Patient safety, an interview from San Francisco

Estheticon met Dr. Neuhann-Lorrenz on the occassion of the 20th biennial Congress of the International Society for Aesthetic and Plastic Surgery in San Francisco in August 2010. She speaks about the safety for patients who decide to have a plastic surgery, about the four aspects that should be considered, about countries that strictly observe the patient safety and she also explains what a „cool-down“ time in plastic surgery is.The main theme of this congress is patient safety. What does this term mean exactly? What springs to mind when you think of patient safety?

It’s to do with the fact that when patients undergo a procedure, they are accustomed to receiving the maximum amount of care and attention and as much information as possible. It is also about medical responsibility.

Can you explain further?

This topic can be divided into four aspects. Firstly, it concerns the procedure that the patient undergoes. Secondly, it concerns the doctor and especially his qualifications. The third point is concerned with the type of surgery being performed and last but not least, the location and facilities where the surgery will take place. It’s also a question of under what circumstances, by what means and with what medical products will the procedure be carried out.

What care should be taken when selecting location and facilities?

Selecting a site involves making sure the operating room is approved by the state health authority or other relevant organisations. There are really strict criteria when it comes to site location for medical procedures. With regards to operations, the medical facility and namely the operating room must be approved and meet quality control standards.

Which countries are subject to these stringent criteria?

Unfortunately, there are only a few countries where this is really heavily regulated. These are Germany, USA, Denmark – you could also say Spain. In these countries, regulation is very strict and also clearly emphasised. Patients seen by a doctor there can be sure that they will receive adequate treatment. Our patients go to the doctor and always think that he will do everything correctly, but this may not always be the case.

Back to patient safety… Can you briefly summarise, for the benefit of visitors to our site, the guiding principles of patient safety and what it means in practice?

When talking about plastic surgery and aesthetic medicine, you need to be sure that the doctor has the appropriate qualifications and is a certified surgeon. In Germany, this would be a Facharzt für plastische und ästhetische Chirurgie. Their knowledge must be gained through specialised medical training. In Germany, ENT (ear, nose and throat) specialists and oral and maxillofacial surgeons can carry out plastic and aesthetic surgery in their fields of expertise if they have an additional qualification in plastic surgery. An ENT surgeon performing breast surgery, or abdominal and hip liposuction is moving beyond the zone which we consider safe.

What else should we look out for when choosing a doctor?

Another aspect is what insurance physicians should have. Even the most skilled hands can cause a fatal accident during an operation. Such events must be covered by insurance, as in most cases a doctor could not bear the economic consequences for the patient. That’s why we urge all doctors who carry out such operations to have insurance, a kind of third-party liability cover. It’s a good idea for a patient to inquire whether a doctor is insured and where.

So consultation with the doctor is very important in this regard?

Yes, exactly. Physicians must discuss everything thoroughly with their patients. They have to inform them fully about the operation and get them to sign a consent form, which the patient needs to understand completely. It should therefore be written comprehensibly, specifically with the patient in mind.

Even so, patients often feel almost powerless in the medical world.

That’s why patients need a so-called « cool-down” time for reflection in order to process the facts before their operation. The patient is like a customer in a shop, overwhelmed with information. With a week to think things over, they can see things more maturely, are better informed and will be much calmer for the operation as they’ve had time to prepare.

Why is the issue of patient safety and all the aspects you’ve described so topical?

The international ISAPS congress (International Society for Aesthetic Plastic Surgery) brings together 86 nations and IPRAS (International Confederation for Plastic, Reconstructive and Aesthetic Surgery), the parent body, 90. Here our colleagues, all qualified plastic surgeons, gather to learn from us about these new methods. Of course, we also learn from them. It is therefore an ongoing process with many changes that need to be adequately explained.

So what does patient safety mean in the context of globalised medicine?

It is possible that people get plastic surgery abroad because they have heard about a particularly good surgeon. Financial reasons may also play a role, but I consider that – as opposed to our patients – a poor argument. We only have this one face, this one body and the outcome of an operation cannot be reversed.

Hence we need to think about everything properly beforehand.

Yes, absolutely. This also applies to payments. If a patient has to take out a loan for surgery, which they can’t then pay back, you can’t return an operated face – unlike a car. The patient must be sure that she wants to undergo surgery and that she is dealing with someone who respects these criteria and is capable of discussing all these aspects with her and therefore does not simply follow the patient’s wishes, but firstly offers a detailed consultation and advice.

It is very important that patients properly discuss the operation in advance. What legal provisions exist in different countries?

Legislation differs greatly. At the moment, the strictest are Singapore, Denmark, France, Brazil, Spain, USA and with certain exceptions, Germany. In terms of strict legislation, Denmark and Singapore are the top countries where laws are enforced and upheld.

How is your company involved here … ………….?

We are currently lobbying organisations for European standardisation, CEL-Institute or ISO, so we can introduce such rules internationally, so patients do not have to be so scared when they decide to undergo surgery abroad. Of course Thai patients should not feel they are treated differently or worse in their own country than in Germany. I’m sure we’ll achieve a good result, first in Europe and then also hopefully internationally.

What are the specific demands?

I am chair of the Government Relations Committee. We have good contacts within the German parliament and are trying to reduce, if necessary prohibit, operations on persons below the age of 18.