any surgeon performing any surgery; it can only refuse to pay the surgeon's private fee. This is not a policy driven by a desire for clinical excellence; it is a cost-cutting exercise.

Mr Laurance ignores the question of patient choice. There are many options in the management of menstrual disorders, some medical, some surgical. A hysterectomy has advantages and disadvantages, but to some women it may offer significant advantages over the alternatives. It is a once-and- for-all solution and patient satisfaction with the procedure is very high. If Bupa denies funding for a procedure chosen by an informed patient and insists on alternative therapies, it is the patient's hands that are tied, not mine.

Few gynaecologists would want to see unnecessary hysterectomies performed, but to attempt to prevent them in this manner is to misuse a blunt instrument, making it unlikely that surgical quality is the driving force behind it.