There was a time when physicians got their patients/clients via referrals from other doctors and via satisfied patients. There was a time when it was considered unethical for a doctor to "advertise." Today that is not the case, and advertising is the norm. Today it would be considered unusual for a physician NOT to advertise. Physicians today are not only listed by specialty in the Yellow Pages, but many have large display ads promoting their practices. Doctors, particularly plastic surgeons, advertise in magazines, on TV, and even in weekly mailers. With the arrival of the Internet, an entire world of advertising and promoting methods has become available to all sorts of businesses. Through the Internet, patients can find doctors and doctors can find patients. Today medicine is a business and not just a profession.
As plastic surgery nurses, where does this leave us? When we are asked by friends, relatives, and acquaintances to recommend a surgeon for different plastic surgery procedures, what do we say? Which direction do we send them? How do we get them the information they need? Then again, does our loyalty lie with the doctors who pay our salaries, the patients they serve or a combination of both? When is being a "patient advocate" crossing the line by telling the truth about a doctor who does not have such a great track record? In what direction do we point these patients to get them the best and most up-to-date honest information?
Those of us who work in a hospital setting are exposed to a variety of surgeons, with numerous capabilities, who perform a multitude of procedures. Not every surgeon does all procedures equally well. It sure would be a whole lot easier if they did. But then again not all hospital-based RNs are in the best position to judge results, as they see only the patient on the day of surgery and only occasionally see the final results. As an office RN, you see the patient pre- and postoperatively; you also see results, but then often have no other surgeon's work to compare it to (unless, of course, the surgery is an attempt at correcting a past surgical problem).
Where do patients go for accurate information? Talk shows seem to emphasize the worst-case scenarios. Advertising is obviously biased. A quick check of the Internet, via the Google search engine, yielded the following numbers of references:
PLASTIC SURGERY: 88,200,000
COSMETIC SURGERY: 72,300,000
RECONSTRUCTIVE SURGERY: 9,210,000
PLASTIC SURGERY CHAT ROOMS: 2,350,000
PLASTIC SURGERY CERTIFICATIONS: 2,200,000
Regarding specific popular procedures:
LIPOSUCTION: 30,100,000
TUMMY TUCK: 29,400,000
FACELIFT: 12,700,000
BLEPHAROPLASTY: 948,000
BREAST AUGMENTATION: 5,890,000
RHINOPLASTY: 2,520,000
These numbers alone are pretty overwhelming, to say the least!!
Internet chat rooms have initiated an interesting format. Instead of patients just sharing their personal experiences, certain doctors have volunteered their time to do "online" questions and answers at various scheduled times regarding various plastic surgery procedures. One wonders, is this expressing a true interest in the patient's well-being or simply another marketing tool of sorts?
Because the topic of this issue is "patient safety," which way do we direct a patient to ensure his or her safety? The biggest misinformation patients seem to get that directly impacts their safety in the operating room is the term "Board Certified" and what it actually means when a surgeon is "Board Certified?" The American Board of Medical Specialists serves in the public interest to oversee the 24 boards that they officially recognize. Each of the 24 boards is responsible for certifying only those physicians with training, judgment, and skills necessary for safe and independent practice within that specialty. There are specific requirements that must be met for a doctor to become a member/diplomat of the Board of Plastic and Reconstructive Surgery. These include graduating from an accredited medical school, completing 5 years in an approved surgical residency program, completing 2-3 years of training in an approved plastic surgery training program, being recommended by the program chair for eligibility, passing comprehensive written and oral examinations, and submitting a detailed list of all operations performed during their second year of practice to be closely scrutinized and meeting moral and ethical standards. Clearly, the term "certified by the American Board of Plastic and Reconstructive Surgery" has significance; the term "board certified" means little, as there are literally dozens of self-designated boards that are not recognized by the American Board of Medical Specialties. A physician may advertise under listings of "Plastic and Reconstructive Surgeons" without having any formal training. Unfortunately, most states have no power to regulate this, and all that most states require for a doctor to be perform any kind of surgery is that the person has graduated from a recognized medical school and has a medical license to practice. In addition, most states have no regulations restricting the formation of boards; therefore, any group of individuals can create a self-appointed board and designate themselves "board certified."
The public assumes that if a surgeon performs a surgical procedure, he or she is qualified to do so. This is not necessarily true, especially in an office situation. In a hospital situation, quality of care is ensured by the two mechanisms of privileges and peer review. Physicians must have privileges for EACH procedure they perform. These privileges are granted by the hospital credentialing committee, which consists of other qualified physicians. Via peer review, the physicians' standard of care is scrutinized and overseen. If the physician's performance is considered substandard, he or she may lose privileges to perform that specific procedure. A pretty good benchmark of a physician's competency to perform a procedure in an office setting is whether or not he or she has privileges to perform the same procedure in a hospital. To confirm this, the patient should ask the doctors in which hospitals they have privileges to do the surgery, and then he or she should call the hospital and speak with someone in the medical staff office who can answer these questions.
Recently there has been an enormous growth of free-standing surgical facilities. Many surgeons have surgical operating suites within their offices. Some states now mandate accreditation of these facilities. Some facilities seek voluntary accreditation to assure a high standard of care. These facilities are subject to stringent safety requirements regarding layout, equipment, and staff. An additional safety factor is that physicians operating in accredited facilities must also have privileges to perform the same procedures in an accredited hospital environment subject to peer review. The three main organizations for accreditation are the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), the Accreditation Association for Ambulatory Health Care (AAAHC), and the Joint Commission on Accreditation of Healthcare Organizations (JACHO).
All of this information should be readily available when an individual contacts a doctor. Doctors and facilities are proud of their associations. If patients were to call a physician and their questions regarding certification are met with hesitation, a red flag should go up. If the doctor is not board certified by the American Board of Plastic Surgery, and the receptionist explains that the doctor is certified by "a different board," another red flag should go up.
It then becomes our responsibility, as patient advocates, to educate the public. We need to stress the importance of researching, not only the plastic surgery procedure, but also the surgeon's credentials and recognized abilities. We need to point the patient in the right direction to the right physician for the right procedure to ensure the right results.