rcdavis Posted May 15, 2013 Share Posted May 15, 2013 okay, so you are working in an ED when a well regionally well regarded plastic surgeon brings his wife in for evaluation of intractable vomiting. During hx, it comes out that she has just had a third liposuction. By her husband. (who also has done her nose, breasts, fanny lift, face lift, and more). He had is own surgical suite, where all these procedures are being done. Pt work up is wnl, and she responds to fluids and Zofran. Sent home with Zofran. Question is... well, is there a question? local surgeon operating on his family with their consent. SBME frowns on this. Only reason you know about this is because of your history taken from the patient. what if any action would you take? Link to comment Share on other sites More sharing options...
SocialMedicine Posted May 15, 2013 Share Posted May 15, 2013 on the surface it sounds like a sad situation. but for all we know they are both quite happy and enjoy the benefits of surgical enhancement. he could be supportive, non judgmental, and doing the procedure because "he is the best in town". Even if I was evaluating vomitus ... just given that history I would probe a bit about mood and say something like "we always ask this question is there any violence or other issues at home?". If she seemed happy and safe I would drop it. The surgeon is not being professional doing that and I would not be surprised if he could face censure. I would probably not document I was aware of his involvement in her care ... the law can be strange sometimes and who knows if there is a duty to report things like that. Link to comment Share on other sites More sharing options...
primadonna22274 Posted May 15, 2013 Share Posted May 15, 2013 Oh goodness: I would document the heck out of it and I would speak (privately) with my medical director and see what his/her take on it was. It would be tempting to report but we all know that could bite us in the ***. What if she throws a PE? Assuming his med mal coverage would be nixed if insurer knew he was treating his own WIFE. What if the marriage goes south and she then decides to sue for damages? What if she ends up with a devastating infection or nerve injury related to plastic surgery performed by her HUSBAND?! Ai-yi-yi. I don't think it's an ethical dilemma at all. I see the whole situation as a big fat ethical DON'T. :) but then did you really have to ask what Prima thinks? :) God bless you Davis. Glad this one didn't land in my lap :) Link to comment Share on other sites More sharing options...
SocialMedicine Posted May 15, 2013 Share Posted May 15, 2013 why are you suggesting he document the heck out of it ? and what do you mean what if she throws a PE ? Is there any law that state a relative cannot provide a persons medical care ? It certainly should be frowned upon, especially in situations like this, but I am not aware it is illegal. Good points raised. Cant say I have come across an issue like that before. Link to comment Share on other sites More sharing options...
Guest JMPA Posted May 15, 2013 Share Posted May 15, 2013 why are you suggesting he document the heck out of it ? and what do you mean what if she throws a PE ? Is there any law that state a relative cannot provide a persons medical care ? It certainly should be frowned upon, especially in situations like this, but I am not aware it is illegal. Good points raised. Cant say I have come across an issue like that before. it would be a hippa violation to disclose this patients infromation. The burden lies on the surgeon. Link to comment Share on other sites More sharing options...
primadonna22274 Posted May 15, 2013 Share Posted May 15, 2013 why are you suggesting he document the heck out of it ? and what do you mean what if she throws a PE ? Is there any law that state a relative cannot provide a persons medical care ? It certainly should be frowned upon, especially in situations like this, but I am not aware it is illegal. Good points raised. Cant say I have come across an issue like that before. We're not talking about whether it's legal. The question is whether it's ETHICAL. I maintain that this situation in which a surgeon repeatedly performs major surgeries on his WIFE is highly questionable from an ethical standpoint and is just a very, very bad idea. Some states are working on legislation to specifically prohibit medical practitioners from treating their own family members except in emergency circumstances. No way in hell you're gonna convince me that lipo, a tummy tuck and boob job are emergency surgeries. Then let's consider the obvious taboo of prescribing controlled substances for a family member--are we to presume the good doctor let his sweetheart suffer postop without any narcotics for pain? Hmmm. Here's some food for thought: http://m.amednews.com/apps/pbcs.dll/article?aid=/20120206/profession/302069939&template=mobile_art Link to comment Share on other sites More sharing options...
primadonna22274 Posted May 15, 2013 Share Posted May 15, 2013 it would be a hippa violation to disclose this patients infromation. The burden lies on the surgeon. Methinks there is a gray zone between the HIPAA obligations and obligation to protect the patient's interest. At the very least I would ask my SP to, ahem, review this particular chart. Link to comment Share on other sites More sharing options...
primadonna22274 Posted May 15, 2013 Share Posted May 15, 2013 Here's another one: http://blogs.tiu.edu/bioethics/2012/04/28/reflections-from-the-front-treating-family-members/ Link to comment Share on other sites More sharing options...
rcdavis Posted May 15, 2013 Author Share Posted May 15, 2013 Lisa, The department director and I discussed this situation, and what if any action we should take. South Carolina, as you point out, prohibits treating family members for any but infrequent minor illnesses, and prohibits prescribing ANY controlled or scheduled medicines, recognizing that " it is unlikely a that an independent and objective determination can be made (by TGE doctor) in the case of a family member." The surgeon does bring the wife to local clinics for non-surgical issues (and there is a suspicion of poly pharmacy by the wive). I cannot find a specific law prohibiting the performance if surgery on a family member, though it does seem to stretch the ethics of surgical canons. In his defense, he IS Better than most, and may be rationalizing that justifies his actions. There is, however, the APPEARANCE of these actions being inappropriate. The surgeon uses a CRNA for anesthesia, We decided to not pursue it further. Ethical considerations are not legal considerations, and to whom would we report? The state? The plastic surgery board? For us to do so, we reasoned, we would have to believe that the patient was receiving care which jeapordized the patient's well being. Which we do not. We don't " like" what he is doing, but do not see any action that we should take because we don't like it... Heaven help the surgeon if she does die on the table, or throws a big clot and dies in the post op period.. Can you imagine the insurance issues if he has her mega-insured? So, my post ( having shown my hand) is to express the frustration of being complacent about a clinician acting unethically... And finding that here really isn't any action that can be taken to review a doctor's actions outside of the scope of hospital peer review. And questioning myself about it. I just read you pubmed reference, and TGE Harvard study of self reporting in a questionnaire sent to 1500 members of the amer. assoc. plastic surgeons, of which 450-ish responded, of which 80+ percent stated that the Would and had operated on family members. Seems like this may be a standard after all.... Link to comment Share on other sites More sharing options...
primadonna22274 Posted May 15, 2013 Share Posted May 15, 2013 I read that Harvard study too RC--and my thought was this was an anonymous survey of plastic surgeons. What kinds of personalities become plastic surgeons? (Rhetorical question I know.) of course they thought they were overwhelmingly the most qualified. Goes with the personality type. But seriously, don't these guys have friends? Nobody learns in a vacuum. They have colleagues. They know who's the best and should be comfortable referring to their colleagues. Ridiculous. (But yes, I fully understand the frustration you are facing here and the incongruent reality that you cannot change it--but I think it's good for all of us to ponder WHY these kinds of not illegal but ethically questionable situations are bothersome to us. Thanks for the pleasant diversion from step 1 studying!) Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 16, 2013 Moderator Share Posted May 16, 2013 one sentence.... report it to the chain of command and document that this occurred to CYA We are "dependent practitioners" and the benefits are exceedingly small, but this might just be one where we get to tell our SP and walk away.... Link to comment Share on other sites More sharing options...
primadonna22274 Posted May 16, 2013 Share Posted May 16, 2013 My thoughts too Ventana. Link to comment Share on other sites More sharing options...
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