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

Seattle Plastic Surgeon tells it like it is for obese women seeking breast surgery.

A recent article published in The Journal of Plastic & Reconstructive Surgery caught my attention.  This article looked at breast surgery outcomes in  7982 patients (that would be almost 16,ooo breasts!!!!) and divided the patients in obese and non-obese.  Their results were not surprising to me but they may be surprising to you.  The obese patients had a nearly 12 fold increase in postoperative complications when compared to non-obese patients. 

Breast reduction is the most common breast operation performed in obese women.  That operation has a nearly 9 fold increase in postoperative complication in obese women compared to the non-obese. 

This is not news for those of us who do a lot of reductions.  The sort of problems that obese women tend to have are fluid  collections (seroma), bleeding, delayed healing and infection.  These complications sometimes require a trip back to the operating room and they always require many, many postoperative visits.  Despite a rocky postoperative recovery, many obese women are still glad they had a reduction after everything is healed up. 

So what’s the big deal?  All’s well that ends well, right?    Let’s look at this from an few different points of view.  If insurance pays for the reduction, they don’t want to see more bills for a hospital readmission to stop postoperative bleeding or a bajillion office visit bills to treat an infected wound.   And insurance companies are looking more closely at surgical outcomes and costs and using this information to rate surgeons.  

If the reduction is private pay, the surgeon is unlikley to bill for increased postoperative visits which can run into 10 – 20 additional visits during recovery.  This can get very time consuming and expensive.  

And for the patient it is no picnic having to pack an area along the suture line that either became infected or fell apart.  Post operative complications are just a total bummer all around, especially when the surgery is totally elective. 

And here another issue.  Let’s say an obese lady has 5 pounds of breast tissue (which is 99% fat) removed and her weight drifts back up to her preoperative weight which almost always happens.  This means that she has gained 5 pounds of fat.  If that fat is just external fat, say on her hips, it’s not a big health issue but if it is intraabdominal fat a.k.a. belly fat a.k.a. visceral fat, it is a huge health risk.  Her breasts may no longer be killing her neck and back but her belly fat may literally be killing her.

So what am I really trying to say here.  Obese patients need to understand that breast reduction has a high rate of complications and that a reduction may actually make them less healthy if they gain back their weight as belly fat. 

So this is a real sticky wicket.  Obese reduction patients are usually helped with back and neck pain with a breast reduction but weight loss would also help those back and neck pain issues.  Non surgical weight loss has no surgical risk and is accompanied by a host of improvements in a patients health.  Think high blood pressure, type 2 diabetes, arthritis, high cholesterol, etc.

So if you are obese and want a breast reduction from me, you will get a little weight loss lecture from me and may get turned down for surgery until you are able to shape up and slim down a little.    You may be willing to accept a high risk for a postoperative complication but I may not be. 

Thanks for reading.  And if you have a quick, easy way to lose weight, please let me know.  I’m all ears. 

 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

I was cleaning my desk this morning (that’s a few blog entries in itself) and stumbled upon an article I has saved from a 2006 issue of the Canadia Journal of Plastic Surgery. This article compared the sterility and cost of “sterile wound dressings” and more common absorbtive items such as panty lines, sanitary napkins and disposable (duh) diapers.

Not suprising was the cost difference with the common items being a fraction of the cost of “sterile wound dressings”. For example, one month supply of panty liners cost $2.43 vs. $16.50 for one month supply of sterile dressings. The surprising finding was that the common items were as sterile as the “sterile dressings”. A small percentage of all items tested grew various common bacteria when cultured.

I have been recommending panty lines or sanitary napkins as dressing to my patients ever since I first read this paper. They look at me kind of funny and are always a little shocked when I refer to this article. Maybe this is why Canadian health care is so much less costly that ours???