Since we last wrote, there has been a firestorm of political activity in Sacramento regarding cosmetic surgery. The Bill AB2968, otherwise known as the ‘Donda West Bill’, was vetoed recently by the Governor reportedly because it did not represent high enough priority legislation given the backlog he was dealing with.
The Bill was proposed after the untimely death last year of Dr. Donda West, mother of Kanye West, one day following a cosmetic surgical procedure. She was found to have preexisting high blood pressure and heart disease, though the contribution of these to her death is unknown. These unfortunate events prompted California legislators to try to find an answer to prevent this kind of tragedy in the future. The resulting bill that was overwhelmingly supported by lawmakers would have required all patients seeking cosmetic surgery to have a physical exam and medical clearance for surgery.
We are fully in support of doing whatever is possible to ensure the safety of patients. That is our oath, to first do no harm. That burden is especially high for elective cosmetic surgery where most of the patients we take care of do not ‘need’ our services. This takes nothing away from the fact that cosmetic surgery can have huge far-ranging benefits. Still, we need to take a zero tolerance policy for surgical complications if we are to do our very best for the patients in our care.
The problem is that legislators generally make bad decision makers when it comes to medicine. More and more medical practice guidelines today are based on evidence from clinical trials. The American Society of Anesthesiologists (ASA) has appointed a task force just for this purpose.
Their last report found surprisingly little evidence that routine preoperative testing does anyone any good. A good history and physical is a good idea for every surgical patient and this should be done by the surgeon and anesthesiologist anyway. For more invasive procedures and higher risk patients, the exam should be done before the day of surgery so that their general health can be optimized ahead of time. Tests, if done, should be targeted to the patient individually.
A routine across-the-board medical clearance is not supported by the findings of the ASA. It sounds pretty harmless, right? Forget about the added time and costs to the system. When we do tests without thinking and without looking for something specific, we often act on findings without thinking too, and this can lead us down the road to more unjustified tests and procedures that may do more harm than good.No comments