A Second Opinion Medical
An Information & Physician
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![[info]](images/sally.gif) As seen on the Sally Show 4/17/2000
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THE IMPORTANCE OF PHYSICIAN QUALIFICATIONS At an April 29, 1991 Congressional hearing on patient safety, Dr. Alexander Walt, then President-Elect of the American Board of Medical Specialties, testified about the need for qualified surgeons in outpatient settings. He said that any doctor who works in an outpatient surgical facility should be either certified by one of the appropriate American Board of Medical Specialty Boards, or should at least have completed a full, approved training program that leads to that examination process. According to Dr. Lawrence Bass, a Clinical Assistant Professor of Plastic Surgery and Co-Director of the Center for Minimally Invasive Plastic Surgery at the New York University School of Medicine, board certification helps determine who, by virtue of training and experience, is qualified to perform a procedure. Dr. Bass testified at a hearing before the New York State Department of Health's Committee on Quality Assurance in Office-Based Surgery on April 24, 1998. He noted that practitioners who are performing procedures outside the scope of their residency training may be board certified practitioners who are doing something other than what their board certification qualifies them to do. Alternatively, they may be non-board certified practitioners altogether. In either case, Dr. Bass said that there is no prima facie reason to assume that they are qualified to do a procedure for which they have not been adequately trained. Thus, a prospective patient should always question whether, for example, a doctor who is trained as a dermatologist has the knowledge and the skills to perform plastic surgery. This is particularly true since, as one anesthesiologist told the committee, there are so many dermatologists going into plastic surgery. Furthermore, patients should find out whether doctors who are practicing within their own specialty have actually completed their training in that specialty. There have been instances where physicians who were only partially trained functioned as if they were experienced and completely trained. For example, a March 3, 1998 article in the New York Times disclosed that New York State health regulators had fined Presbyterian Hospital at the Columbia Presbyterian Medical Center $66,000 for failing to supervise two residents who were caught performing inexpensive plastic surgery on weekends without the supervision of senior doctors. Dr. Bass also testified that another means of ensuring quality in office-based surgery is to mandate that only those who are credentialed to perform a class of procedures in a hospital may be permitted to perform them in the office setting. He pointed out that hospital credentialing verifies training and ensures good current standing in the medical community. The public should be taught to look for these measures of competence. A qualified surgeon is important not only to achieve a satisfactory outcome, but to reduce the risks to the patient during the procedure. As one anesthesiologist told the committee, "the better the surgeon, the quicker the procedure; the quicker the procedure, the less the anesthesia and the lower the risk." Moreover, a surgeon who has been properly trained is less likely to create subsequent complications for the patient. Dr. Christopher Freyberg, an emergency physician at St. Vincent's Hospital in Manhattan, sometimes sees such complications in the emergency room. As told to the committee, bad results from procedures can range from bleeding after abortions to disfigurement in liposuction cases. The liposuction cases are often subject to what Dr. Freyberg refers to as "Frankenstein's Rule." Simply put, some surgeons botch the procedures so badly that other plastic surgeons do not want to treat the patients later. Thus, the patients may be forced to go back to the surgeons who disfigured them, just as the monster that Frankenstein created had to return to him. If patients take the time to check their physician's credentials, they can avoid such pitfalls altogether. CONCLUSION: However, when something goes awry, they can just as easily kill or maim those patients instead. Grave injuries and even deaths can occur no matter what precautions have been taken in the operating room. But the risks of adverse consequences increase when there are no controls over what goes on there. Hospitals and ambulatory surgical centers in New York now have strict regulations for the performance of surgery within their facilities.5 However, under current law, office surgical units have no such regulations. In fact, hot dog vendors on the street are more regulated than office surgeons. At least their carts have to be inspected to see if they are meeting public safety codes. Conversely, absent a complaint, there are never any inspections of operating rooms in offices to see if they are meeting appropriate standards for cleanliness and infection control or to see if their equipment is up-to-date. Dr. Ervin Moss, the physician credited with enactment of New Jersey's office surgery regulations and a consultant to other states on this issue, is a strong proponent of regulations rather than guidelines. That is because guidelines are not intended to be absolute requirements or standards. Nor do they have the force of law behind them. It should be apparent to most people that in an area as fraught with danger as this one is, only strict enforcement with penalties for violations will suffice. Of course, not every office surgeon is a charlatan. There will always be doctors within the state whose surgical and ethical practices will not only meet but exceed any requirements that the Health Department could impose upon them. However, the Investigations Committee has found that most of these doctors are not opposed to regulation. If anything, they are clamoring for it. They recognize the need to police those of their peers who, through lack of competence and/or ethical standards, are causing irreparable harm to the patient public through substandard and unacceptable practices in their office operating rooms. It is impossible to know how many patients are injured in New York each year as a result of office surgeries. Since there are no mandatory reporting requirements for adverse occurrences, there is very little statistical data on the issue. There is only anecdotal evidence of the type presented in this report. However, if the Health Department does enact regulations, it can and should require office surgeons to report any incident related to surgery, special procedures like endoscopies and pediatric magnetic resonance imaging, or the administration of anesthesia within the office which results in a patient death, a complication or untoward event, or transport of the patient to a hospital. The systematic compilation of such data would clarify once and for all the very real risks of office surgery. Ultimately, the Legislature must empower the Health Department to enact such regulations and to implement inspections of office surgical units throughout the state. Disciplinary proceedings against individual doctors are not enough to stem the tide of medical malpractice in these offices. That is because such proceedings take place after the fact and not every instance of malpractice is reported to the Board of Professional Medical Conduct. Moreover, if doctors know that their offices are subject to inspection and that they may be assessed penalties for violations, they will be less likely to transgress the basic principles of good surgical practice in the first place. The time for action is now, before another life is lost to the inadequacies of an office staff or to the lack of proper anesthesia equipment. The citizens of this state deserve to know that when they go to an office for an operation, they as are just as safe there as they would be anywhere else. The above was taken from the: Cosmetic Surgery - The first step in dealing with risk in cosmetic surgery is to acknowledge it. Although the risks to healthy, well selected patients are small, they are nevertheless real. Knowing the risks ahead of time is critical to good decision making about surgery and equips patients who do encounter complications to better deal with any further treatment needed. Second, explore the limitations of surgery with your surgeon in detail, asking about what other interventions might be necessary if problematic healing is encountered. Make certain your doctor is properly trained - Unfortunately. "Board Certified" doesn't necessarily mean much today. There are a plethora of "Boards" set up for the express purpose of allowing members to masquerade as trained specialists. Most doctors performing cosmetic surgery today ( and calling themselves "cosmetic surgeons") have no training in plastic surgery, and many have no training in surgery of any kind! Laws allow any physician with a license to call himself anything he wishes. Make sure the facilities to be used are appropriate for the contemplated surgery - There has been an explosion in cosmetic surgery performed in non-hospital facilities. This has been driven in part by economics ( small centers usually charge less than hospitals), but has also been promulgated by the flood of physicians practicing "cosmetic surgery" without proper credentials. The huge numbers of cosmetic procedures performed by general practitioners, dermatologists, gynecologists and others could only take place in freestanding facilities outside of the purview of credentialing bodies. Clearly, some procedures can be safely and skillfully performed outside of the hospital environment. However, it is the obligation of the practitioner to see to it that patient safety is not thereby compromised. Ask questions! Second Opinion? Every patient is entitled to a complete explanation of any diagnosis or proposed therapy so that an informed decision to accept, delay or refuse the recommended treatment can be made. This right to informed consent is especially important if you are faced with major surgery or when the diagnosis you have been given is serious or life-threatening, like cancer. In fact, the more serious the diagnosis and the more drastic the treatment, the more you may want to get another medical opinion from a second doctor. Your own doctor will probably support your request for a second opinion. Here are some other situations when you might want a second opinion:
Are delays for second opinions risky? Depending on the nature of the diagnosis, you may want to begin some sort of treatment right away. However, in most cases, obtaining a second opinion shouldn’t cause too long a delay and can help to ensure that the treatment you are about to pursue is appropriate for your diagnosis. If you have any doubts regarding your physicians initial diagnosis or treatment recommendations, proceeding without obtaining a second opinion could also be risky. As noted in the American Cancer Society’s book Informed Decisions, “most experts agree that in most cases, getting more opinions does not create dangerous delays.” Your decision is the one that counts! As the patient facing a serious medical problem, you have to make decisions about accepting or refusing recommended treatments. It’s important for you to feel confident that the advice you’ve been given is the best available. Requesting a second opinion can add to your certainty that you are making the right choice. You can get a second opinion whenever non-emergency surgery is recommended. Most doctors approve of patients getting a second opinion and will assist you in doing so. Second opinions are a way for you to get additional expert advice from another doctor who knows a lot about treating medical problems like yours. Second opinions can reassure you - and your doctor - that the decision to have the surgery is the correct one. Second opinions are your right as a patient. They can help you make a better informed decision about non-emergency surgery. CALL TODAY AND TALK TO AN INFORMATION SPECIALIST - 850-862-5075
Choosing to have plastic surgery is an important decision, and so is selecting a plastic surgeon. Psychological Aspects: Your Self-Image and Plastic Surgery Each of us has a "self-image," a perception of how we believe we look to others. People who are happy with their self-image are more likely to be self-confident, effective in work and social situations, and comfortable in their relationships. Those who are dissatisfied tend to be self-conscious, inhibited, and less effective in activities. Plastic surgery -- whether cosmetic or reconstructive -- encourages and promotes a strong, positive self-image. Even a small change on the outside can create an extraordinary change on the inside, allowing an individual's self-confidence to flourish. Because the changes resulting from plastic surgery are often dramatic and permanent, it's important that you have a clear understanding of how surgery might make you feel-- long before a procedure is scheduled.
Appropriate Candidates for Surgery There are two categories of patients who are good candidates for surgery. The first includes patients with a strong self-image, who are bothered by a physical characteristic that they'd like to improve or change. After surgery, these patients feel good about the results and maintain a positive image about themselves. The second category includes patients who have a physical defect or cosmetic flaw that has diminished their self-esteem over time. These patients may adjust rather slowly after surgery, as rebuilding confidence takes time. However, as they adjust, these patients' self-image is strengthened, sometimes dramatically. It's important to remember that plastic surgery can create both physical changes and and changes in self-esteem. If you are seeking surgery with the hope of influencing a change in someone other than yourself, you might end up disappointed. It's possible that friends and loved ones will respond positively to your change in appearance and self-confidence, however understand and accept that plastic surgery will not cause dramatic changes in people other than you. Inappropriate Candidates For Surgery Though there are exceptions, individuals who may be advised to seek counseling prior to any consideration of surgery include: Patients in crisis, such as those who are going through divorce, the death of a spouse, or the loss of a job. These patients may be seeking to achieve goals that cannot be obtained through an appearance change-goals that relate to overcoming crisis through an unrelated change in appearance is not the solution. Rather, a patient must first work through the crisis. Patients with unrealistic expectations, such as those who insist on having a celebrity's nose, with the hope that they may acquire a celebrity lifestyle; patients who want to be restored to their original "perfection" following a severe accident or a serious illness; or patients who wish to find the youth of many decades past. Impossible-to-please patients, such as individuals who consult with surgeon after surgeon, seeking the answers they want to hear. These patients hope for a cure to a problem which is not primarily, or not at all physical. Patients who are obsessed with a very minor defect, and may believe that once their defect is fixed, life will be perfect. Born perfectionists may be suitable candidates for surgery, as long as they are realistic enough to understand that surgical results may not precisely match their goals. Patients who have a mental illness, and exhibit delusional or paranoid behavior, may also be poor candidates for surgery. Surgery may be appropriate in these cases if it is determined that the patient's goals for surgery are not related to the psychosis. In these cases, a plastic surgeon may work closely with the patient's psychiatrist. The Consultation Honesty, with yourself and with the surgeon is essential. It's important that you set aside any awkwardness you might feel, and speak candidly about the changes you'd like to see. At the end of the consultation, you should feel confident that you and your surgeon understand each other completely. Also, it is unwise to stress a minor functional problem if your true desire is to have an improved appearance. A patient who pretends to be seeking relief for a functional problem may confuse the surgeon about that patient's true goals for surgery. Often these patients stress a functional problem with the hope of obtaining insurance coverage for the procedure even though a functional problem does not exist. If your goals for surgery are not clearly communicated to your surgeon, you may not be satisfied with the final result. Plastic Surgery For Children For reconstructive procedures such as cleft lip and palate repair, or infant skull surgery, the benefits of early treatment are usually quite clear. Parents typically meet with surgeons, psychologists, and other specialists who provide abundant assurances that surgery is the best choice for their child. However, in elective procedures like otoplasty (ear pinning), the choices may be more indefinite. If the child doesn't seem to notice that he or she looks "different," parents may be advised not to force the issue of surgery. However, if the child is being teased or feels he or she doesn't belong, parents should probably consider surgery for the emotional health and self-esteem of the child. It's important to follow the recommendation of a pediatrician and to consider the feelings of the child and the parents. Certain cosmetic surgery procedures may also be of significant psychological benefit for some teenagers, provided that he or she is well-adjusted both socially and emotionally. Parents need to keep in mind that feelings about self-image tend to change with maturity, and that cosmetic surgery should never be forced on a teenager, nor should a teenager force an issue which a surgeon feels is not an appropriate cause for surgery. Timing of Surgery Adjusting to Change However, if you plan to have breast surgery, nose surgery, or another procedure that may involve a dramatic body change, the post-operative adjustment period may take longer. Until you learn to accept your redefined body image as your own, your reflection may seem somewhat unfamiliar. Getting the Support You Need Be sure to select a support person who will be just that--supportive. Graciously decline offers of help from those who may be critical of your decision to have surgery or may be overly troubled by your temporarily bruised and swollen appearance. Also keep in mind that it's not unusual for a well-meaning friend or relative to say "I liked the way you were before," or "You didn't really need surgery," Comments such as these may cause or worsen feelings of regret or self-doubt, particularly during the early recovery period. Rely on your support person or your surgeon to help you though these difficult times--and try to focus on the reasons you decided to have surgery in the first place. Coping with Post-Operative Depression Knowing what to expect in the post-operative period may help you cope better in the days following surgery. It's helpful to remember that the depression usually lifts naturally within about a week. Brisk walks, light social activity, and small outings may help you shake the blues faster. Handling the Critics Some patients find it's helpful to arm themselves with a standard reply to post-operative criticism, such as, "This is something I did for myself--and I'm very happy with my results." Remember, if you are content with how the results of plastic surgery make you look and feel, then the procedure was indeed a success. Taken from; Special to ABCNEWS.com
Doctors often end up playing Russian roulette with our lives.
If you believe that, then you probably also believe in the Tooth Fairy.
And Then There’s the Money Well, that’s fine, maybe even noble, and it probably makes for better doctor-patient relationships. But it doesn’t address Weed’s concerns. Do doctors’ brains work better just because they work outside of HMOs?
I’m not going to suggest that you and I can make a difference in fostering a medical knowledge infrastructure that serves us better. Savants like Weed have given it their best shot, but they’ve only made a small dent in the tradition of arrogance and denial. |
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