22 Jun Choose a Qualified Surgeon!
BY Dr Terrence Scamp.
It’s quite a striking headline.
“BRONX WOMAN SENTENCED TO A YEAR IN JAIL FOR ILLEGAL BUTT-LIFT PROCEDURES”
Basically an “adventurous” lady was charging $1500(US) to do butt-lifts which were done by injections of Silicone. Now Silicone injections are not approved by either the FDA or the Australian TGA but quite apart from this the lady had no medical or nursing qualifications at all.
The story gets better. She was arrested originally in January 2011 but when released on bail she moved to a different location and continued to perform the Silicone injections.
Now that’s an extreme example but there are more and more stories appearing in the press of what the Americans call “white-coat fraud”. This is basically people pretending to be doctors or doctors doing procedures outside their field of expertise.
Naturally enough cosmetic surgery is the area where most of these transgressions have occurred. To do a heart operation you need a qualified, specialized team and the right hospital back-up and access. All this requires appropriate credentialing and hospitals check this very carefully as it would obviously put them in the firing line from a medico-legal point of view.
However where procedures are performed in rooms or a mini-day theatre owned by the practitioner then the safety checks simply don’t exist. Thus a cosmetic procedure may be performed by any doctor and the patient may not be well informed in advance of their qualifications for this procedure.
I’m sure my colleagues would echo my remarks when I say I’ve lost count of the number of times that a patient has come to see me about a problem with a procedure, and said they had a plastic surgeon perform it elsewhere. The look of surprise on their face can be quite striking when I explain to them that the person that treated them may be a doctor but is certainly not a plastic surgeon.
Qualified plastic surgeons will have an FRACS (Fellow of the Royal Australasian College of Surgeons) in plastic and reconstructive surgery registered as their specialty with the Medical Board. This can be checked on the website www.ahpra.gov.au . In addition qualified plastic surgeons are usually members of ASPS (Australian Society of Plastic Surgeons) also available on the website www.plasticsurgery.org.au , and ASAPS (Australasian Society for Aesthetic Plastic Surgery) www.asaps.org.au . They are particularly likely to be members of the latter if they have a strong interest in cosmetic plastic surgery.
The FRACS in plastic and reconstructive surgery is the only qualification that proves that a doctor is a plastic surgeon. There are a myriad of letters and abbreviations bandied around and some of them mean no more than belonging to a group and can be obtained by means of an application fee. Not surprisingly both consumers and even other doctors at times get confused by these things.
The complexity of the issue extends beyond this however. Plastic surgeons have a broad base of skills and knowledge not only with surgical techniques but also with the non-surgical alternatives such as laser and injectables. Based on this broad depth of knowledge they can help guide you in selecting the appropriate procedure for your condition and for your wishes. An operation may get the best result but if you simply can’t spare the time to recover then there may be a non-surgical alternative which is able to give you a significant result with little or no down-time. A practitioner with less diverse skills is more prone to steer you towards what they themselves offer, rather than providing you with a range of alternatives.
The problem magnifies if you’re considering treatment in a foreign country. Again my colleagues and I commonly see complications from patients who have had treatments particularly in Asia. Some of these are the routine complications that can happen to anybody, although appropriate remedy may be delayed by being thousands of miles away from the original treating doctor and difficulties with communication.
Other times we see a procedure that’s been performed and although the result is adequate it is clear to us that it was probably not the optimal choice of procedure and as a result the outcome is less than optimal too.
On occasion however we see complications that are so bizarre that we are left wondering what the true qualifications of the initial treating practitioner were. If it’s difficult enough to know who is sitting on the other side of the desk in Australia not surprisingly that estimation is even more prone to wild inaccuracies if you add in the problems of language and culture.
In general in Australia the legislation controlling who performs what procedure is based around the generalized assumption that a doctor will do the right thing. The laws were made in much earlier times and although that guiding principle is still generally true unfortunately the expansion of cosmetic surgery has attracted a more entrepreneurial spirit and one can truly question whether the “right thing” is being done.
Sadly it pays therefore these days to be careful and get well informed prior to selecting a practitioner to perform your cosmetic procedure. The contact details provided may well help you along that path safely.
AHPRA 1300 419 495
ASPS 1300 367 446
ASAPS 1300 027 277