Wednesday, May 5, 2010

What People Think of Plastic Surgery

Another thoughtful essay from Dr. Robert Goldwyn’s book “The Operative Note: Collected Editorials” (published in August 1992).

What People Think of Plastic Surgery

In conjunction with the publication of my book, Beyond Appearance: Reflections of a Plastic Surgeon, I recently was on a number of radio talk shows. Through the wonders of modern communication, I was fortunately able to participate in most of these sessions without having to go to the studio. To relax in bed and to have one’s voice perpetrated on the citizens of Alaska, for example gives one an inkling of how easily those in high political office can abuse their power. To what extent these talk shows influenced the sales of my book I really do not know. But what I did learn was what many people are thinking about in relation to plastic surgery specifically and medicine generally. Although I was ostensibly on these talk shows to discuss my book, it was not long before larger issues and personal surgical events took over. What follows is not intended to be a factual survey of public opinion, but simply a series of impressions.

First, the good news. Most of those who called in were very much aware of the worthwhile achievements of our specialty. Many mothers expressed their gratitude for what plastic surgery had done for their children deformed from birth or trauma. Several men reported how well our colleagues had reconstructed their faces after removal of a cancer. Some callers wanted to know what I thought would be important discoveries in our field. A few asked specifically how close we were to perfecting artificial skin and methods to forestall aging. In that regard, aesthetic aspects of our activities soon dominated the reconstructive. Not surprisingly, many women phoned in to inquire about face lift, eyelidplasty, abdominoplasty, and liposuction. Men also described their experiences with plastic surgery, with most calling about hair transplants and rhinoplasty. Those who complained about what they considered a poor outcome of their aesthetic surgery admitted that they had been warned of that possibility but still thought that they should have received a better result, especially since, in the words of one woman, “I had been charged an arm and a leg for my face.”

A common question from the talk masters and listeners was how to find a qualified plastic surgeon. Many said that advertising had confused them. Why would a good doctor advertise? If he is as talented as he claims, why shouldn’t he be busy enough? Another question was whether a plastic surgeon would admit that he or she did not do a certain procedure and refer the patient to someone qualified. A frequent query was whether we “operated on everybody.”

What I gleaned from more than 20 talk shows was that the public believes that all plastic surgeons do cosmetic surgery and that anybody who say that he or she is a cosmetic surgeon is most likely a plastic surgeon. Credentials and board certification, though they are important to us and should be to the patient, are poorly understood. Almost any diploma on the wall will do. Availability, kindness, and cost are the determinants for a large group of people. Many regard an aesthetic operation as a commodity, a luxury item to be shopped for and purchased. A sentiment of many callers was that it is not really surgery since it can be done in the office and is not covered by insurance. Several vented their resentment at having something go wrong and then being unable to get to the doctor. One caller remarked (I was keeping notes), “He was there to take my money but not my complaints. He sent the nurse out to do that. Is that what you learn in medical school?”

The longer the talk show, the more likely the surfacing of disappointment and hostility. While almost every caller treated me with respect, undiluted, high regard was not what many had for the medical profession. The public is no longer our ally, if they ever were. A crucial factor, not surprisingly, was money. If we charged nothing for our services, our patients would undoubtedly like us more, but only if the result were perfect and we were kind. In this real world, however, most of us are not saints, most of our work is not perfect, and yet we charge for it.

I did receive one unusual call: Someone championed “genetic honesty.” saying that he was against any reconstruction that changes nature’s workmanship, even the most faulty, as in the instance of a child born with a cleft lip or a craniofacial mishap. Within seconds, the phones became alive with callers who verbally murdered that nihilist. They did my work beautifully.

As an aside, let me offer another fact: Nobody wrote me to become my patient. Many people did send letters asking how they could find a plastic surgeon in their area for a specific problem. I referred them to the Executive Office of the American Society of Plastic and Reconstructive Surgeons.

I did get a call, however, from someone who insisted he speak to me immediately, even though I was busy with patients. Finally, my secretary capitulated and I took the call: “Doctor Goldwyn,” the voice boomed, “I read your book, and I think it is one of the best I have ever read. Congratulations on such an achievement [by then, I was purring]. Sir, it would be an honor for me to sell you life insurance.”

So much for books and talk shows.

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