Dermatologists and cosmetic surgery - a personal view of regulation and training issues

Aesthetic/Cosmetic Surgery and Ethical Challenges

Is aesthetic surgery a business guided by market structures aimed primarily at material gain and profit or a surgical intervention intended to benefit patients and an integral part of the health-care system? Is it a frivolous subspecialty or does it provide a real and much needed service to a wide range of patients? At present, cosmetic surgery is passing through an identity crisis as well as an acute ethical dilemma. A closer look from an ethical viewpoint makes clear that the doctor who offers aesthetic interventions faces many serious ethical problems which have to do with the identity of the surgeon as a healer. Aesthetic surgery that works only according to market categories runs the risk of losing the view for the real need of patients and will be nothing else than a part of a beauty industry which has the only aim to sell something, not to help people. Such an aesthetic surgery is losing sight of real values and makes profit from the ideology of a society that serves only vanity, youthfulness, and personal success. Unfortunately, some colleagues brag that they chose the plastic surgery specialty just to become rich aesthetic surgeons, using marketing tactics to promote their practice. This is, at present, the image we project. As rightly proposed, going back a little to Hippocrates, to the basics of being a physician, is urgently warranted! Being a physician is all that a ''cosmetic'' surgeon should be. In the long run, how one skillfully and ethically practices the art of plastic surgery will always speak louder than any words.

A novel approach to teaching dermatology and plastic surgery in a combined module for undergraduate medical students

Introduction: Medical students need to be equipped with the knowledge and skills to serve their communities properly. Interdisciplinary integration by merging similar disciplines together at the level of planning and implementation is a novel idea. Objectives: The aim is to describe the methods and steps that were followed to plan and implement a module in dermatology and plastic surgery for the fifth year medical students of Albaha University Faculty of Medicine, to explain how two similar courses can be designed and merged into one module. Methods: We followed the Kern's six steps for curriculum development in order to plan and implement the dermatology and plastic surgery module. Questionnaires were applied to measure the degree of both students and staff satisfactions about all Kern' steps of the dermatology-plastic surgery interdisciplinary course. Non-parametric t-test was used in the statistical results of Likert scale. Results and discussion: According to these steps, the module committee identifies the problem and assesses the needs of the targeted learners. Then, goals and objectives of the module and educational strategies were determined. Finally, the evaluation and feedback were obtained from both faculty and students. Using a Likert scale to measure the degree of the satisfactions among students and staff for Kern'steps, no significant P-value was obtained for course evaluation steps, in contrast to the goals/objectives, educational strategies and implementation steps in which significant P-values were obtained. Conclusion: Implementing Kern's methodology for curriculum development resulted in the integrated module of dermatology and plastic surgery with no major problems at all levels.

The evaluation of malpractice cases arising from aesthetic intervention in Turkey based on Supreme Court case law

AIM

The aim of this study is to evaluate medical malpractice cases arising from aesthetic services based on the decisions of the Supreme Court.

MATERIAL AND METHODS

In the study, compensation and criminal lawsuits finalized by the civil and penal courts of the Supreme Court were examined retrospectively. All the case law decisions were obtained from the official website of the Supreme Court: www.yargitay.gov.tr. Nine hundred and eighty-one decisions were obtained after performing a keyword search in the website; after duplicates and unrelated cases were removed, 81 decisions (N = 81) were evaluated.

RESULTS

The analysis showed that lawsuits related to medical malpractice involving aesthetic interventions are mostly finalized by the civil courts, which decide claims for compensation. Malpractice primarily occurred in private hospitals and beauty centers, and operations were found to be commonly performed by physicians and beauty experts. Malpractice cases were found to be mostly caused by poor medical intervention, a lack of attention/care, and faulty/incorrect treatment. The average compensation amount provided by the civil courts is 55 558 ± 50 014 TL (14 209 ± 12 318 USD).

CONCLUSION

On the basis of these results, it is recommended that the awareness and training level of healthcare personnel should be increased, and precautions should be taken at both the institutional and the national levels.

Esthetic dermatology and emotional well-being according to gender

INTRODUCTION

There has been an increase in the demand for esthetic dermatology treatments within the general population. The purpose of this study was to analyze, within the scope of general population, the relationship between people's perception of esthetic dermatology treatments and emotional well-being, as well as for differences in gender.

METHODS

The Aesthetic Dermatology and Emotional Well-Being (DEBIE) Scale, [Journal of Cosmetic Dermatology vol. 13 (2014) 336-345] was applied to 770 Spanish people over 18 years old. The scale is structured according to six factors and classified into two dimensions: (1) Emotional Well-Being and (2) Perception of Aesthetic Dermatology. Cronbach alpha for the total scale was very high (0.90). Data analysis includes the following: (1) bivariate correlations with Pearson's coefficient; (2) gender differences through Student's t test, and (3) the effect size through R² and Cohen's d.

RESULTS

A statistically significant relationship which is directly proportional has been identified between the degree of emotional well-being of people (self-esteem and assertiveness, optimism, and motivation) and the knowledge and attitude toward Aesthetic Dermatology. There are statistically significant differences according to gender: Women have a lower level of emotional well-being than men, as well as greater knowledge and more positive attitude toward Aesthetic Dermatology.

CONCLUSIONS

People who are familiar with Aesthetic Dermatology and have a better attitude toward it, are also more self-confident, more optimistic and more motivated; with emotional strength. Regarding gender, it is expected that women may seek more consultation and esthetic dermatology treatments than men do.

Aesthetic/Cosmetic surgery and ethical challenges

Is aesthetic surgery a business guided by market structures aimed primarily at material gain and profit or a surgical intervention intended to benefit patients and an integral part of the health-care system? Is it a frivolous subspecialty or does it provide a real and much needed service to a wide range of patients? At present, cosmetic surgery is passing through an identity crisis as well as an acute ethical dilemma. A closer look from an ethical viewpoint makes clear that the doctor who offers aesthetic interventions faces many serious ethical problems which have to do with the identity of the surgeon as a healer. Aesthetic surgery that works only according to market categories runs the risk of losing the view for the real need of patients and will be nothing else than a part of a beauty industry which has the only aim to sell something, not to help people. Such an aesthetic surgery is losing sight of real values and makes profit from the ideology of a society that serves only vanity, youthfulness, and personal success. Unfortunately, some colleagues brag that they chose the plastic surgery specialty just to become rich aesthetic surgeons, using marketing tactics to promote their practice. This is, at present, the image we project. As rightly proposed, going back a little to Hippocrates, to the basics of being a physician, is urgently warranted! Being a physician is all that a "cosmetic" surgeon should be. In the long run, how one skillfully and ethically practices the art of plastic surgery will always speak louder than any words.

Decision factors and the recognition of medical specialty in patients receiving cosmetic laser and intense pulsed light treatment

BACKGROUND

In addition to dermatologists and plastic surgeons, physicians of other medical specialties also provide cosmetic laser and light treatment.

OBJECTIVE

This study aimed to determine the major decision factors in patients who received cosmetic laser or intense pulsed light treatment and how they perceived different medical specialties in providing such services.

METHODS

The method of factor analysis was adopted to extract the common characteristics (major decision factors) from a list of 17 items patients would regard as important when they planned to receive laser and intense pulsed light treatment. In addition, the level of recognition of different medical specialties in cosmetic patients was indirectly forecast using an analytic hierarchy process.

RESULTS

Medical competence (0.3296) was the most important decision factor, followed by recommendation (0.2198), friendliness (0.1350), cost (0.1307), complete service (0.0984), and the physical attributes of the physician (0.0865). Dermatologists and plastic surgeons outscored cosmetic practitioners in five factors except for cost, in which the plastic surgeons were weakest.

CONCLUSION

Medical competence and recommendation are the core issues for cosmetic patients. Dermatologists and plastic surgeons gain better overall recognition than physicians of other medical specialties in cosmetic patients.