2023-08-31 17:18:00
“To err is everyone’s, only to the fool to preserve in error” said Cicero. This is applicable, even in the surgeons more experienced. The origin of human fallibility has been held since time immemorial and different causes have been assigned to it: divine origin, changes in evolution, astral attribution, “bad luck”, bad intention, judgment and poor and deficient planning, etc. The death of Silvina Luan this Thursday, August 31, revived the controversy over aesthetic interventions, good medical practices and the responsibilities of professionals.
Given the advancement of medical science with the enormous technological development, it seems unacceptable, especially for those of us who practice medicine, who an unfavorable result may appear in the postoperative period of an aesthetic surgical or plastic reconstructive treatment.
We doctors are obliged to prove why it has happened, but in medicine and mainly in plastic surgery the explanation may not be so obvious as most neophytes may think.
It is not an exact science, and in many cases the equation 2+2 is not 4 and gives another result with different consequences than expected.
The surgeon must be attentive and awake to the subtle conditions and factors that predispose to failure. The plastic surgeon must not only recognize and correct the error -or errors-, but also has the obligation to identify its causes and avoid repeating it in the future.
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However, error is synonymous with humanity, as Euripides has already said: “Men are men, they must necessarily err.”
However, the surgeon must ask himself a number of questions.
Plastic surgery: when can it fail?
The first concept that the surgeon must “get into his head” is that he is dealing with psychologically and physically variable and complex human beings, whose tissues and organs depend on biological phenomena that are unpredictable in their physiological evolution and in which it will never be possible to predetermine. How will the response to surgical aggression be?
Any surgical act, be it minor, medium or great complexity, must have the same responsibility for the surgeon and there should be no “small surgeries” for him.
For each of the patients who undergoes surgery, “his” surgery is the most important; The extraction of a simple sebaceous cyst is just as valuable and worrying for each of them as the reconstruction for a severe congenital facial malformation or an aesthetic operation.
At the Ricardo and Enrique Finochietto Municipal Graduate Surgical School, a phrase that reflects this was used as an official quote: “You have to do small things as if they were big to be able to do big ones as if they were small.”
plastic surgery It is not a “magical” act comparable to hairdressing or cosmetology maneuvers; It is an act of surgery where all the basic postulates of the Surgical technique and tissue management similar to other specialties such as neurosurgery, general and vascular surgery, etc.
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Some people consult to undergo the surgical techniques of plastic surgery with the preconception that it is an “easy, fast and simple surgery”, which can be practiced in non-surgical areas and that the next day they will return to their jobs.
Unfortunately, many doctors consider plastic surgery to be of a lower scientific hierarchy, associating it with banal and superfluous treatments with extremely easy techniques: it is essential not to confuse plastic surgery con aesthetic medicinealthough they are related.
The erroneous and fallacious nature of these beliefs is associated not only with unfavorable results but also with severe complications and legal claims that are difficult to defend in court.
The plastic surgery is considered the union between art and science, but the difference is that “sculpture is made” in living tissuesbiologically active with different responses in each patient, not only physically, but mainly mentally.
failures in plastic surgery
And A favorable result for the surgeon may be unfavorable for the patient and vice versa.. What really matters, in practice, is that the patient is satisfied with the result.
The plastic surgeon who faces a problem like the one described has a scientific and ethical obligation to collect photos, clinical histories, files and special cases to offer them to their colleagues through scientific papers, presentations at congresses and/or publish them in the form of books, providing the experience that daily activities have offered them both in private practice and in public hospitals.
Malpractice, the Silvina Luna case
The patient who is dissatisfied with the unfavorable result of plastic surgery has a significant negative emotional impact which creates a stressful reality for the surgeon who wishes they had not operated on him.
The doctor not only feels that he has failed in lend help (which is his most important function) to the person who has gone to request it from his office, but has also achieved a dangerous transformation of the patient. This, instead of applauding our talent and technique, accuses us of being incompetent and a bad surgeon; appears the ghost of having failed as doctorsa profession that has demanded so many sacrifices and studies from us and continues to demand it.
When a patient iinitiates contact with a plastic surgeon to perform surgical treatment of any aesthetic or functional deformity, believe you will find perfection and that no problem will appear as a consequence of this surgery.
However, although most patients are satisfied, due to various circumstances and causes, some feel dissatisfied and complain in the postoperative period.
In the preoperative consultations there is the opportunity to detect “difficult patients” and explain the reality of plastic surgery; it is also important to honestly trust them with the chances of success in solving your problem. If the surgeon does not believe in the success of his technique and what he proposes to the patient, he should not operate on him, he will save himself from a lawsuit.
Currently television, cinema and networks have become illusion makers from an aesthetic point of view, since the propaganda of false results and “retouched” bodies encourage people to misconsider plastic surgery, depriving it of the true scientific and artistic value it has as part of medical science.
It may also happen that they have placed almost “magical” expectations on the benefits of plastic surgery, making surgeons superior beings, with an exquisite sculptural technique whose movements they cannot fail nor complications occur: tremendous mistake of concept.
All the cases once morest Aníbal Lotocki, the doctor denounced by Silvina Luna
Some people try to correct painful situations or circumstances in their lives, such as losing their job, abandoning their partner or loneliness with aesthetic changes to their body, exaggerating not only their expectations but also their demands on the surgeon. asking for physical changes that surgery cannot achieve.
When the surgeon wants to comply with this absurd and utopian requirement, unfavorable results appear or naturalness is lost in favor of artificial aspects that “give away” the surgery.
The surgery that failed
The first thing the surgeon should look for is the cause why the patient is dissatisfied.
The reaction to the complaint or claim should not transform us into little or nothing receptive, since that would allow resentment to reach greater proportions, increasing the patient’s aggressiveness. The surgeon must answer truthfullyconfiding in the inconveniences that may have occurred during the surgery, drawing attention to previous diseases that might have influenced the result and even emphasizing the improvement that will come following a few months necessary for the treated area to deflate.
Another issue is trying to blame diseases, tissues, or habits of the patient as culprits for their poor outcome. This can delay the true complaint but it will inevitably come by increasing the patient’s anguish, anger and complaint.
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when the patient presents an unfavorable result legitimately justified by infection, asymmetry, poor healing, deserves respect and empathy from the surgeon, who should do everything possible to solve the problem.
When some bad results are very evident, denying the truth of the patient’s complaint leads to increasing the claim because it gives the impression that we are insulting the intelligence of the patient trying to make him understand that he is wrong.
The situation can get worse if the surgeon loses control of the situation. It must be available at all times to evacuate all the demands emanating from the patient’s consultations; the formation of a barrier of lack of understanding between both protagonists must be avoided.
All the facilities to be in contact with the patient must be kept active because if the surgeon becomes difficult to reach, the lawyer will be reached faster.
Although sometimes they do not want to admit, the surgeon who is going through this situation is also anguished, stressed and wants to solve the problem as soon as possible.
“It is inappropriate and illogical for the patient to take responsibility for the expenses caused by additional procedures to solve bad results or aesthetic surgical complications” (JO Güerrissi)
The economic aspect of an unfavorable result is very important. For patients of reconstructive surgerysocial works, health insurance can cover the costs caused by complications, sequelae or poor results.
In the case of cosmetic surgery, it is inappropriate and illogical for the patient to bear the costs of additional procedures to solve bad results or complications.
You must learn from bad situations and therefore the surgeon must treat the dissatisfied patient in the same way he would like to be treated in such a situation.
He good result of any plastic surgery begins for the surgeon from the first consultation, making a correct diagnosis of the problem presented by the patient, evaluating the expectations that he places on the result, assessing whether his suitability and experience will be sufficient to be able to reach a satisfactory result and fundamentally assessing the patient’s mental conditions: why is he requesting that surgery? it is necessary? should it be done?
*Doctor of Medicine, Member of the Argentine Academy of Surgery, Authorized Teacher of the UBA, International Member of the American Plastic Surgery Association.
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