Practice And Practice – If Some Doctor Trained In The Psychiatry Program, On Mars, Can Do A Beautiful Facelift, I’m For It.
A couple of months ago I saw a woman in the office. Her face looked very odd. The surgeon, it turns out, was not a plastic surgeon. No problem!
There are a number of non plastic surgeons who do some very nice work; but that’s not all that often.
And it’s perfectly legal for an MD to do anything in which he or she feels competent. It’s a good law because it allows a physician to track problems which may take him or her out of his specialty, but still well within the range of hisher talent and knowledge.
The limits of any medical or surgical specialty are kind of fuzzy around the edges. So if a surgeon is exploring the abdominal cavity for something and finds something else, than what was suspected, the surgeon should be able to take care of the problem, without increasing the risks by waiting for some other “specialist” to be called in, merely because the other speciality has a more relevant name.
If I want to do Neurosurgery, or Cardiac Surgery, or… I am permitted to do this.
Very few hospitals, however, would let me through the front door. Nor would it be very smart of me to try. But it’s legal.
It’s why the phrase caveat emptor goes before any purchase.
It’s why the bedrock law of medicine is primum non nocere, first do no harm.
But, if I want to do something that may be outside my official area of expertise, in addition to a padlock on the hospital door, I am held in check by something called “Standard of Care”. This is a legal statement about the idea of the best care possible. It is the bar of excellence, set by those specifically trained to do and teach the work, whatever that work might be.
I do a good amount of expert witness work in medical malpractice cases, and the Standard of Care is always at the core of the legal contention. On a number of occasions I find myself working with the attorney defending a doctor who was not a plastic surgeon. My only concern is Standard of Care. Did he or she, the doctor that is, do good work, but had an unfortunate result. Being retained by defense or plaintiff side, doesn’t mean I give only favorable testimony. I am retained for my opinion, which under the right question, could favor the other side. Justice is the pile left after two lawyers duke it out in a court of law.
Cosmetic surgery does seem very appealing to physicians of differing backgrounds. It’s seems appealing not only for its rewards, but because it looks doable to anyone with a surgical background, and for some, even without a surgical background.
I don’t get it.
This work is not easy by any stretch…
In doing work outside your field of competence, “practice” becomes something unintended by its formal name. It is first time practice.
It can look sort of like Battery.
To be gross, the patient can become the lab rat.
That’s all about the ethics of medical invention, and for another time.
In a poker game if you haven’t figured out, in the first five minutes, who the sucker is, it’s probably you.
So there’s a reason why Medicine is called “practice”.
It’s not practice for the first time, as on a piano
It’s Practice out of excellence (in training).
It’s Horowitz getting better.
It’s “practice” that refines and individualizes the medical care.
No two humans, (who ever lived) are alike, even identical twins. Over time, and with “practice” you get better and better at the nuance of medicine – the differing nature of each disease, each condition, and each patient.
I am a better plastic surgeon now than I was ten years ago, and I was really good then. The Brits have the right idea about acting. Practice is working all the time, taking as many different roles as often as time and chance, allows: a chorus girl one day and Hamlet the next…don’t even!
The point to all this is this: I don’t care who sings the National Anthem, or Kol NIdre, as long as it’s done well. If some doctor trained in the Psychiatry program, on Mars, can do a beautiful facelift, I’m for it. But that’s not all that common. Actually a surgical psychiatrist is not a bad idea.
So anyway, because I see more and more people following some unfortunate work, I have had to make a special place in my practice for Reconstructive Cosmetic Plastic Surgery. It’s almost a subspecialty of mine.
To fix some surgical result or other is really, after all, reconstructive surgery.
Everyone knows it’s easier to do it right the first time. When this is done, and disappointment happens, the fix is relatively straight forward, (there’s nothing simple). In that case, the fix amounts to a refining and not a do over.
As Candace used to say, nobody sets out to make a bad movie.
So I worked on this woman.
It took three operations to fix things and there are still things I want to do.
I hope she comes back if or when the success fades.
For me it’s all very frustrating, but lord help me, I do love the work.
It’s almost Schadenfreudian.
Thanks for listening