Truth in Medical Education?

Armando Soto, MD
Article by
Orlando Plastic Surgeon
Regular readers know that one of the things that really gets under my skin is the problem of non-plastic surgeons performing plastic surgery.
 
 
While I know intellectually that an eye doctor with a few days of training in liposuction could not hope to be proficient, and therefore represents little threat to my practice, the situation still stirs deep anger in me.
 
 
Why? Because of the large number of patients I have seen and continue to see in my Orlando plastic surgery and skin care center with devastating (and frequently impossible to correct) deformities caused by poorly trained and unscrupulous doctors (non-plastic surgeons) aggressively advertising themselves as "liposuction experts".
 
 
In every one of these cases (I see at least one or two a month), the victim is much more unhappy with her appearance after her encounter with the "liposuction expert" than she was before, because whereas before the procedure she may have had a bit of fat she didn't like, it at least was an appearance that occurred in nature. Now she has dimples, dents, and looks like a shark bit her. She used to be unhappy with how she looked in shorts... Now she won't wear them.
 
 
In many of these cases, achieving anything like an acceptable appearance requires a much larger procedure than the initial, poorly executed liposuction procedure- which means the patient must spend a good deal more money and endure a more difficult recovery than she might have had were she to have had the good fortune of finding a board certified plastic surgeon in the first place.
 
 
As stated above, in some cases correction is not possible at all and they must endure the deformity and weight of their poor decision for the remainder of their lives.
 
 
Let's be clear-- the fact that in my region there are so many eye doctors, urologists, and family practice doctors that believe a few days of training and a liposuction machine make them experts in body contouring has generated a fair amount of income for me. I correct these deformities every week. In fact, these women have become some of my most loyal patients--having learned the hard way that you can't trust your safety or your appearance to just anyone.
 
 
But I would much rather not have women in my community defrauded and injured in the first place.
 
 
Amazingly, a Florida law already exists requiring nurse practitioners and physician assistants to inform patients of their educational levels so that the patient doesn't become confused and think they are physicians, but there is NO law requiring physicians to inform patients of their core training before performing surgery on them.
 
 
So why isn't every doctor with an itch doing heart surgery on unsuspecting patients?
 
Traditionally what has kept doctors from practicing outside of their area of core training has been the systems that American hospitals have in place for certifying physicians to work within their walls.
 
 
In order to perform heart surgery at any particular hospital, a heart surgeon would apply for privileges at that institution, pay a fee, and in some cases sit for an interview. The application requires clear evidence of the physician's training in heart surgery and specific details about the operations he/she would like to do within the hospital.
 
 
If a doctor can't prove they were trained in residency to do the procedures they would like to do in the hospital, they simply aren't allowed to do those procedures there.
 
It would seem that not allowing doctors to do heart surgery without residency training in heart surgery is common sense. Unfortunately, the fact is that this system of attaining hospital privileges is the ONLY thing keeping doctors from practicing outside their areas of training...
 
 
The law says that any doctor can perform any procedure he/she believes themselves competent to perform on any patient who gives them consent. Read that again.
 
 
So I, as a plastic surgeon, could legally perform a hysterectomy, if I could do it in my office (since no hospital would let me do it there) and I could find a woman to let me.
 
 
If you are injured through the negligence of a doctor, you can make a claim after the fact, but again, the ONLY thing preventing this from occurring in the first place is the hospitals.
 
 
The reason this is so significant is because every one of these disreputable "liposuction experts" is performing the procedures in their office- away from the scrutiny on their training.
 
 
Why do you think they are doing so? Bingo--because there is no hospital in the country that would allow an eye doctor into their operating room to perform liposuction (or any other procedure for which they are not trained for that matter).
 
So why do so many otherwise intelligent people actually fall prey to these unscrupulous doctors? Why are urologists, eye doctors and others even interested in doing liposuction? How is it that they obtained liposuction equipment in the first place?
 
 
Part of the blame lies with the intense media interest in all things plastic surgery- our constant hunger for revolutionary advancement- the "next big thing"- I call it the "You CAN have it all" thought process that led to the economic crisis we are all enjoying so much right now.
 
 
This thinking caused medical device manufacturers to come to market with expensive, marginally effective and marginally safe pieces of equipment for liposuction. Realizing relatively quickly that the devices did not, in fact, represent an advancement in body contouring technology relative to what board certified plastic surgeons were already using every day, and therefore finding there was no market among well trained plastic surgeons, and not wanting to have to swallow their investment in research, development and marketing, they decided to create a market... Non-plastic surgeons....
 
 
If they could convince these physicians that liposuction is easy and that there were vast sums of money to be made (not a difficult sell considering what managed care and the healthcare system have done to physician compensation and quality of life), they would instantly have a potentially large market for their very expensive pieces of equipment.
 
 
And these companies have large marketing budgets.
 
 
So, instead of the honest, fundamental questions being asked... the questions that any conscientious scientist or physician would ask immediately when confronted with a new, "advanced" technology, the information the public was fed was "spun"...
 
The fundamental questions I refer to are, "Does the technique/device work better than what we already have, and is it safer? Is it less expensive? Does it have other benefits over what we already have?"
 
 
The answers to these questions, as regards these liposuction technologies, are that NO, they are not more effective, they are NOT safer, they most certainly are NOT less expensive, and they have no benefits to the patient, and in fact may be dangerous to the long term health of the body.
 
 
This was spun to be- "Intelli-lipo" works! It shrinks your skin! You won't bruise because it coagulates your blood vessels! You don't need surgery!
 
Again, the question is not "Does it work?" The question is "Does it work BETTER than what we already had?"
 
 
The fact that the device coagulates blood vessels is NOT an advancement- any plastic surgeon would tell you that the goal of any well conceived procedure is to PRESERVE structures as much as possible, and in fact one of the major benefits of the oldest liposuction technique known (and the gold standard against which all must be measured) is that it PRESERVES nerves and blood vessels!
 
 
Saying you don't need surgery is fundamentally a lie, because liposuction IS surgery (whether done in an office or an OR), and make no mistake about it, these devices ARE liposuction machines, no matter how clever their names get.
 
Because these procedures are not occurring in a hospital, the manufacturers of these machines have large marketing budgets, and because there are a lot of doctors out there who think they should be making more money, this has become a serious problem.
 
 
And your government doesn't care until they get complaints from citizens. 
Now you're thinking, okay Dr. Soto, if I'm to believe that this is a serious problem and people are really getting injured by these unscrupulous and untrained doctors, why haven't I heard about it? Why haven't they had their licenses taken away? Why haven't they been sued?
 
 
This has been the very most frustrating part of this mess for me.
 
You would think that the average woman who sustains an injury or deformity as a result of a procedure performed by someone poorly trained would be eager to complain, and to spread the news among the community that the practitioner should be avoided.
 
 
But it turns out that in almost every case I have ever seen, the victim is absolutely mortified by the damage caused to their body by their own poor decision making- and absolutely and resolutely refuses to complain or even talk about it to their friends and neighbors (let alone authorities). Truly sad.
 
 
It almost reminds me of battered wife syndrome, in which the wife starts to think she deserved the beating and refuses to complain. Battered patient syndrome...
 
I'm wired to be an optimist, and so I hope that after reading this, you will share it with anyone and everyone you know who might EVER consider liposuction (or any other plastic surgery procedure). Education and understanding will shine the light of truth on this problem over time, and hopefully it will stop.