The Persistence of Repeated Errors

Abstract

A review of the past four annual plastic surgery claims review panels shows a disappointing persistence of the same complaints. It is always the hope of any risk manager that the distilled wisdom gained from past mistakes, intensely relevant to the daily practice of plastic surgeons and transmitted in an intelligible fashion, will have some effect on future behavior. Regrettably, in the case of aesthetic surgery claims, it has not. Despite numerous efforts to stimulate awareness among our colleagues, we are still plagued with persistently poor documentation and preoperative photographs, inadequate informed consents, and insufficient patient selection criteria. Following are some examples of what gives medical malpractice risk management people acute heartburn. Despite repeated warnings, a continual flow of totally avoidable claims directly linked to smoking still occurs. In at least three recent cases involving wide tissue undermining procedures, such as face lift and breast surgery, the patients were heavy smokers. As a result, they suffered sloughs or sloppy healing, causing poor scars. If a patient is a heavy smoker (a pack or more per day), the surgeon should consider declining or postponing surgery or should carefully document that the patient was warned of possible complications if he or she continued to smoke. If the surgery is to proceed after a “no smoking” period, we advise at least a 1-month postponement and a separate statement signed by the patient stating that he or she has not smoked for that period. One such case involved a 35-year-old patient who saw her aesthetic surgeon for breast reduction surgery. Her breast size at that time was 40EE, and this caused pain across her back and up her neck. The surgeon, who had advised the patient to stop smoking 1 month before surgery, performed a bilateral breast reduction without incident. Ten days later the …