A ^Retired Plastic Surgeon's Notebook

Michael Jackson, Conrad Murray, the Moon Walk and Scope of Practice

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 physicians 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


Category: General Health, Government and Politics, Patient Beware, Patient Safety, Plastic Surgery | Tags: , , , , ,

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