Starting the PS Journey and thoughts on going outside the US

Diana indicated she had concerns and fears about PS in Mexico...

I listed items that I have seen many times over in my practice that are of concern to patients.  I posted no "horror stories" (some from these very boards) and indicated no ill will towards any doctor.  Specifically said "I intend no criticisms toward anybody or any program."

I'm glad to hear I was wrong about the level of care offered at Dr. Sauceda's clinic. Didn't know all those services were avaialble. My ignorance, and thanks for the correct information Jessica.

That's what the boards are for, and it's what Diana's question was all about.  I haven't been on here (and other educational forums)  since 2003 "bashing" anybody and  I am certainly not "worrying about losing patients." 

That being said Tony, you have some misconceptions about residency programs that maybe I can help with:

Residents do not "practice" on patients.  They are in their final year of training (some are in their 5th to 7th year after med school), and will be on their own in less than a year. They are supervised by an attending surgeon and at my program (and many others) the attending surgeon performs/confirms the markings and are physically present for most of the case. I am available 100% for aftercare if the patient asks...otherwise it's done at the med school.

Well, we can pick nits all day long, and everybody can get all  ...so how about we call it quits and perhaps agree that if you are considering medical tourism you might want to:

1. Investigate and arrange for your medical aftercare options at home

2. Check your insurance plan to see if you have coverage while away, as they vary widely

3. Do the numbers on your implant warranties. (Well, not you Tony.)

4. Learn about the options and pricing available at residency programs

5. Get with your family doc about appropriate blood clot prevention prior to travel.

6. Know the level of care available wherever you go, and compare this to stateside standards. 

Fair enough ?








 

OK Dr L

Let me see if you can help me understand a little more about a "residency program." ?  Even if this 7th year student is the top in his / her class -- how many lower body lifts would this person have done by that time ?  Of those how many do you think would have been performed on someone like myself who had lost over two hundred pounds ? And since you say this person could be in their 7th year - how much of that time is classroom work ? research ? watching others perform surgery ? listening to other doctors like you ? and most important -- how MUCH time have they spent operating on WLS post op patients ?  I think we both know that these programs cover a WIDE area of Plastic Surgery however most people on this forum are post WLS patients or have been able to lose a large amount on their own so they would not be a normal patient to a lot of your students and most of their classwork .  Now that being said -- I do not know for sure so if you can tell me that most of this program you work with is different -- I would be glad to listen all about it .

And just for the record in exactly one week after my surgery -- my surgeon performed surgery on another patient who had also lost over two hundred pounds .

Now please tell me this and I will leave the subject alone . You said that since 2003 you have been on the forums and boards and like I first stated I have seen you give a lot of advice and have been very helpful to several people on here -- so thank you again for that .  However you have stated that you did not post about the horror stories from patients going out of the country which shows good character in my view but would you not say there has also been several problems and horror stories from patients using US doctors ?  And is it not also true that if a patient in the US has problems with their first plastic surgeon that they may have problems getting another surgeon to do follow up for them ?  So it is not just patients leaving the country but maybe traveling across the US as I would have had to to see you ? 

And YES I do agree with your steps one thru six.  And hope everyone does a lot of research before they have any surgery done.

Tony

PS  I would like to say in no way am I mad or upset -- just wanted everyone know that all doctors outside the country are not the same -- just like not all doctors in the US are the same !  And I hope you can agree with that statement ?

And I hope just because I do not agree with you on everything that you understand I do still appreciate what you have done for this forum and several of its patients.

Hi Tony

Thanks for the note. Happy to explain. 

Resident experience varies from program to program.  What counts is the experience of the staff (or faculty) who supervise.  In all cases, that doctor signs his name to the chart and is responsible for the result (or lack of result). 

By responsible, I mean legally, ethically, and personally.  

Say I let a resident choose a patient who is a poor candidate, or let them do the markings incorrectly, or try and remove too much or too little skin, or make any other error....who do you think will take the reponsibility?  We have a "captain of the ship" doctrine in surgery, and long after the resident has moved to Hollywood, it's going to just be the patient and I.  Personally, I want any patient associated with my name to be as good as they can be.  

We are trained with "graduated responsibility."  If a resident shows good judgement, I let him take the next step.  If he's uncertain, he watches me do it, then gets a try next time.  This is the way we learn, over thousands of cases in our training.  We start with putting in IVs and drawing blood.  It's not "go try that body lift over there and let me know how it goes....ooops !"

As for individual doctors qualifications, complications, and triumphs, and failures....well lets just leave those out of these discussions.  It's not helpful, and could be defamation of character if your facts arent straight.  There are good and bad docs everywhere just as you say 

My best instruments are Pitanguay forcepts and D'Assumpacao clamps.  Named after the famous Brazilian plastic surgeons who pioneered the techniques.

EVERY DOCTOR myself included,  has complications and unfavorable outcomes.  In fact, I'm sure I lead the way in post-WLS problems, because I do so many of these challenging cases.  Heck, one of my patients bled and needed a blood transfusion on national TV (Big Medicine) for all to see !

The wind will blow and the waves will crash if you're out there long enough....it's how you pilot the ship in that counts.

Which leads me to the most important point of my concerns with medical tourism.  Post-WLS plastics are big cases with a much higher than average incidence of problems.  Just read through these boards or go over to makemeheal.com.  Hundreds and hundreds of postop care questions, problems, and concerns:

http://messageboards.makemeheal.com/tummy-tuck/

Since 2007, over 9700 patients have read my post about swelling after surgery.  It was so popular the moderator made it  a permanent thread.  

http://messageboards.makemeheal.com/tummy-tuck/swell-hell-wh at-normal-t57927.html

That tells me that patients have a lot of concerns after surgery and want advice, support, and input from their doc. Not infrequently they need more.  I know my patients do.  They paid for it. 60% of my hours are spend in aftercare...way more than in surgery.  If I only saw my patients for 2 weeks my charge for patients and time spent with them would be much lower.

So arranging aftercare is something that takes special consideration when leaving the country.  The operating surgeon is obviously best qualified to do this, and yet I hear of too many patients who come home, have issues, and basically are stuck trying to find help. 

Hence my suggestions about planning for your aftercare ahead of time.

Sure would like to hear about how others have planned for their aftercare ....maybe you could ask that question in a separate post so others could learn and share ?

I'm kinda scared to right now

Best always

Thanks to all again for posting, especially DrL. I asked for all opinions, of both patients who have gone outside the country as well as those who stayed state side and of course I value the feedback from medical professionals. All opinions as well as experiences from patients who had had issues as well as Doctors who have handled problems has given me a better overview of both the up and downsides and allowed me to decide which course I will take. Thanks also for mentioning cosmetassure.com, that I will check out next.

Sincerely,

Diana