Dealing With Anonymous Patient Reviews As A Physician

The internet is a double edged sword to the Plastic Surgeon.

Patients from near and far can read about and research our skill and services but at the same time a handful of malicious people can significantly tarnish a great reputation which we have strived to achieve and maintain.  

As a surgeon and as a human I have always strived to maintain the highest ethical and moral pathway. Most of us went into medicine to help people. What we do as cosmetic surgeons may not save lives but it does save quality of life and that is evident in our patients' smiles and behavior after successful cosmetic surgery.  As doctors we strive to achieve and maintain a pristine reputation but as in anything else in life, it is impossible to please all the people all the time.  

The internet has given a voice to everyone but it seems like angry, bitter, malicious people take advantage of this soap box and platform much more often than normal happy folks.  You can see this on comments on YouTube or blogs or chat rooms of all kinds - not just medical or plastic surgery related. 

But in our field, we depend on our reputation and while you may have thousands of happy patients, a small handful of unhappy ones can affect your reputation.  Personally I have seen that the vast majority of my negative online anonymous patient reviews or ratings are from people who I have either never seen in my office or have seen but refused to operate on as patients.  I recently had a "1 star negative review" on YELP from a person who has never even come to my office nor met me but decided that she did not want to pay $100 for an hour of my time for a consult and felt obligated to give me a negative rating for not offering free consults!  We have all had such occurrences.  But how do you deal with it?

My method has always been dealing straight forward with any and all comments.  If it is out there then it begs clarification and a reply from my staff or office managers or even myself.  There has to be accountability.  In the restaurant industry, restaurants can actually review and rate their patrons, not just vice versa! As physicians, we have to respect patient confidentiality and HIPAA but that does not mean we must be silent and let any anonymous person's comments go without a reply or clarification especially when most of us work so hard to do the right thing and practice with skill, ethics and integrity.

Resources for physicians:

• Frontdesk Patient Satisfaction Marketing
• Free Webinar: How To Protect Your Medical & Professional Reputation Online

Top 5 Cosmetic Surgery Treatments In 2011

According to the American Society of Plastic Surgeons cosmetic surgical procedures increased 2 percent, with nearly 1.6 million procedures in 2011. The top five surgical procedures were:

• Breast augmentation (307,000 procedures, up 4 percent) 
• Nose reshaping (244,000 procedures, down 3 percent)
• Liposuction (205,000 procedures, up 1 percent)
• Eyelid surgery (196,000 procedures, down 6 percent)
• Facelift (119,000 procedures, up 5 percent)

Richard D. Gentile, MD MBA, A Plastic Surgeon In Ohio

Our interview with Dr. Richard Gentile of Gentile Facial Plastic & Aesthetic Laser Center with three locations in Ohio.

Name:  Richard D. Gentile, M.D., M.B.A.
Location: Youngstown, Akron, and Cleveland, OH
Website: www.facialplastics.org

That’s interesting: Dr. Gentile is deemed as one of America’s Top Facial Plastic Surgeons by the Consumer’s Research Council of America. 

Profile: Graduate of Ohio State University, The University of Cincinnati College of Medicine and Baylor College of Medicine Residency Program. International lecturer and author of many publications including the 2011 Textbook “Neck Rejuvenation” published by Thieme. Dr. Gentile is a past member of the Executive Committee of the American Academy of Facial Plastic & Reconstructive Surgery and served as its Treasurer from 2004-2007.

How did you realize you were meant to practice cosmetic medicine?

As an undergraduate student I had the privilege of spending a week externship with a Plastic Surgeon in Columbus Ohio. It was really my first exposure to medicine and I was significantly influenced by the mentoring that occurred. During medical school I was equally influenced by head and neck cancer procedures and elected to pursue postgraduate residency studies encompassing both cosmetic head and neck and reconstructive surgery.

With three different locations in Ohio you must be busy. Can you describe how your clinics operate and how you staff them?

The Facial Plastic & Aesthetic Laser Center is a fully integrated aesthetic practice with a free standing state licensed and nationally accredited surgery center adjacent to it. There are satellite offices in Akron and Cleveland Ohio where consultation and minor surgery is offered. We are privileged to see patients from all regions of Ohio, Western New York, Western Pennsylvania and West Virginia. We also see patients from other states and foreign countries as well. A full service medical spa is located in the Boardman office and one of the largest private laser clinics with 20 different aesthetic lasers.

Our main office is not located in a large metropolitan area so staffing is sometimes a challenge. (Larger metro areas feature more cosmetic practices training staff who then have experience in medical spas or pastic surgery centers when they interview for new positions.)

Unless someone moves into our area we usually do not have the opportunity to hire experienced personnel so we have to train them on site. Another disadvantage is the smaller surgery centers need per diem or part time staffing patterns unless they operate five days a week and frequently it is difficult to find personnel who are interested in more limited schedules. Understanding these special needs allows us to zero in on those candidates who are interested in the employment opportunities we offer. We have several aestheticians, a cosmetic surgery coordinator who also assists our marketing efforts, two RN’s one exclusively dedicated to the surgery center and anesthesia staff who are retained from a national staffing firm. Our front office has a billing director and a receptionist.

What IPL or laser technologies are you using? What are your thoughts about the technologies you’re using now?

We have two Lumenis One platforms one in Boardman and one in Cleveland. They are equipped with IPL, Light Sheer laser hair removal diode laser and Nd:Yag. We also utilize three fractional lasers the Lumenis Ultra Pulse with deep FX , the Cynosure SmartSkin laser, and the Sciton Contour with ProFractional capabilities. We also utilize radiofreqency units for skin tightening with LumenisAluma and Pelleve. We frequently combine these modalities in multi-modality laser skin rejuvenation. The Cynosure Med Lite is one of our most frequently utilized lasers and is used for Tatoo removal, non ablative skin rejuvenation and dermal toning. A 532 nm diode laser is used for non-ablative treatment of vascular and pigmented lesions. Laser Lipolyis is a big part of our practice particularly in the head and neck and we developed many of the facial surgery protocols for laser assisted facelifting procedures or Smartlifting™ procedures.

Have your marketing efforts successfully increased the volume of patients coming in your clinic?

We use or have used virtually all media to market our practice and find particular success with internet based, social media, and seminars to educate the public about the procedures we offer. Being features on the websites of our technology partners also helps to let patients know about the services we offer.

Our favorite referral are those that come from a satisfied and happy patient sending their friends and family members to us and those make up about 50% of our new patients.

Are there particular treatments that have increased your profits dramatically?

Our services are divided about 50-50 between surgical services and the other office based non surgical services including neurotoxins (Botox), dermal fillers and laser procedures. Among our surgical procedures 90% are facial plastic & reconstructive in nature but primarily cosmetic and not as much reconstructive surgery as previously.

A small percentage of our practice revenue comes from skin care products and related sales.

What lessons have you learned in your practice that you can pass on to those who have just started their medical spa?

Listen to your patients. I think it is important that they are not always in your office so that you can give them the result you think they should have. They are there to hear about how you can best help them achieve the result they are interested in. The closer you come to achieving their goals the more satisfied and happy they will be. Learn from the unhappy patients so that it can help you to either modify your approach or better select patients so as to not try to please the difficult to please patients.

It has been a great privilege to practice Facial Plastic & Reconstructive surgery for nearly 25 years and the greatest development from early practice to later practice is the accumulation of wisdom from the early years of practice. When first starting in practice you sometimes carefully walk into the exam rooms of post op patients not quite sure what the result is going to be like or whether there will be complications. 25 years later you pretty much know what to expect and the kinds of results that will be achieved. We are always innovating and trying to add modifications to our techniques that will enhance our patients post- operative results. So while we are getting closer all the time our practice continually strives to obtain the best surgical and non surgical results available anywhere.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.

Symbol of Excess: Is Any Publicity Good Publicity In Medicine?

By Patricia Walling

Once upon a time, cosmetic surgery was talked about in hushed tones.

Hollywood starlets were whisked through back doors into surgical suites, swathed in scarves and sunglasses to protect even the whisper of an identity. Then celebrities began talking, and soon Americans were seemingly obsessed with the transformative promises of cosmetic surgery. From requests for Nicole Kidman’s nose to Angelina Jolie’s lips, cosmetic surgeons were soon being asked to transform patients into lesser versions of their favorite stars. Larger breasts, higher cheekbones and a smaller chin soon became normal requests. Yet some may wonder, has this quest for perfection taken a toll on the American psyche? When is cosmetic surgery a beneficial procedure, and when is it simply one more symbol of excess and vanity in an increasingly image-oriented society? There are no easy answers.

When reality TV starlet Heidi Montag announced in January of 2010 that she had undergone a marathon of cosmetic surgery, racking up 10 procedures in a single day, many wondered if her dreams of the perfect body and face hadn’t become an obsession. However others in the medical community, such as those in medical transcription, saw in the 10 surgical procedures something more terrifying, addiction.

By all accounts, Montag was beautiful, a blonde-haired, blue-eyed young woman with a natural smile, but when discussing the plastic surgery procedures with People Magazine, she referred to herself as “an ugly duckling.” From a mini brow-lift to Botox to liposuction to breast and buttock augmentations, the procedures nearly killed Montag, but she stood firm behind her decision, saying Hollywood’s visions of beauty had pressured her into it. However, apparently 10 surgeries were still not enough. When the hoopla died down around the reality star’s new look, her husband announced later that year that she wanted to augment her breasts again. The surgery was to be filmed for a new reality show they were shopping. Was her subsequent admission to a plastic surgery addiction just another reality show ploy or did the superficial nature of Hollywood push her to a true addiction?

These days, it seems that more and more women feel the need to get some type of plastic surgery to order to achieve the Hollywood beauty ideal. According to an article in Medical News Today cosmetic surgery procedures increased an astonishing 700 percent between 1995 and 2005. Similarly, in an in an article discussing the psychological ramifications of Montag’s procedures, Fox News noted that 91 percent of all patients opting to have elective cosmetic surgery were women. While the average age of a patient wanting plastic surgery has not skewed younger, it has become far more socially acceptable for individuals, generally women, in their teens and 20s to have plastic surgery procedures.

A teenager going under the knife is hardly news anymore, but even children are getting in on the act. One mother recently made headlines when her seven-year old daughter had her ears pinned back and a fold on one ear corrected. An article in the New York Daily News details the mother’s decision, which she said was made to prevent bullying. She recounts adults making comments about her daughter’s ears, in front of her daughter. Oftentimes other children would refer to the girl’s ears as “gross” and wonder what had caused them to look strange. The plastic surgeon that performed the procedure, Dr. Steven Pearlman, agreed that children born with seemingly minor differences can face major harm in terms of the “development of their self-identity” if such deformities are not corrected. All of this raises the specter of a major ethical conundrum. At what point is it appropriate to refuse a patient’s cosmetic surgery procedure? What problems can be fixed through therapy or friendships rather than rhinoplasty and brow lifts? There is no easy answer.

A list of guidelines published by Mayo Clinic notes a number of things that individuals considering cosmetic surgery should keep in mind. Beyond considerations about expense and risk, individuals should think about what they expect the procedure will accomplish. If a woman believes that having Angelina Jolie’s lips will make her look like Angelina Jolie, she will be disappointed with the results. Likewise, if she believes that the procedure will make her happier, she is likely to be equally as disappointed.

While it is possible that a patient with reasonable expectations will experience a boost in self-esteem, cosmetic surgery is not the panacea of the average and aging as portrayed by popular culture. A patient’s depression won’t improve just because her chin no longer juts out. Plastic surgery won’t turn a patient into the epitome of female beauty, nor will it save a marriage or improve a social life. It short, no amount of plastic surgery can buy happiness.

A Fox News article discussed the specific implications of Heidi Montag’s surgery shortly she revealed her totally remodeled body. Among those who weighed in on the pros and cons of plastic surgery was Debbie Then, a psychologist who specializes in women and appearance. She fears that many people who go under the knife, especially at a young age, want to change who they are as individuals, something that is simply not possible to do through cosmetic procedures. A new nose might give an individual confidence, but it will not suddenly transform her from a wallflower into a social butterfly. Yet, that’s just what popular culture seems to teach.

From teasing about big ears to beliefs that women lose something of themselves as they age, the reasons individuals opt for cosmetic surgery are numerous. Yes, there is an element of vanity to their decisions, and certainly plastic surgery is more common in cultures with significant disposable incomes, but the heart of the matter is in the values that are placed on beauty above personal substance. If a woman wants to fix her nose or plump her lips, she should not be reviled for doing so, no more than a man should be reviled for getting hair plugs. Improving one’s appearance in an effort to feel better about oneself is perfectly acceptable. However when that need to better oneself physically surpasses any belief in the intrinsic values of each individual’s personality, it is time to question the role cosmetic surgery has assumed in the popular conscience.

About: Patricia Walling is a contributor for several healthcare related blogs, including http://MedicalTranscription.net. She self-identifies as a perpetual student of health care, and is based in Washington state.

Healthy Aging's Annual "Top of Class" Survey

Our friends over at Healthy Aging are gathering their annual "Top of Class" votes for our industry.  Cast your votes and we will publish their results in January.

Physicians must stay on the cutting-edge of technology. Your knowledge of leading industry reps, manufacturers and distributors can assist your colleagues during crucial equipment selection and purchasing decisions. Share your experience with colleagues in our annual "Top of the Class" survey, which allows dermatologists, estheticians and plastic surgeons to identify companies they feel are "among the elite."

Review the categories listed below, then cast your vote for your favorite vendors* by Dec. 30, 2010. We’ll tabulate the results and share the "Top of the Class" vendors online in January 2011. 

Click here for the survey.

Medical Spa MD {4} Mr. Adrian Richards MBBS, MSc, FRCS (Plast.) - Cosmetic Medicine In The UK

A real eye-opener for physicians in the US... In this episode of the Medical Spa MD Podcast we discuss cosmetic medicine in the UK with plastic surgeon Mr. Adrian Richards.

Listen to this episide here.

Mr. Richards qualified as a Doctor in 1988 and for the last 12 years has specialised in plastic surgery. He has full registration with the General Medical Council No. 3286812 and is a Member of both the British Association of Plastic and Reconsructive Surgeons (BAPRAS) and the British Association of Aesthetic Plastic Surgeons (BAAPS), the leading British professional bodies for plastic surgery and reconstructive surgery. He is an author and has written a best-selling textbook ‘Keynotes on Plastic Surgery’. He is founder of Cosmetic Courses, a company accredited by the Royal College of Physicians, which provides training to medical practitioners entering the aesthetic market and was the lead investigator in recent clinical research into the use of Botulinum Toxin A (Botox) for cosmetic purposes.

In this episode we're discussing cosmetic medicine in the UK with Adrian Richards. It will probably come as something of an eye-opener for physicians in the US to learn that; most cosmetic surgeons in the UK don't really worry too much about informed consent, being sued by a patient is a rarity, filler injections are unregulated, and that physicians are routinely employed by non-physicians. I found the differences to be striking.

We also discuss how Adrian markets his services through social media, videos, and podcasts of his own as we delve into cosmetic surgery across the pond.

Some of what we talked about in this episode.

• Mr. Adrian Richards MBBS, MSc, FRCS
• Aurora Clinics UK
• Facebook Marketing for Physicians

Breast Reduction Surgeries on the Rise.......for Men

Men feeling self-conscious about the size of their breasts is nothing new—as members of the Seinfeld generation will recall, the episode in which Kramer invents "the Bro," or the "Mansierre" to tame oversized "man boobs" first aired in 1995.

This can't be good.

According to the BBC, in recent years discomfort over what are colloquially known as "moobs," is prompting increasing numbers of men to go under the knife. According to the British Association of Aesthetic Plastic Surgeons, the number of men who underwent breast reduction surgery in the U.K. increased from 323 in 2008 to 581 in 2009, a jump of 80%. Yet, instead of reflecting a surge in gynecomastia, the medical condition in which hormonal changes result in abnormal enlargement, swelling and discomfort in men's breasts, experts suggest that the uptick in cosmetic surgeries is more likely a reflection of both obesity, and increased media scrutiny of "man boobs." (Case and point, several gossip sites have entire photo galleries dedicated to male celebrities' fleshy breasts.)

Of course, for some men, surgery may provide relief from what can be an embarrassing and uncomfortable condition. Yet, as plastic surgeon Rajiv Grover points out to the BBC, for many men, it's not a hormonal imbalance, but simply being overweight, that is the root cause of bigger breasts. "Quite a few cases are caused by obesity, and we often say to men to look at their lifestyles before thinking about the scalpel," Grover said.

Is Taiwan Asia's Next One-Stop Plastic Surgery Shop?

Tourists who frequently return to Taiwan might recommend savoring succulent street food or exploring Taipei's boisterous night markets. Or they may pass along the business card of a favorite plastic surgeon or dermatologist....

And why not? Taiwan has long been popular with its expatriate population as a medical-travel destination. At Taipei's abundant health care facilities, the equipment is modern and sophisticated, and most importantly, prices are considered a steal. Some of the biggest savings are in liver-transplant surgery, which runs to around $91,000, compared with some $300,000 in the U.S.

Price tags like that have built a small but devoted following for Taiwan's niche medical-tourism market, and it's about to get a lot more customers. Taiwan's neighbors across the strait have been making their way to the island for a nip or a tuck since travel restrictions for Chinese tourists were lifted in mid-2008. Now, in the latest of a series of agreements and concessions between China and Taiwan, Taipei announced last week that Chinese tourists will soon be allowed to travel individually to the island — a development that many medical-tourism proponents are hoping will be a boon to their industry - especially the plastic surgeons.

Taiwan's current policy only permits controlled tour groups from the mainland, which limits options for Chinese who seek varied medical services.

Under group-travel restrictions, tourists are told where they can go and when. They can't deviate from the set itinerary," says David Wang, a plastic surgeon and chairman of the Taiwan Medical Tourism Development Association. "I've heard of a few people who will secretly come [for plastic surgery], perhaps under a fake name or by claiming they are here on business."

Now, Chinese patients seeking operations can plan ahead and book Botox treatments and eye-bag or double-eyelid surgery at Wang's offices on their own schedule.

Mainland tourists could be a huge boost. According to Taiwan government statistics, just over 972,000 tourists from China journeyed to the tear-shaped island in 2009 — a 195% jump from the figure in the previous year, when the two sides made transit and tourism agreements. Further encouraging cross-strait exchanges, last month Chinese aviation officials announced a 10% to 15% reduction in airfares for flights between the two sides. With over a million projected to visit this year, even more mainlanders will be emptying their wallets into Taiwan's service sector.

Wang, the plastic surgeon, already travels to China about once a month to promote his practice, and he isn't the only one. Many enterprising proponents of Taiwan's medical tourism have been making the cross-strait journey in the hopes that they, too, might entice more mainlanders to seek medical care on the island.

Not many people know about the quality of Taiwan's health care system," says Richard Wu, CEO of Taiwan Task Force for Medical Travel. "It's our priority to first put out Taiwan as a brand name and then promote individual hospitals for services."

The fact that these customers will now be able to travel to Taiwan solo will only help. "No one would join a group tour that lets everyone else know they are going for plastic surgery or other medical reasons," Yen says. "With individual travel, you can just tell your neighbor you are going to Taiwan for vacation."

Plastic Surgery Trends For 2010

The Consumer Guide to Plastic Surgery thinks they know what’s in store for cosmetic medicine in 2010, from how the newly proposed “Botax” could affect your self-improvement plans to which new products will come to market. Here's what you might see in 2010:

Even More Botox-Like Products Will Come to Market
First there was Botox Cosmetic; then 2009 brought the Botox alternative Dysport. In 2010, expect to see a few more Botox rivals, including a topical form of the popular wrinkle relaxer and at least one more injectable. A couple of injectable Botox cousins are in development, but PurTox will likely be the next to get a nod from the Food and Drug Administration (FDA). The main difference in these injectables seems to be how long the results last and how quickly the products start to work on your crow’s feet.

Fat Injections to the Breast Will Be Used Cosmetically
After being condemned by plastic surgery associations, fat injections to the breast were deemed OK for "touch-ups" after breast reconstruction in 2008. But these once controversial injections may soon play a role in cosmetic breast augmentation. Taking fat from a part of the body where there is too much (your thighs or butt, for example) and injecting it into your breasts where there is too little, may replace the need for breast implants when done in conjunction with a breast lift. Some kinks still need to be worked out, but fat injections to the breast are likely here to stay.

Surgeons Will Invent – and Perfect – Body Contouring Surgeries to Follow Massive Weight Loss
More and more people are undergoing bariatric surgery to lose weight, only to be left with hanging fat and flab in highly visible areas. As plastic surgeons put on their thinking caps to better address these issues, expect to hear about many new procedures, including the corset trunkplasty. This new surgery targets above-the-belly-button flab, to recreate an hourglass silhouette in formerly obese women and get rid of love handles in men who have lost massive amounts of weight. This area has been ignored by many traditional body contouring procedures that target the lower abs, buttocks and/or thighs. We will hear more about corset trunkplasty and other innovative body contouring procedures in 2010.

Fat Freezing Heats Up in 2010
Fat freezing (or cryolipolysis) may give liposuction a run for its money in the coming years. This technology works by freezing fat cells and breaking them down. Zeltiq is in clinical trials now, and results look promising. Stay tuned.

Cohesive Gel Breast Implants Receive FDA Approval
These so-called "gummy bear implants" have been making their way down the pike for some time, and they just may get the long-awaited FDA nod in 2010. Filled with cohesive silicone gel, these leak-resistant implants – used in Europe and Brazil – are being studied in the United States. Gummy bear implants have the positive attributes of silicone gel, but the gel doesn't migrate. This is a good thing, because if the shell should fail, the gel wouldn’t leak into surrounding tissue.

Lipodissolve Study Results Stun Skeptics
Lipodissolve, an experimental "fat-melting" technology, is being billed as a non-surgical alternative to liposuction. Also called mesotherapy, lipodissolve is performed via injection of a cocktail of chemicals into muffin tops, saddlebags, love handles and other trouble spots to dissolve fat cells. Critics were outspoken, which is why the American Society for Aesthetic Plastic Surgery started a rigorous scientific study of lipodissolve, using standardized ingredients. And while even the trialists were skeptical at first, and the final results have not been tallied, it works. The study results – to be released in 2010 – may encourage many doctors to offer lipodissolve. Still, lipodissolve is only for small areas of localized fat and will never replace liposuction.

“Botax” Will Raise Eyebrows
A health care reform bill will be passed in 2010, and it just may include a five percent tax on all cosmetic surgery procedures (except those deemed medically necessary). Let’s say that breast augmentation with implants costs $10,000 in 2008; add a five percent levy, and the total becomes $10,500 in 2010. With business already down, most plastic surgeons are up in arms about the Botax. There is also fear that taxing cosmetic surgery in the U.S. will encourage many to seek out services abroad or through unskilled providers who offer procedures at cut rates in America, compromising their safety.

Surgery-Free Tummy Tucks Trim Waistlines
Non-invasive body contouring procedures such as Thermage, VelaShape, UltraShape, LipoSonix and Zerona will continue to grow in popularity in 2010. Once reserved for the face,

Thermage also uses radio waves to lift and firm skin on your stomach, knees, arms, legs, hands or butt. VelaShape employs bipolar radiofrequency energy to reduce the size of the fat cells, along with infrared heat to tighten the skin. And Zerona uses a “cold” laser to painlessly zap the fat cells beneath your skin. These technologies (and more) may give tummy tucks and lower body lifts a run for their money in 2010.

Face Transplants Face Upsurge
Face transplant surgery was once nothing more than fodder for sci-fi thrillers like the movie Face/Off, but they are now becoming a reality. Eight have been performed so far in the United States and abroad, but there will likely be many more as reconstructive facial surgeons further hone their skills and work toward perfecting their highly complicated techniques.

Minimally Invasive Cosmetic Procedures Experience Rebirth
As our economy starts to show signs of life again, more people may opt for cosmetic surgery procedures, reversing the steep decline of the last two years. Don't expect the numbers to reach their record highs anytime soon, though. There will likely be a slight increase in plastic surgery procedures – especially minimally invasive ones such as injectables that allow people to put off more invasive (and expensive) procedures like face lifts until they really need them (and can better afford them).

Consumer Guide to Plastic Surgery is published by Ceatus Media Group LLC, an online provider of health information and physician directories. Consumer Guide to Plastic Surgery is a registered trademark of Ceatus Media Group LLC. http://www.yourplasticsurgeryguide.com

Cosmetic Surgeons enlist patients to fight the Botox Botax.

Cosmetic surgeons are asking for patient help to fight the Botox Botax. Here's what the ASDS (American Society for Dermatologic Surgery) is giving it's members to solicit the support of Botox consumers: Here's the form.

The U.S. Senate health care reform bill  (Patient Protection and Affordable Care Act) contains a proposed 5 percent tax on "elective cosmetic medical procedures."  While this may look like an attractive option to Senators looking for ways to pay for health care reform, we know that:

• Cosmetic medical procedures taxes are an unreliable and risky revenue source, which has proved to be a failure at the state level;
• A tax on cosmetic surgery discriminates against working women;
• The definition of cosmetic procedures is arbitrary and almost impossible to administer; and
• enforcement would necessitate review of patient medical records by tax collectors, a clear invasion of privacy.

Please enter your zip code below to be connected to an automatic email system which allows you to send a quick message to your Senator asking him/her to vote against this tax.

I've received an number of emails about this over the last 48 hours. Is anyone worried that this 'Botax' will hurt your medical spa, skin clinic or cosmetic practice?

Medical Spa MD: Burned out & depressed plastic surgeons more likely to commit medical errors?

Surgeons who are burned out or depressed are more likely to say they had recently committed a major error on the job, according to the largest study to date on physician burnout.

The new findings suggest that the mental well-being of the plastic surgeon is associated with a higher rate of self-reported medical errors, something that may undermine patient safety more than the fatigue that is often blamed for many of the medical mistakes.

Although surgeons do not appear more likely to make mistakes than physicians in other disciplines, surgery errors may have more severe consequences for patients due to the interventional nature of the work. Some estimate that as many as 10 percent of hospitalized patients are impacted by medical errors.

"People have talked about fatigue and long working hours, but our results indicate that the dominant contributors to self-reported medical errors are burnout and depression," said Charles M. Balch, M.D., a professor of surgery at the Johns Hopkins University School of Medicine and one of the study's leaders. "All of us need to take this into account to a greater degree than in the past. Frankly, burnout and depression hadn't been on everybody's radar screen."

Nine percent of the 7,905 surgeons who responded to a June 2008 survey commissioned by the American College of Surgeons for a study led by researchers from Johns Hopkins University School of Medicine and the Mayo Clinic reported having made a major medical mistake in the previous three months. Overall, 40 percent of the surgeons who responded to the survey said they were burned out.

Researchers asked a variety of questions, including queries that rated three elements of burnout -- emotional exhaustion, depersonalization and personal accomplishment -- and others that screened for depression.

Each one-point increase on a scale that measured depersonalization -- a feeling of withdrawal or of treating patients as objects rather than as human beings -- was associated with an 11 percent increase in the likelihood of reporting an error. Each one-point increase on a scale measuring emotional exhaustion was associated with a 5 percent increase.

Mistakes also varied by specialty.  

Surgeons practicing obstetrics/gynecology and plastic surgery were much less likely to report errors than general surgeons.

Researchers acknowledged the limitations of self-reporting surveys, saying they couldn't tell from their research whether burnout and depression led to more medical errors or whether medical errors triggered burnout and depression among the surgeons who made the mistakes.

The results are being published online on November 23 in the Annals of Surgery and will be published in the printed journal in an upcoming issue.

Notably, the research shows that the number of nights on call per week and the number of hours worked were not associated with reported errors after controlling for other factors.

"The most important thing for those of us who work with other surgeons who do not appear well is to address it with them so that they can get the help they need," says Julie A. Freischlag, M.D., chair of the Department of Surgery at the Johns Hopkins University School of Medicine and another of the study's authors.

via sciencedaily.com

Perhaps the most relevant items here are the decreased reporting of problems by plastic surgeons and the fact that 'depersonalization' has entered the discussion.

I'm really curious about what plastic surgeons think of this study.

Botax: Taxes on Botox and plastic surgery?

The medical spa and plastic surgery community is in an uproar over some proposed legislation that could make a trip to the plastic surgeon or a Botox injection at the medical spa more expensive.

People are calling it the Botax. It's a 5 percent tax on elective procedures such as Botox, Juvederm, Restylane, laser hair removal, facelifts, breast augmentation and other nips and tucks that lawmakers are hoping will help fund the nearly $1 trillion health care plan.

The bill says the tax would not apply to surgeries to fix a deformity either from birth, accident, or disease. It would apply to procedures like face lifts, liposuction, cosmetic implants and teeth whitening.

But as Dr. Paula Hicks points out sometimes cosmetic surgeries have very medical purposes.

"Certainly breast reduction surgery is a very good surgery for a lot of women and a lot of them will get denied by the insurance company as cosmetic surgery," said Dr. Hicks of the Ave Medical Laser Spa and Laser Clinic.

Under the proposal, Dr. Hicks says an eyelid tuck, which can help with vision, would cost an extra $100 in taxes on top of the $2,000 price tag for the procedure.

She says that could be a big hit to her business since most of her clients are not wealthy.

"Most of these procedures are not done on people that are rich and have endless amounts of money, it's middle class working women that would be targeted with this tax and it's really not fair."

According to the American Society of Plastic Surgeons 86 percent of cosmetic surgery patients are women. Sixty percent of them have annual incomes between $30,000 and $90,000.

The tax, if approved, would raise $6 billion over 10 years.

Allergan, which sells Botox, took a civil rights angle: The tax “discriminates against women,” the company said in a statement. Some 86% of cosmetic surgery patients are working women ages 35-50, with an average annual income of $55,000 per year, according to Allergan.

“What’s next? Are we going to tax people who color their hair?” the CEO of Medicis, a drug company that sells fillers, told Dow Jones Newswires.

The American Academy of Cosmetic Surgery, which is fighting the provision, says “a large portion of those being taxed would be the baby-boomer generation. And as this age group continues to age, the more interest will be generated in cosmetic procedures.”

A spokesman for the 2,500-member group said they were surprised to see the provision in the Senate bill this week, because it had already surfaced and sank in July. The tax is not in the House bill.

The tax is on elective procedures, and would not apply to any procedure to correct birth defects or issues arising from disease, accidents or trauma. The CBO says it would raise about $5 billion over the next decade.

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