Saturday, October 25, 2008

Plastic Surgery 101 takes on the big apple + Alloderm and breast surgery

Sorry for the gap in posts! It's been almost 2 weeks and I just haven't been "feeling it" for updating the blog.

Presently I'm in lower Manhattan at a symposium on the use of Alloderm in breast reconstruction surgery. Alloderm is produced from human skin where the proteins which would ordinarily cause you to reject the tissue graft have been removed. What's left is a "living prosthetic" that can be used to reinforce the body's tissues.

Alloderm has gained popularity in breast reconstruction as it allows us to bridge the concepts of traditional reconstruction with techniques we use in breast augmentation. I was kind of an early adopter of using Alloderm over 3 years ago in response to some of the limitations of the techniques I was taught during my training. At this point, Alloderm (or related products) are used not infrequently by many surgeons.

I'd like to briefly mention two restaurants here in NYC that my wife and I had wonderful dinners at

Bouley - where I'd strongly recommend the 5 course Chef's tasting menu. Magnifique!

The Tribeca Grill - Great steak! Very affordable for a nice restaurant in NYC.


Sunday, October 12, 2008

Doctor Shopping - Finding the doctor you need

So I'm sitting in Starbucks near my house with my kids when this group of joggers comes in for a post-run sit around. They immediately get off into some discussion about orthopedic sports medicine and their various injuries, complete with editorials about how their doctor is wonderful, how they were "misdiagnosed", and wondering how different specialists gave them contradictory advice or opinions.

I kind of felt sorry for them. Picking a doctor is tricky, even for doctors. As I work doing surgery at half a dozen hospitals, I have a general idea of the reputation of different surgeons' abilities and personalities in several parts of town.

When I was a resident working with dozens of different attending surgeons, I definitely felt like I could get a feel for who was outstanding or poor. However, when my wife had musculoskeletal back pain, I was left to kind of "guess" at the competence of a neurologist (whom I really respect BTW) who was treating my wife. Some of their field is just too removed from my scope of practice to be fluent in.

Eavesdropping on the joggers reminded me of a letter in the New York Times health section on an article about picking doctors, "You Can Find Dr. Right, With Some Effort". There was a really insightful letter from an ER doctor that stood out to me which I think is worth republishing:

As an emergency physician for 32 years, here is how I would and would not go about finding a personal physician:

1. Chronic medical care: choose primarily based on personality, secondarily on skills. All doctors are smart, in the top 1% of the population, which makes them abnormal to start with. For ongoing care, you need the minority with great personalities. For skills, just make sure they are ABMS ( board-certified.

2. Surgical care: Choose primarily based on skills. Ignore their personality. Here you want the best technician with the best judgment, not Marcus Welby. It will usually be a short-term relationship for a problem that requires invading your body and significant medical judgment issues. It’s not worth trying to find someone who combines both skill and personality; if you get both, it’s a bonus.

3. Acute care: You’re at your most vulnerable and have no time to research. Your regular doctor rarely can see you for acute care: you end up in an urgent care center or ER. Choose based on skill and judgment only, which must necessarily be based on quickly accessible reputation and qualifications.

OK, how do you find someone based on skill/judgment, or based on personality?

1. Personality: Here’s the only place to use friends, neighbors, and trusted acquaintances. These people are qualified to judge this aspect of a physician. This is totally unrelated to a physician’s skill or competence, but this is important for chronic medical care.

2. Skills/judgment: Never use the recommendations of non-medical personnel. They have no basis on which to judge. Avoid online evaluations: they are statistically prejudiced and don’t account for individual practice variances. Instead, use trusted medical acquaintances such as physicians or nurses to make recommendations. They have both the personal experience and medical sophistication to make such recommendations.

I'd agree in general with the insights of this doctor, especially with surgeons. For instance, there were some grade-A sociopaths I knew/know in various specialties whom are outrageously gifted surgeons. I'd be happy to let them do my liver resection, organ transplant, aneurysm clipping, etc... as long as I did not have to speak to them ever again.


Wednesday, October 01, 2008

BOTOX on the brain - You know you're a plastic surgeon when....

You know you're a plastic surgeon when you watching the press conference tonite by the US Senate leadership about passing the $700 billion USD bailout bill and not being able to take your eye's off of Sen Mitch McConnell's BOTOX'd brow!

Sen. Mitch McConnell (R-KY)

Other pols who stand out for BOTOX

Hillary Clinton (D-NY)

Nancy Pelosi (D-CA)

Nancy Pelosi's Cat :)