Seattle Plastic Surgeon loves David Sedaris’ account of his experiences with Socialized Medicine in the heart of Old Europe.

American Humorist David Sedaris

This week’s New Yorker Magazine has a hilarious piece by humorist David Sedaris.  Mr. Sedaris now lives in Paris and I squeal with delight every time I read one of his essays on his French experiences.   Here is his take on French medicine.  This is just an excerpt and you  should really pick up the April 2, 2012 New Yorker to read the entire essay. 

I was lying in bed and found a lump on my right side, just below my rib cage.  It was like a devilled egg tucked beneath my skin.  Cancer, I thought.  A phone call and twenty minutes later, I was stretched out on the examining table with my shirt raised. 

 ”Oh, that’s nothing,” Dr. Medioni said.  “A little fatty tumor.  Dogs get them all the time.”

I thought of other things dogs have that I don’t want:  Dewclaws, for example.  Hookworms.  “Can I have it removed?”

“I guess you could , but why would you want to?”

He made me feel vain and frivolous for even thinking about it.  “Your right,” I told him.  “I’ll just pull my bathing suit up a little higher.”

When I asked him if the tumor would get any bigger, the doctor gave it a little squeeze.  “Bigger?  Sure, probably.”

“Will it get a lot bigger?”

“No.”

“Why not?” I asked.

And he said, sounding suddenly weary, “I don’t know.  Why don’t trees touch the sky?”

This conversation would never happen in my office.  The conversation would go something like this.

Me:  It’s probably a lipoma, a fatty tumor.  They are very common.  (I’d leave the dog reference out).  It could be something else but I am almost certain it’s a lipoma.

David:  Can I have it removed?

Me:  Sure.  I would send it to pathology to make sure it wasn’t something more serious and that would take care of it.  These lipomas can get pretty big.  I could remove it next week in the office.  I would inject some local anesthetic and remove it though a small incision.  You could drive yourself home.  It will leave a scar but the scar won’t be as noticable as the lipoma.

David:  Will my insurance pay for it?

Me:  Maybe, it depends on your insurance.  I’ll have you pay me, then I will send the information to your insurance company and they might reimburse you. 

David:  How much will it cost?

Me:  I’ll have my patient care coordinator give you a price quote and get you on my schedule.  Make sure you don’t take any aspirin between now and next week. 

So here’s the difference:  I’m happy to take the lipoma out.  I like doing surgery and that’s how I pay my bills.  Also, I want to make sure it is a lipoma.  If it is something horrible like a fibro-fatty cancerous horrindoma and Mr. Sedaris has a delayed diagnosis because of me, he will sue me for a bazillion dollars.   I, like all American doctors, practice defensive medicine.   In America, defensive medicine is the standard of care.  Also, this conversation takes place between two Americans.  American patients  like to get things fixed and American doctors like to fix things.   Even minor things.  So there will be about $500 changing hands because of Mr. Sedaris’  lipoma, $250 for the use of the operating room and $250 for my time and skill.    In France, $50 changes hands because  Dr. Medioni is dismissive about Mr. Sedris’ lipoma and is not worried about being sued even with the 0.1% chance his clinical impression is wrong.  And  Mr. Sedaris lives with his lipoma and pulls his bathing suit up a little higher. 

This, folks, is why American Health care is so expensive.

Thanks for reading!  Dr. Lisa Lynn Sowder

Here’s some news I have been waiting for since 2004.  Woo, hoo! 

OH HAPPY DAY

This is from Plastic Surgery News online:

New Jersey repeals cosmetic tax

The Moon Walk, not everyone should try this.

Seattle Plastic Surgeon weighs in on the Dr. Conrad Murray verdict.

I remember clearly the day that Michael Jackson died.  I was operating at Seattle Surgery Center and the news went around the O.R. quickly as did speculation of his cause of death.  Drugs was at the top of my list.

As the story unfolded, we in medicine were blown away by the bizarre circumstances of Jackson’s death.  Propofol overdose.  What?  Propofol given by his private physician in his home.  You have got to be kidding.  How nuts is that???

This very sad story at least allows for some education of the public on the topic of Scope of Practice.   It is not a well known fact that there are no federal scope of practice laws and no state scope of practice laws in California, Washington (where I practice) or in most states.

What this means is that physicians with a medical license are not restricted as to what type of medicine they practice.  In the case of Dr. Murray, he was practicing anesthesia without training, experience or certification in anesthesia.  Yikes, huh?

The formally trained and board certified anesthesiologist with whom I work use Propofol all the time but they use it in an operating room with monitoring of the patient, control of the patients airway and with resuscitation equipment at hand.  Those essential ingredients were not available at Michael Jackson’s home.  Another thing lacking was Dr. Murray’s judgment.  It took him 20 minutes to call for help.

Something in plentiful supply was hubris.  Dr. Murray was in way, way over his head but did not recognize or admit his folly.    Hubris is also plentiful in ”cosmetic surgery”.  Over the past 20 years there has been a flood of non plastic surgeons physicians entering the field of “cosmetic surgery” through the back door.  These physicians have formal residency training in fields from radiology to ophthalmology to obstetrics/gynecology to emergency room medicine.  There are no laws that prevent these physicians from calling themselves cosmetic surgeons.

One reason for this flood is financial.   Twenty years ago there was a sea change in medical reimbursement and physicains have been squeezed financially by third party payers to the point where many physicains honestly can barely make it.   The “easy money” of “cosmetic surgery” is tempting.   Take a weekend course on liposuction or breast augmentation or buy this fancy, dancy laser!   But honestly, there is absolutely nothing easy about cosmetic surgery.  Many of these physicians (and their cosmetic patients) learn this the hard way.

Also, more and more surgery is being on in the private office setting.  One does not need hospital operating room privleges to operate in their own private O.R.  And even most state and federal regulations of outpatient operating rooms do not have requirements about the training and board certification of the physicans using the operating room.  The regulators are more concerned with the facility that the physicians who use it!  And in some states, an operating room can “fly under the radar” of all regulation because they use only local anesthesia.  And that topic is worth a whole blog of its own.

And, it gets even darker.  There are also at least a dozen “boards” and organizations that a physicain can join to give them credibility with potential patients.  Confusing?  Oh yeah.  On purpose?  Oh yeah.

So if you are looking for a plastic surgeon for a cosmetic procedure, don’t settle for a “cosmetic surgeon”.  If that surgeon were fully trained and boarded in plastic surgery, believe me, they would call themselves a plastic surgeon.   You can check to see if your” cosmetic surgeon” is a board certified plastic surgeon here.

 I know that I don’t know how practice radiology, opthalmology or ob/gyn or emergency medicine and I don’t try.  And I certainly know I don’t know how to Moon Walk.

Thanks for reading.  R.I.P. Michael.  Dr. Lisa Lynn Sowder

Lip enhancement can be subtle. It doesn’t have to be bizarre.

Seattle Plastic Surgeon is thrilled to share news of the FDA approval of Restylane for lip enhancement and/or augmentation.  It’s about time!

Earlier this month the FDA approved the hyaluronic acid filler Restylane for lip enhancement.  This puts what is sort of like the Good Housekeeping Seal of Approval on a procedure that I have been doing for several years.

Lip enhancement/augmentation gets a really bad rap in the popular media because it is so overdone in many high profile individuals.  But really, it doesn’t have to be that way.  No Donald Duck lips are necessary.  The enhancement can be really lovely and subtle like the lady in the photo.  She had just 1 cc of filler placed in her lips with most of it going to her lower lip.  Nice, huh?   This is yet another thing I love about practicing plastic surgery in Seattle.  Patients want lovely and subtle, not LOOK AT ME.

Most lip enhancement/augmentation patients can go about their usual business and social lives the day after injection.  The bruising and swelling is usually pretty minimal if the patient is careful not to take any medication that can encourage bruising (aspirin and ibuprofen are the most common offenders) for a week before injection and is vigilant about icing the area for a few hours after injection. 

So from now on when you hear lip ehancement/augmentation/enlargement etc., don’t think bizarre Donald Duck lips ala the First Wives Club.  Think lovely and subtle and now FDA approved!

Thanks for reading.  Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder

Hip Seattle Plastic Surgeon does not offer Groupon for services.  Shocking, huh?

Groupon for medical services is considered fee splitting and it's illegal.

I know, I know – Groupon is just the best thing since sliced bread but you won’t be finding it in my office, at least not until the laws change.

Yeah, it would be kinda fun to get a bajillion people to give Botox a try so they can see how fabulous it is and maybe turn them into life long Botox patients but the downside for me is that it is illegal.  You see, when a person buys a Groupon, the Groupon folks take a cut and that cut is called fee splitting and for medical services, it’s illegal.

The law does not look at this any differently than me paying another doctor for sending patients my way.  That sort of bad doctor behavior is taken very, very seriously.

So Botox Groupons just isn’t going to be something I offer.  Although, I would likely get some much needed rest behind bars, I think my family and my practice might miss me.

Thanks for reading!  Dr. Lisa Lynn Sowder

Yesterday the Food and Drug Adminstration issues new rules on the labeling of sun protection products.  These rules have been many years in the making with many stakeholders involved.  This news  is welcome to me and my patients as is any regulation that promotes accurate information and truth in advertising.

Only sun protection products that protect against a broad spectrum of ultra- violet rays can claim protection against skin cancer and skin aging.  No product can call itself a sunblock.  Strong sunscreen, yes but sunblock, no.  The SPF system will be redone to give patients a more accurate way to measure protection.  No longer will we see promotions of SPF 100 which really does not exist (SPF 100 means you can spend 1500 minutes or 25 hours in the sun without getting much more than a little “color”).    Also, sweatproof and waterproof labels will disappear.

So expect some better information on sun protection products’ packaging and remember:  It only works if you use it.

Here’s wishing you a great and tan free summer.  Thanks for reading.  Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder

What do you mean it's not FDA approved?

Today I had this question from a prospective patient.   Off-label use means exactly what it says – something is being used off label.   The label in off-label is the label or insert included in a medication or device that describes the product and its FDA approved use(s).  It is not at all unusual for medications or devices to be used in a situation that is not FDA approved. 

Here are a couple of examples.  Retin-A was initially approved as a treatment for acne.  Retin-A was also found to reverse some signs of skin aging and it was used for years as an anti-aging cream until the FDA finally approved Retin-A for that particular use.  Botox is another example.  It is approved to treat wrinkles between the eyebrows (the glabellar wrinkles) but it is also used for other facial wrinkles, crowsfeet for example.   HA fillers such as Restylane, Juvederm, Prevelle and others are approved for specific areas of facial creases like the nasolabial fold that runs from the side of the nose to the mouth.  But the HA fillers are also used for other areas that need some volume, for example the tear trough which the groove under the lower eyelid that can make some people look sad and/or tired. 

Off-label just means that the FDA has not approved a particular drug, substance or device for a certain area, for a certain indication, in a certain dose or for a certain population group.  It does not mean that the physician using something off-label is working on his or her Frankenstein monster in the back room.  And off-label use is perfectly legal.  The FDA cannot dictate how doctors practice medicine.  The FDA does forbid the manufacturers of drugs and devices from advertising their products for off-label use or promoting such use to physicians.

Soooooo….fear not and trust me. I’m a doctor.