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President
Clinton's
Letter

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As seen on the Sally Show 4/17/2000

 

 



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:
The performance of surgery and the administration of anesthesia are serious undertakings in any facility. When they are done well, they can enhance health, well-being, and quality of life for many patients. 

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:
SENATE COMMITTEE ON INVESTIGATIONS, TAXATION, AND GOVERNMENT OPERATIONS PROBLEMS OF OFFICE SURGERY February 1999 Committee Members

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!
Research his or her background and qualification’s!
Supplied by the NY Plastic Surgery Association

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:

A rare disease has been diagnosed.
More than one treatment option has been recommended.
The diagnosis has not been confirmed.
You are interested in treatment options with which your doctor is unfamiliar.
You are uncomfortable with the advice you have been given.

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

 

Taken from; Special to ABCNEWS.com
Nicholas Regush

Doctors often end up playing Russian roulette with our lives.
This doesn’t happen because they’re deliberately trying to put us in harm’s way. No, the problem is that they’re inundated with, and often overwhelmed by: new, highly technical medical information; conflicting expert opinion; media medical hype; skillful, if not deceptive, sales pitches from drug manufacturers; and demands from their patients for heavily advertised “miracle” treatments
It hardly helps matters that managed care pressures many doctors to pour their patients through a profit-driven sieve.


Swamped by Tradition
But the underlying cause of this information-overload crisis is the entrenched, almost defiant belief, honed by stalwart tradition, that the doctor’s brain is capable of processing an endless stream of new facts. Moreover, doctors are assumed to be able to record all this data in a highly organized fashion, retrieve it on demand and apply it with minimal error and sound clinical judgement to each and every patient.

If you believe that, then you probably also believe in the Tooth Fairy.
One strong critic of this “data processing” view of medicine is Dr. Lawrence Weed, a pioneer in medical information systems. Formerly at the University of Vermont, he now runs a computer company in Burlington, dedicated to providing doctors with electronic diagnosis and treatment tools.

And Then There’s the Money
It should come as no big surprise that debates about the future of health care don’t usually include consideration of how doctors might benefit from using computers to diagnose and treat. Health care squabbles usually focus on money and more money and how it should be dished out, and on how to improve access to treatment. It’s considered radical these days for doctors to give a digital salute to HMOs and set up their own community-care practices, often asking patients to pay fees out of pocket.

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.
The brave can chew out their doctors for putting all their faith in their own brains. But let’s face it, they’re the products of a medical education system that continues to emphasize memorization in the era of the Internet. So, don’t be too unkind to your doctor. At the very least, go in armed with all the information and questions about your condition that you can muster. And if you feel bold, perhaps a comment about the lack of a computer to aid memory might be a hint in the right direction.

 
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Last modified: July 06, 2001