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Committee Opinion Number 709, August 2017

(Replaces Committee Opinion Number 359, January 2007)

ABSTRACT: Monetary reimbursement of physicians in exchange for medical advice and treatment is well established and accepted in medical practice. However, financial pressures and the pervasiveness of entrepreneurial values have led some physicians to widen the scope of activities for which they seek reimbursement. Some of these commercial activities are ethically problematic in the clinical setting. Obstetrician–gynecologists should strive to ensure that commercial enterprises in medical practice do not compromise the patient-focused mission of clinical care. In this Committee Opinion, the Am...


Committee Opinion Number 695, April 2017

(Replaces Committee Opinion Number 371, July 2007)

ABSTRACT: Sterilization is the most common method of contraception among married couples, with nearly twice as many couples choosing female partner sterilization over male sterilization. Although sterilization is among the most straightforward surgical procedures an obstetrician–gynecologist performs, it is enormously complex when considered from a historical, sociological, or ethical perspective. Sterilization practices have embodied a problematic tension, in which some women who desired fertility were sterilized without their knowledge or consent, and other women who wanted sterilization to...


Committee Opinion Number 427, February 2009

ABSTRACT: The World Health Organization estimates that 67,000 women, mostly in developing countries, die each year from untreated or inadequately treated abortion complications. Postabortion care, a term commonly used by the international reproductive health community, refers to a specific set of services for women experiencing problems from all types of spontaneous or induced abortion. There is increasing evidence that misoprostol is a safe, effective, and acceptable method to achieve uterine evacuation for women needing postabortion care. To reduce maternal mortality, availability of postab...


Committee Opinion Number 523, May 2012

(Reaffirmed 2014)

ABSTRACT: Re-entering the practice of obstetrics and gynecology after a period of inactivity can pose a number of obstacles for a physician. Preparing for the leave of absence may help reduce the difficulties physicians may face upon re-entering practice.


Committee Opinion Number 621, January 2015

(Replaces Committee Opinion Number 472, November 2010)

ABSTRACT: The advantages of health information technology (IT) include facilitating communication between health care providers; improving medication safety, tracking, and reporting; and promoting quality of care through optimized access to and adherence to guidelines. Health IT systems permit the collection of data for use for quality management, outcome reporting, and public health disease surveillance and reporting. However, improvement is needed with all health IT, especially regarding design, implementation, and integration between platforms within the work environment. Robust interopera...


Committee Opinion Number 464, September 2010

(Replaces No. 328, February 2006, Reaffirmed 2014)

ABSTRACT: Ensuring patient safety in the operating room begins before the patient enters the operative suite and includes attention to all applicable types of preventable medical errors (including, for example, medication errors), but surgical errors are unique to this environment. Steps to prevent wrong-site, wrong-person, wrong-procedure errors, or retained foreign objects have been recommended, starting with structured communication between the patient, the surgeon(s), and other members of the health care team. Prevention of surgical errors requires the attention of all personnel involved ...


Committee Opinion Number 636, June 2015

(Replaces Committee Opinion Number 449, December 2009) Reaffirmed 2017

ABSTRACT: Phenylketonuria (PKU) is an autosomal recessive disorder of phenylalanine (Phe) metabolism characterized by deficient activity of the hepatic enzyme, phenylalanine hydroxylase. Increased blood Phe levels are toxic to a variety of tissues, particularly the developing fetal brain. The mainstay of treatment for PKU is the dietary restriction of Phe, which results in decreased blood Phe levels. Lifelong dietary restriction and therapy improves quality of life in patients with PKU and should be encouraged. Genetic counseling is recommended for all reproductive-aged women with PKU, and sh...


Committee Opinion Number 517, February 2012

(Replaces No. 367, June 2007) (Reaffirmed 2018)

ABSTRACT: Handoff communication, which includes up-to-date information regarding patient care, treatment and service, condition, and any recent or anticipated changes, should be interactive to allow for discussion between those who give and receive patient information. It requires a process for verification of the received information, including read-back or other methods, as appropriate.


Committee Opinion Number 478, March 2011

(Reaffirmed 2018)

ABSTRACT: Family history plays a critical role in assessing the risk of inherited medical conditions and single gene disorders. Several methods have been established to obtain family medical histories, including the family history questionnaire or checklist and the pedigree. The screening tool selected should be tailored to the practice setting and patient population. It is recommended that all women receive a family history evaluation as a screening tool for inherited risk. Family history information should be reviewed and updated regularly, especially when there are significant changes to f...


30.
August 2012

Committee Opinion Number 531, August 2012

(Reaffirmed 2016. Replaces No. 331, April 2006 and No. 400, March 2008)

ABSTRACT: Despite significant national attention, medical errors continue to pervade the U.S. health care system. Medication-related errors consistently rank at the top of all medical errors, which account for thousands of preventable deaths annually in the United States. There are a variety of methods—ranging from broad-based error reduction strategies to the adoption of sophisticated health information technologies—that can assist obstetrician–gynecologists in minimizing the risk of medication errors. Practicing obstetrician–gynecologists should be familiar with these various approaches tha...


Committee Opinion Number 674, September 2016

ABSTRACT: New or emerging surgical procedures and technologies continue to be developed at a rapid rate and must be implemented safely into clinical practice. Additional privileging may be required if substantively new technical or cognitive skills are required to implement an innovative procedure or technology. Guiding principles for privileging should include cognitive and technical assessment to ensure appropriate patient selection and performance of the new procedure. Implementation also should include pertinent institutional and staff support as needed. A dynamic process for assessment a...


Committee Opinion Number 590, March 2014

(Replaces Committee Opinion Number 487, April 2011) (Reaffirmed 2018)

ABSTRACT: Patient care emergencies may occur at any time in any setting, particularly the inpatient setting. It is important that obstetrician–gynecologists prepare themselves by assessing potential emergencies, establishing early warning systems, designating specialized first responders, conducting emergency drills, and debriefing staff after actual events to identify strengths and opportunities for improvement. Having such systems in place may reduce or prevent the severity of medical emergencies.


Committee Opinion Number 739, June 2018

ABSTRACT: The American Medical Association reported in 2015 that physicians 65 years and older currently represent 23% of the physicians in the United States. Unlike other professions such as commercial airline pilots, who by law must have regular health screenings starting at 40 years and must retire at 65 years, few health care institutions or systems have any policies regarding the late-career physician. Although there is an increase in accumulated wisdom and verbal knowledge with age, there is also an overall decline in recall memory, cognitive processing efficiency, and executive reasoni...


34.
February 2018

Committee Opinion Number 730, February 2018

(Replaces Committee Opinion No. 519, March 2012)

Abstract: Fatigue and sleep deprivation may affect a health care provider’s skills and communication style, and also may affect clinical outcomes. The National Sleep Foundation recommends 7–9 hours of sleep per night for an adult. However, there are no current guidelines limiting the volume of deliveries and procedures performed by a single individual or on the length of time he or she may be on call. Medical literature has shown that even a single night of missed sleep measurably affects cognitive performance. When adults do not sleep at least 5 hours per night, language and numeric skills...


Committee Opinion Number 205, August 1998

Tubal ligation at the time of cesarean delivery requires significant additional physician work even though the technical work of the procedure is brief. Informed consent by the patient requires considerably more counseling by the physician regarding potential risks and benefits of this procedure than is necessary with alternative means of sterilization and contraception. Also, many states require completion of special informed consent documents in addition to the customary consent forms required by hospitals. These forms must be completed before scheduling the procedure.


Committee Opinion Number 250, January 2001

The American College of Obstetricians and Gynecologists (ACOG) Committee on Coding and Nomenclature believes that physicians must code accurately the services they provide and the diagnoses that justify those services for purposes of appropriate payment. This requirement is consistent with the rules established by the American Medical Association (AMA) Current Procedural Terminology Editorial Panel and published as the Current Procedural Terminology (CPT) and with those established by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), which are pub...


37.
January 2001

Committee Opinion Number 249, January 2001

(Reaffirmed 2005)

Physicians are responsible for accurately coding the services they provide to their patients. Likewise, insurers are obligated to process all legitimate insurance claims for covered services accurately and in a timely manner. It is inappropriate for physicians to code or for insurers to process claims incorrectly in order to enhance or reduce reimbursement. When either party engages in such a practice intentionally and repetitively, it should be considered dishonest and may be subject to civil and criminal penalties.


Committee Opinion Number 715, September 2017

ABSTRACT: Educators in obstetrics and gynecology work within a changing clinical learning environment. Ethnic, cultural, and social diversity among colleagues and learners have increased, and methods of communication have expanded in ever more novel ways. Clerkship, residency, and fellowship directors, in partnership with chairs and senior faculty, are urged to take the lead in setting the tone for workplace etiquette, communication, and social behavior of faculty and trainees to promote a high standard of civility and citizenship. The Council on Resident Education in Obstetrics and Gynecolog...


Committee Opinion Number 582, December 2013

(Replaces Committee Opinion Number 417, September 2008. Reaffirmed 2018)

ABSTRACT: Noncoital sexual behavior is a common expression of human sexuality, which commonly co-occurs with coital behavior. Sexually transmitted infections, including human immunodeficiency virus (HIV), herpes simplex virus, human papillomavirus, hepatitis virus (types A, B, and C), syphilis, gonorrhea, and chlamydial infection, can be transmitted through noncoital sexual activity. When engaging in oral and anal sex, most individuals, including adolescents, are unlikely to use barrier protection for a variety of reasons, including a greater perceived safety of noncoital sexual activity comp...


Committee Opinion Number 705, July 2017

ABSTRACT: Mental health disorders in adolescence are a significant problem, relatively common, and amenable to treatment or intervention. Obstetrician–gynecologists who see adolescent patients are highly likely to see adolescents and young women who have one or more mental health disorders. Some of these disorders may interfere with a patient’s ability to understand or articulate her health concerns and appropriately adhere to recommended treatment. Some disorders or their treatments will affect the hypothalamic–pituitary–gonadal axis, causing anovulatory cycles and various menstrual disturba...


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