Barry Zide, M.D., D.M.D.
Department of Surgery (Plastic Surgery)
New York University Medical Center
550 1st Avenue
New York, N.Y. 10016

barry.zide@med.nyu.edu

I AM AN EXPERT IN ANYTHING YOU WANT

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There is a Yiddish word that you and every other plastic surgeon needs to know, and that word is "mishigas," which can be freely translated as the craziness that you experience from patients and some colleagues. When you do mostly aesthetic surgery, you are transformed into a major mishigas magnet, but doing reconstructive surgery does not confer natural immunity from this affliction. I will expound with examples.

Certain patients always say the same thing, given an equal opportunity. For instance, yesterday I was taking preoperative pictures of a patient's knees and medial thighs for liposuction. The camera was 3 feet away and aimed right there, and she said, "You're not getting my face in that picture, I hope." And a couple of days ago, a patient was sent to me with a diagnosis of malignant melanoma (thin); only the small biopsy site was visible, as the primary lesion had been excised. I did the usual wide excision of the biopsy site, and while dropping said tissue in the container, I was asked, "Did you see anything?" as if I operate at a molecular level. My buddy, John, told me of a patient who was waiting outside the operating room in a stretcher prepared for his facial surgery. John asked, "Any last questions?" At that juncture the patient responded with, "You're not gonna cut me, are you?" Now, these examples relate more to neuroses and fears than to bad behavior.

What about what recently happened to one of our most esteemed colleagues? The surgeon was supervising fine residents in a cosmetic procedure, which went well. Little did they know that the patient had a huge body-image disorder. Postoperatively, the patient took her preoperative pictures, put them next to her "morphed" postoperative ghoulish pictures, and published them on the Internet. The doctor had to get a lawyer to obtain an injunction to stop her, but he lost business, money, and stature in the interim. Of course, the patient had to pay nothing.

And then there is the influence of the media that leads patients to ask, "How many of these procedures have you done?" We would not be in this business if we did the same procedure every day, as do many general surgeons. Besides, each patient needs something special. What is the correct way of responding?

My series has not been published yet.
Somewhat less than 1000.
Our office is so busy we do not have exact data.

No one ever told me how many of anything I had to do to become an expert.

And what about the patient who wants to see preoperative and postoperative photographs that you do not have? My latest ploy for that is great: "The new HIPAA, the Health Insurance Privacy Act (my translation), which ensures patient confidentiality, does not allow us to show those pictures anymore. I wish I could, though; they were impressive, really."

The methods by which I try to keep a patient from going elsewhere unnecessarily do not go beyond this petty, nebulous presentation of data. Some of my colleagues, though, are downright creative. I saw a patient who had a poorly performed chin implant, and she told me her doctor's name. She also told me that her insurance had paid for the surgery entirely. I actually got the patient to get the operative note, which her original doctor's receptionist or the insurance company provided. I just wanted to know what type of implant I was dealing with, but the operative note was a dictation for cancer surgery of the chin with a flap reconstruction. I called the doctor, whom I knew, and flat-out asked, "What were you thinking by doing this? You could put your license on the line with fraud like this!" His response was, "Gee, Barry, I guess my office nurse dictated that for me." Are you kidding?

A colleague of mine constantly has his name in the news and magazines. After recent newspaper exposure of his supposed expert genius, a public relations firm called me and asked me if I wanted more patients. I asked her who her clients were, and she freely supplied that doctor's name. But when I bumped into that surgeon at a recent meeting and commented to him how effective his P.R. seemed to be, he said " I don't use P.R.; my office manager calls the press sometimes without me even knowing." Are you kidding?

I know a surgeon in town, Dr. Blank, who was fired from the residency and, fortunately, found another program in which to finish his training. He opened an office, calling it the Dr. Blank Surgical Center. So now he advertises in a magazine with his name, under which he titles himself "Chief of Plastic Surgery" and "Director of the <st1:place><st1:PlaceName>Blank</st1:PlaceName> <st1:PlaceName>Surgical</st1:PlaceName> <st1:PlaceType>Center</st1:PlaceType></st1:place>." Are you kidding?

A terrific scam has been going on for years here in this teeming metropolis. A very attractive woman suggests in the advertisement that she is familiar with the varying areas of expertise of only the best doctors in the city. The ad goes something like, "Let me find exactly the right plastic surgeon for your specific needs." The intimation is that she has a profile of all of us when, in fact, a single elderly plastic surgeon in town pays her for each ad-referred patient, who goes only to him. Now that's effective marketing (and completely misleading and spurious).

Cosmetic surgery becomes more technically demanding every year, but only if you, the doctor, decide to be more daring from what you learn. We all jumped on the mid-face lift through the eyelid bandwagon and then off again. A lot of us jumped on the ultrasonically assisted liposuction bandwagon at outrageous prices, and some jumped off. On the one hand, the patient screams for the next newest thing and some of us run to become the first, sic, the early experts. If that pays off, they may go on TV, and then their magazine ad can say, "as seen on TV" or "as discussed on 'The View.'" The latest craze, and definitely mishigas at the red-alert level, is this "short scar face lift." Did not we all use these shorter scars when previous face lift patients wanted a touch-up? Is this not just doing less work behind the ear in younger patients who probably did not need much postauricular work? But, now, some of us, the new experts, capitalize on the term short scar as if a new operation had just been invented. Am I wrong on this?

At this point in my career, I feel reasonably skilled at surgery, adept at staying out of trouble, and reasonably able to deal with most situations. I refer some hand or breast cases that my colleagues do better than I. But, still, many come to me seeking "the expert." Now I go with the flow. If the technique is something I know I can do, I say, "I can do that very expertly-no problem," and then I wonder if they'll book. It's mishigas to worry about it.

P.S.: Thanks to Doug Roth for a great title!

Read my letter to Editor of JPRS regarding libelous statements about me:

<o:p>http://groups.msn.com/losingface/yourwebpage.msnw</o:p>

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