Additionally, we can think more about teaching our residents and medical students how important it is to have a strong ethical approach in their practices. We see in plastic and cosmetic surgery that some unscrupulous physicians might practice under the name of these specialties, but are not qualified to do so, and this often results in less-than-standard care for the patient. We have ethics committees in our specialty societies which try to help monitor this level of activity, and they depend strongly on information from the colleagues of those who are violators of ethical standards. AppropriatenessPatients often seem to know exactly what they want, but some of them simply come to us for the best advice about doing everything necessary to improve their appearance and self-esteem. This gives us a lot of latitude and may result in the statement at one end of the scale that, "You really look good and don't seem to need anything" to a preparation of a list of surgical procedures which could carry that patient to a better appearance and sense of self-esteem. There is a lot of room for individual interpretation, and there is an opportunity to push people to do multiple procedures that may have marginal indications if surgeons are less ethical in their approach to these patients. We additionally are faced with the problem of patients who actually demand more, and we somehow are coerced into doing more, hopefully not beyond what our good judgment and sense of ethics tells us to do. Marketing, referrals Some of the advertisements dealing with plastic and cosmetic surgery suggest that such procedures are really very easy to perform and the results are really very good. Sometimes this actually is the case, but not quite in the same sense as the advertising promotions might lead a patient to believe. Consider, for instance, the ads for "instant non-surgical facelifts" or "lunch-time facelifts." Also, we should consider how we treat patients who come from other doctors. By speaking about the other physicians' treatment in a negative way or by unfairly comparing how good our own techniques are compared to others, it is possible to lure patients into our practice and to try new operative procedures. Additionally, when patients come from another plastic surgeon to us with either a bad result or complications, it is well to put ourselves in the position of the treating surgeon to understand exactly why this might have occurred. If any one of us ever practices plastic surgery without a complication, it will probably be a first in this specialty. Some plastic surgeons actually give referral fees to cosmetologists and hairdressers, either in the form of free services or financial remuneration. This is basically a "kickback" mentality and has been outlawed in medicine, both legally and ethically, for many years. Yet, some practitioners promote their practice by getting "word-of-mouth" advertising business from these referral groups. I believe this is an area where we need to help police the specialty, and this type of behavior should be reported to the ethics committees of our plastic and cosmetic surgery societies. Constant vigilance There are many other areas where we need to be constantly vigilant. |
