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Candid dialogue about complications

Article-Candid dialogue about complications

Dr. Gutowski
In a twist on the typical conference topic that focuses on what's gone right in a practice, a group of five young, board-certified plastic surgeons agreed to talk candidly about what's gone wrong.

It turns out that discussing complications was just the right thing to do.

Cosmetic and plastic surgeons were very interested in the panel discussion, which drew a standing-room-only crowd at this year's American Society of Plastic Surgery 2005 conference in Chicago.

The idea of discussing this delicate yet important issue was put forth by Adam Lowenstein, M.D., a plastic surgeon with Kaiser Permanente in Denver, Colo., and upcoming chairman of the Young Plastic Surgeons Committee.

Bringing complications out in the open

"Everybody has complications, and some people are more comfortable discussing them than others," he tells Cosmetic Surgery Times.

"I was a little concerned about finding five people who would be willing to discuss problems, especially when they're relatively young surgeons. But I was very pleased when they agreed. In speaking with a lot of senior surgeons, I found them to be very excited about the topic, too."

The panel was structured so that each young surgeon (in practice 10 years or less) presented one report of a case in which a complication resulted. The specific topics ranged from a hematoma in a facelift to an infection following breast reconstruction to a large abdominal wall wound.

After the panelist discussed the complication and how he or she handled it, an established expert in the audience commented, and an open audience discussion followed.

Frank discussion beneficial

The result was that young surgeons, seasoned professionals and conference attendees spoke frankly, discussed some challenging problems and arrived at amicable solutions.

Major initiatives of the society focus on quality and patient safety, says panel moderator Philip Wey, M.D., F.A.C.S., of Plastic Surgery Arts in New Brunswick, N.J., and clinical associate professor of surgery at the University of Medicine and Dentistry, New Jersey, Robert Wood Johnson Medical School.

"One of the ways that we as plastic surgeons can improve the care of our patients is through panel interactions like these," he says.

The audience feedback flowed freely, and discussions were lively and attentive, according to Dr. Wey.

"It was reassuring to know that the management of these complications was appropriate. ... There were no major controversies. Many times, there is no right answer; it becomes a judgment call.

"It's easy to show your best work," he continued, "but I was especially impressed by the abilities of these very talented plastic surgeons to stay with their patients and help them through all stages of care. In the end, each of the surgeons managed their complications beautifully, and all of the patients had a good outcome."

Panelist Karol Gutowski, M.D., F.A.C.S., assistant professor of surgery and chief of plastic surgery at William S. Middleton Memorial Veterans Hospital in Madison, Wisc., agrees.

"Something can always be done better," Dr. Gutowski says. "And someone has to show the complications so we are aware of the potential downside of any procedure and know how to get out of it. And that, hopefully, will translate to physicians and patients being better informed about potential outcomes."

Another young panelist, Anne Taylor, M.D., F.A.C.S., a plastic surgeon in Columbus, Ohio, says the panel discussion was a good reminder to surgeons that they are not negligent or performing below standards if they have complications.

"The chief of a department told me when I was a resident that you could not be considered for the chief position until you had experienced all of the complications, meaning, if you operate long enough, they will happen," she says.

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