Sunday, April 15, 2012

"Doing the Wife's Tummy Tuck" - An informal survey of surgeons' reactions

About 2 weeks ago, an American plastic surgeon told the story of how he performed his own wife's "tummy tuck" - a cosmetic surgical procedure to remove excess, sagging skin from the abdomen.  The blog post is on the popular medical blog aggregator site, KevinMD, and also on Dr. Di Saia's own website.  Rather than having me recount the story, I encourage you to follow one of the links and read the brief post for yourself.  Reading it on Dr. Di Saia's website may give you a better appreciation of his practice context and expertise.

I shopped this story around the surgeons' lounge last week and the response was vigorous and unanimous: Bad idea.  The surgeons expressed several concerns:

First, while the outcome for the patient/wife was good in this case, any surgeon knows that this will not always be so.  In the rare case when things go wrong in the operating room, it becomes an extremely stressful and dangerous situation very rapidly.  In those cases, the patient's best asset is a calm, dispassionate surgical team that can think clearly and act decisively.  Every surgeon I spoke with admitted that their judgement would suffer if they were called upon to lead the team managing their loved one's surgical crisis.

Next, many of the surgeons wondered about the possible effects on a marriage if the results of the surgery were not exemplary.  Would the wife be comfortable in raising a concern to her husband?  If her own lifestyle depended on her husband's professional reputation, would she admit that she was dissatisfied with the outcome?  How would the surgeon/husband balance his professional appraisal of the cosmetic result against his personal satisfaction with his partner's appearance?

One surgeon commented that there is a ethical prohibition against physicians establishing intimate relationships with their patients, and wondered how that principle should be applied in this case.  The intertwining of professional and personal relationships can be messy.

During the discussions, almost everyone commented that they had, at one time or another, rendered some medical care to their family members: antibiotics for strep throat, sutures for a cut suffered while at the cabin, or various and sundry slings, splints and bandages.  And, most agreed that, in case of an emergency with absolutely no other suitable care available, they would operate on a loved one to save their life.  But this doesn't apply to a tummy tuck - the ultimate in elective, cosmetic surgery.

Some other comments:

How would Dr. Di Saia obtain full, informed and free consent to blog/tell the world about his wife's surgery?  

Was there any commercial incentive to perform this surgery, and then tell the story (i.e. "I'm so confident of my skills that I operated on my own wife!")?

Did the facility where the surgery was performed have any rules about this situation?  How did the rest of the surgical team feel about this? 

What do you think?  Are we over-reacting to this story?

25 comments:

  1. It is not surprising that after the fact Dr. Di Saia says he did the right thing - this is almost always the case when the action was questionable to begin with. (I suspect it is a coping mechanism; does the police officer who shoots an unarmed teenager live forever in guilt or do they convince themselves that given the circumstances it was the right thing to do?)

    That said, I think it is telling that his closing remark is:
    "I would be dishonest not to admit that it was a bit more “wear and tear” on me than the average case. Keeping the family surgery to a minimum is my recommendation for those who may follow."

    As a number cruncher, I can tell you that "keeping to a minimum" means aiming for a target of zero, otherwise it quickly becomes commonplace.

    It is worth noting that for most circumstances 5 is a close approximation of infinite; i.e. the difference between the 5th and 6th case is very little in contrast to the difference between 1st and 2nd and 3rd and 4th cases.
    There is also the proverb that if something happens once, do not worry it won't happen again. But if it happens twice, it will surely happen a third time.

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  2. What are his other options? As an expert in the field, show would his wife ask for a referral? If the surgeon he refers her to has a less than perfect outcome, would blame still fall back on him and ultimately sour their relationship? Would any negative result done by anybody still reflect badly on him? After all, he referred her, or the obvious questions come up; "why didn't you get your husband to do it? Isn't he good enough for you? Don't you trust him?

    If he does the surgery himself, he controls the situation. And if he believes himself to be amongst the best in the practice, he might feel bad about sending his wife to someone whom he believes won't do as good a job...It might be better to live with your own mistakes and successes than those you referred your wife to...

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  3. I don't know what to say about this but I've heard that if things go wrong the doctors is under a certain pressure and if the patient is his wife or sister or some relative the pressure is bigger.
    I'm lucky that my husband is not a surgeon so when I went to have tummy tuck in Toronto I chose this clinic: http://www.edelsteincosmetic.com/ because I saw hundreds of before and after pictures, a prove that they have many satisfied patients.
    Now that I'm thinking the husband should have suggested hie wife to go to a friend, or the most skilled surgeon he knew and have the procedure there, but off course with some costs....At his clinic I'm sure the surgery was for free, so this might be a reason why he performed the procedure of his wife, to save some money:)

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