Physician qualifications: who should perform plastic surgery?

Much depends on the qualifications that surgeons must obtain before they can call themselves "plastic surgeons" and perform procedures that are defined as "plastic surgery." Who must these doctors be? Do they all have to have a certain specialty or be members of a certain college or society? Does a surgeon have special qualities and qualifications if he or she has been trained in a certain program or is board certified? Certainly, a patient seeking a plastic surgeon expects the surgeon to be well trained in the procedure required and to be able to handle any complications that may arise.

Some surgeons disregard the training, education, and professional skills of their colleagues. Is this moral? On the one hand, if a surgeon knows that another physician is not trained to perform a certain procedure and has seen serious complications after that physician performed such procedures, is it morally his duty to warn about it? On the other hand, there are surgeons who present themselves as knights in armor on a white horse, whose mission is to save society from surgeons who meddle in other people's affairs. Yet some of these "knights" have been seen protecting their own financial interests without any altruistic considerations.

Today, the plastic surgeon has behind him giants from general surgery, orthopedics, otolaryngology, ophthalmology, maxillofacial surgery and dermatology - so he should be the least likely to complain about territorial disputes.

Another topic is the development and use of new surgical procedures and devices. Since no surgeon is born with the skills to perform surgical procedures, all must be trained. Some more than others. For example, a surgeon may become familiar with a new procedure by attending a medical conference or by carefully reading a specialized journal. Is it ethical to introduce a new and perhaps untested procedure into one's own practice? And is it appropriate to present oneself as the "best surgeon" in order to practice an operation for which the improvement is not obvious?

Also, continuing the theme of training and professionalism, the question arises whether every surgeon can become an "expert" in any operation related to his specialty? Standards of medical care do not say that every operation must be "perfect" and that a favorable outcome is guaranteed. But society expects a certain level of competence from its doctors, including surgeons. Here the subject of morality is the competence of the surgeon.

Another question we must ask is whether physicians have the right to perform surgery in their office or in their office operating room if they are unable to obtain the same procedure in a licensed surgical clinic or hospital that is subject to rigorous peer review? Should potential patients be told that their surgeon is not licensed to perform certain procedures in a licensed medical center? It could also be argued that because of an imperfect licensing system that is subject to local politics and, at times, the personal interests of competing surgeons, some specialists are unable to obtain permission from their superiors to work in certain institutions. Could it be argued that the lack of equality of recommendation exposes patients to unnecessary risk?

But who would deny that the main purpose of our profession can be the subject of competition? Do not all patients deserve a competent doctor, and in particular a competent plastic surgeon? It seems that rules, regulations and guidelines for improving competition could be useful.

It was noted that "many surgeons have an innate or acquired tendency to exaggerate the number of operations they perform and to underestimate failures. Some might call this mendacity; the more charitable might say that it is a manifestation of exuberant optimism."

So our final prayer might be, "Lord, please give me a surgeon who knows what he's doing."

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