When to Operate on Colleagues? An Unspoken Ethical Dilemma among Aesthetic Plastic Surgeons.

Abstract

As the demand for aesthetic surgery increases, one must consider the distinct ethical challenges that surgeons face in performing such interventions. Furthermore, the practice of plastic surgeons operating on their own relatives may raise notable concerns, including breach of confidentiality, objective decision-making, patient autonomy, and liability. According to the American Medical Association’s Code of Medical Ethics, “physicians generally should not treat themselves or members of their immediate families” except in cases of emergency, due to the potential “influence [on] his or her professional medical judgment and interference with the care being delivered.”1 While the American Medical Association’s Code of Ethics advises against operating on family, there are no clear guidelines on whether operating on colleagues and subordinates (e.g., medical students and residents) is justifiable. The purpose of this article is to discuss considerations for performing aesthetic procedures on colleagues. Several studies have affirmed that aesthetic surgeons are comfortable with operating on their own families. In fact, Slavin et al. conducted a survey on 465 aesthetic surgeons and determined that 88 percent reported they would operate on a spouse or relative.2 Although surgeons achieved low complication rates and favorable aesthetic results, there are additional considerations that may confound the mere decision to operate. A key concern involves the risk of compromising professional objectivity, which can be detrimental to overall patient care. Another concern lies in the mismanagement of the protocol of informed consent, which may preclude discussion of potential complications and poor clinical outcomes. The situation may, in fact, grow more complex when surgeons consider operating on their colleagues, such as fellow attendings, residents, or medical students. In addition to the aforementioned issues, surgeons may face greater scrutiny when operating on other medical professionals.3 Furthermore, given the professional exposure to surgeons’ skills, medical professionals may be more cognizant and critical of aesthetic and functional results. The Hippocratic Oath states, “To reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required.”4 However, appreciating a teacher or offering assistance does not equate to providing aesthetic surgical care to colleagues.5 This ultimately leaves the discussion open to debate in today’s medical world. We contend that the decision to operate on one’s colleagues is a personal one but requires multiple considerations (Table 1). Furthermore, given our positive experience when treating colleagues and trainees, we provide a series of recommendations that can help the plastic surgeon navigate the decision to operate on a colleague or trainee (Table 1). In relaying this information, we aim to spark an open discussion on this topic to resolve this dilemma. Table 1. - Recommendations for Determining How to Approach Operating on a Medical Colleague Dos Do Nots Intervene if the colleague-physician relationship is considered to be only professional, meaning that it conforms to the expected technical and ethical standards of the medical profession (taking into consideration the principles of informed consent, patient autonomy, and objectivity).Treat the colleague like a lay patient. Intervene if the colleague-physician relationship is considered to be more than professional. Treat the colleague in a preferential manner. Establish a professional boundary and discuss treatment management, concerns, and ethical and financial issues early. Feel pressured to accept every colleague’s request for treatment. Refer the colleague to someone else if you decline to provide treatment.Connect medical professionals with opportunities to gain second opinions for the procedure. Leave the patient without a referral if you decline to provide treatment. Provide medical professionals with the equivalent materials/instruction for the operation, preoperative and postoperative course, and so on. Perform the procedure of informed consent as you would do for any other patient and respect the patient’s final decision regarding the procedure. Carry out an objective history and physical examination in order to ensure the best care possible for the patient. Follow the well-established scheduled clinical visit time course (from preoperative to postoperative timepoints), as you would do for any other patient. In conclusion, performing procedures on colleagues and trainees presents a unique set of challenges for plastic surgeons. In considering the important issues of patient confidentiality, autonomy, objectivity, and liability, we propose a series of recommendations for aesthetic surgeons to guide decisions on how to pursue operating on colleagues. Future studies should elucidate the prevalence of such arrangements and assess the clinical outcomes and satisfaction conferred by such procedures. DISCLOSURE The authors have no commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this article. No funding was received for this work.