PubMed1995
Psychosomatic thinking leads a shadowy existence in surgery. That this is not justified is shown here by using the example of erroneous indications for appendectomies. Historical analysis revealed that the idea of 'chronic recurrent' appendicitis was erroneous from the very beginning. It can only be understood in the context of the particular medico-scientific conditions in the early 20th century. Statistical analysis identifies primarily girls and young women as the group predominantly affected by this erroneous diagnosis: mostly women have been and are operated, whereas true (= acute) appendicitis is a disease predominating in males. By means of a psychodynamically oriented look at stereotypically occurring individual cases in a heuristic manner, links to statistic results were found, permitting a restrictive concept for indications which was new for our hospital but had already been realized for a long time in the Anglo-American countries. Within three years daily surgical practice could be modeled, so that the number of appendectomies decreased to one fourth of the original number, while the frequency of acute appendicitis and of cases with perforated appendix remained unchanged. For the first time more male than female patients have been appendectomized, in accordance with the epidemiology of the disease. Altogether, this qualitative success was only possible, because the psychosomatic way of thinking by the involved physicians has been accepted for daily surgical routine on all hierarchic levels. It is therefore stressed that surgeons, too, should participate regularly in Balint groups, above all during specialization.