Numerous newspaper, magazine and media reports in recent years have exposed potentially unsafe surgical practices that are occurring in non-accredited surgical facilities. These are sometimes performed by questionably-qualified doctors who call themselves “cosmetic” surgeons. Such reports bring into glaring focus the need for anyone considering cosmetic surgery to verify the credentials and expertise of both cosmetic surgeons and their cosmetic surgery facilities.
Do Your Homework
If you are considering cosmetic surgery, it is definitely in your best interest and safety to select a highly qualified plastic surgeon who performs procedures in a fully accredited surgery center. Several criteria provide a helpful checklist to assist in your selection of a properly trained and credentialed plastic surgeon.
Board Certification
State laws allow physicians to perform any procedure in the privacy of their own office. In the present healthcare climate, many doctors are trying to increase their revenues by performing self-pay cosmetic procedures in their offices. There are even weekend “cosmetic surgery” courses that provide instruction about individual procedures, allowing partially trained surgeons or even non-surgeons to offer a specific operation.
The American Board of Plastic Surgery (ABPS) regulates the training, testing and continuing education of board-certified plastic surgeons. Training (after medical school) is five to seven years in duration and provides the surgeon with the judgment, knowledge and experience required for board certification. Most importantly this training prepares a surgeon to avoid, recognize and treat complications that may occur in the operating room or after surgery. While any physician can learn a step-by-step “cookbook” procedure and even obtain “experience” through repetition, this is not the equivalent of the objective, verifiable qualifications of board certification.
Medical Staff Privileges
Hospital credentials are another valuable guide for prospective cosmetic surgery clients to evaluate a surgeon’s qualifications. Hospitals credential physicians and surgeons by documenting training, experience, ethics, licensing and board status. Even beyond these criteria, a hospital has the legal and moral responsibility of oversight and peer review of members of the medical staff to assure quality of patient care.
Each surgeon has a core of surgical procedures that he or she is allowed to perform in that particular hospital — i.e., hospital privileges. Physicians operating in a non-accredited office setting, however, have no such restrictions or oversight and are not limited in the scope of procedures offered. Hospital privileges confer an important “checks and balances” function when evaluating physicians. Hospital privileges should always be verified before undergoing cosmetic surgery in a physician’s office.
Office Accreditation
Accreditation of office surgical facilities provides assurance that a specific facility meets national standards of patient safety. The American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF), the American Association for Ambulatory Health Care (AAAHC) and The Joint Commission are recognized agencies that provide accreditation for ambulatory surgery facilities.
Such accreditation requires stringent standards for the physical environment, equipment, personnel, monitoring, infection control and emergency equipment and policies affecting patient safety. Plastic surgeons who are board-certified through the American Board of Plastic Surgery (ABPS) are required to operate in accredited office facilities. Be sure to consider this important safety measure when evaluating your plastic surgeon.
Office Anesthesia
As a safety measure, many states require special registration or even facility accreditation for the use of sedation or general anesthesia in an office setting. Obviously, having the capability to provide full anesthesia in an office setting increases the costs of the facility. These added overhead costs may be a reason why some physicians rely only on local anesthesia and oral sedating medications as the anesthetic of choice. Cutting such corners, however, may compromise patient safety by eliminating these regulatory, financial and professional burdens to the surgeon.
Major surgery using only local anesthesia may be tolerable, but for many patients it can be uncomfortable and even painful. Patients are usually given oral sedatives and are “talked through” the “rough spots” of the procedure. This is not acceptable as the only alternative. In addition, over-sedation with oral medications and excessive dosing of local anesthetics can be a dangerous problem in a marginally equipped and inadequately staffed facility.
Unfortunately, every year there are reports of patients who were given excessive doses of local anesthetics and suffered severe complications as a result. This is a complication to be avoided.
Is local anesthesia really safer for major surgery? It may not be safer if high doses of oral sedatives are given to help patients so they can “get through” surgery under local anesthesia. It may not be safer if a drug reaction or surgical complication occurs in a facility that is poorly prepared to recognize, treat and transfer a patient if needed. It may not be safer if evaluation of the patient shows that general anesthesia is preferred because of medical reasons, but not available as an alternative. It certainly may not be safer when the surgeon lacks recognized and verifiable qualifications.
Final Thoughts
There is a reason board certification and other qualifications exist for plastic surgeons. It really comes down to your safety and quality of care. Please choose your plastic surgeon wisely.
The West Georgia Center for Plastic Surgery, a Tanner Medical Group practice, is located in Carrollton. For more information or to inquire about a personalized consultation, call 770-834-6302 or visit WestGeorgiaPlasticSurgery.org.