Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

Plastic Surgery: Thoughts Before Going Under The Knife

More than 10 million Americans undergo elective cosmetic procedures each year. Dr. Jon LaPook reports on what every patient should know about anesthesia with Dr. Panchali Dhar, author of “Before the Scalpel.”


Watch CBS News Videos Online

Plastic Surgery: Risks Of Going Under The Knife

Last year — despite the recession — there were about 10 million cosmetic procedures in the United States. According to the American Society for Aesthetic Plastic Surgery, over 90 percent were in women and about 1.5 million were surgical. 
 
The top five surgical procedures were breast augmentation (311,957), liposuction (283,735), eyelid surgery (149,943), rhinoplasty (138,258), and abdominoplasty (127.923). As you awaken on the morning of your elective surgery, there’s no way you haven’t yet met the surgeon who will be performing the procedure. But odds are you still haven’t met the person who will be most responsible for keeping you alive: the anesthesiologist. 
 
The anesthesiologist is more than just the person who controls pain during the procedure. He or she is responsible for keeping your blood pressure, pulse, and oxygen level at the proper levels and for resuscitating you if something goes wrong. In the best of all worlds, you have seen your primary care provider prior to the day of surgery and been medically cleared. But it’s up to the anesthesiologist to reassess your condition and, if needed, cancel the procedure. 
 
In my mind, there are two main reasons why an anesthesiologist should recommend canceling an elective procedure — cosmetic or otherwise (such as back surgery):
 
1. The patient is medically too sick to undergo surgery and the risks outweigh the benefits.  An example would be a person whose diabetes is out of control and blood sugar levels are too high.
 
2. The anesthesiologist feels the procedure is not indicated.
 
The first reason is not controversial at all. The second is sure to raise a few eyebrows — and not cosmetically. I’ve never heard of an anesthesiologist recommending canceling a procedure for reason number 2. (Readers, please let me know if you have.) 
 
Traditionally, the role of explaining the pros and cons of a procedure and obtaining consent falls primarily on the shoulders of the surgeon — as well it should. In my personal experience, surgeons have been extremely thoughtful and conscientious about trying to make sure the right patient gets the right procedure. But multiple studies have shown that the process of consent is flawed and that many procedures would never be done if all the options — including doing nothing at all — were properly explained.

When everybody else — surgeon included — are swept up in a decision to do a procedure that’s not in the best interest of the patient (such as one too many plastic surgeries), the anesthesiologist represents one last chance for somebody to speak up and say, “not on my watch.” I suspect this would be necessary relatively rarely — but it would be a nice safety net for the patient.


You may also like these posts

Read comments »


Comments are closed.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »