In any study, all relevant information needs to be collected and evaluated if the intent is to reach valid conclusions. In this study, to conclude that inappropriate surgeries were performed, the office records were just as important to review as the hospital records. Information regarding the discussion between the physician and patient regarding alternative, less invasive treatments may in fact only be found in the office record.

It is true that a nonbiased objective discussion should be held between the physician and patient without any conflict of interest using language that is understandable to the patient.

In addition, a normal pathology report does not always indicate that the surgery was not indicated. For example, if a woman is bleeding to anemia and other less invasive modalities have been tried and failed or cause unacceptable side effects, the pathology report may indeed be interpreted as normal. However, the problem has been alleviated and quality of life improved for the patient.