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Plastic Surgery as ???Show Biz???

2004; Lippincott Williams & Wilkins; Volume: 114; Issue: 7 Linguagem: Inglês

10.1097/01.prs.0000143583.87642.e8

1529-4242

Mark Gorney,

Digital Imaging in Medicine

For those of us who remain in the passing generation of plastic and reconstructive surgeons, the spectacular technical evolution of the specialty and our admirable capacity as problem solvers stands in sharp contrast to the questionable ways we try to satisfy the public’s curiosity about our work. Whether or not we approve or disapprove of what aspect of our work our spokespersons focus on, there is little question that the spotlight has always been mostly on aesthetic surgery. Sadly, since the Federal Trade Commission’s unfortunate decision to lift traditional prohibitions on advertising by physicians, “marketing” techniques have emerged as the El Dorado of our specialty. Plastic surgeons, as well as those less qualified, have now mined this vein to near exhaustion. An interesting question now begins to emerge: is there a definable point when these efforts become counterproductive? Is there a level at which the extreme makeover produces extreme consequences? In the opinion of this observer, if we are not there yet, we are sure damned close. The decision by the American Society of Plastic Surgeons to bestow its blessings and cooperation on the “Extreme Makeover” program did manage to restrain the wretched excesses of other imitators. Nonetheless, the whole concept of plastic surgery as “show biz” is hardly accepted with unalloyed enthusiasm by our rank and file. It is undeniable that this is an extraordinary opportunity to attain national attention without shelling out beaucoup bucks on a personal publicity flack. As one unfortunate sidelight, it has also produced a share of embarrassingly ugly, invidious behavior by those not tapped for stardom. Some of the venomous comments would put Bette Davis at her bitchiest to shame. From a psychological point of view, I find that sort of reaction deplorable but fully understandable. The sight of all the hoopla and hysteria about a postoperative result that is readily reproducible in hundreds of surgical suites across the country every day is not calculated to impress most of us. I understand the ultimate objective. I know the theory that in the long run “it benefits all of us.” It is also a little bit like castor oil. I’m not at all sure the awful taste is worth the benefit. What most practices in this country lack is the luxury of affording the limousines, the clothes, the dental work, and the professional makeup. Above all, for most of our colleagues with lots of aesthetic work, the adventure hopefully ends quietly with a smile, a handshake, and maybe a grateful peck on the cheek. Lamentably, few of our offices have a grand carpeted staircase and spotlights for the “presentation” of the result, complete with uncontrolled hysterical weeping crowd at the moment of “revelation.” As your vigorous defender, I can assure you that the consequences of sacrificing surgical judgment for 15 minutes of fame can backfire on you badly. Sadly, it is your humble servant who acts as the first screen on any claim against you. I know where the skeletons are buried. The experience is not pleasant. Often I don’t know whether to laugh or cry. Of all the claims against plastic surgeons, close to 80 percent are about aesthetic surgery. At least half of these claims are based on overblown, unrealistic expectations and shattered dreams. We tend to forget that we are the only practitioners whose treatment success or failure is largely in the eye of the beholder. Unlike most other doctors, we are not attempting to make a sick patient well; we are taking a well patient and making her unwell to make her better. This is not wood or clay, gang; this is flesh and bone, which can be perversely unpredictable. The mere fact that the patient has shared in that “stardom” and 15 minutes of fame does not deter a claim. (We have the experience to prove it.) If something goes awry, it only tends to generate even more negative publicity. I guess what bothers me most is the fact that we are trivializing what is in fact serious surgery, often with unpredictable results and/or side effects generated by that patient’s genetic package. What does a plastic surgery television program with the name “The Swan” suggest to you? What happens when the ugly duckling looks in the postoperative mirror expecting to see that swan but instead sees a reflection more suggestive of a parakeet? The endless search for show business applications to our work can only result in the expansion of the public’s unreal image of us as infallible magicians who routinely perform miraculous transformations. It pushes the unfavorable liability statistic curve upward in both frequency and severity. It certainly magnifies the tendency for our colleagues to sneer at us in the hospital hallways and locker rooms. Certainly we need to keep the public informed of the advances in out work. Certainly we need to convince the public that the certificate hanging on all our walls stands for something. However, there are still a few of us who look at plastic and reconstructive surgery as the noblest thing one can do with one’s head, heart, and hands. We cringe at the gradual degeneration of our raison d’être into a carnival midway complete with lights, clowns, and barkers. It really makes a fella proud to be a soldier!