12 Dec 2011

Safety and Private Office Surgery

Private offices have some distinct advantages over hospitals for cosmetic surgery:

1. The medical and nursing staff are specialized in cosmetic surgery
2. Special equipment unaffordable to hospitals may be available
3. Exposure to ‘hospital-grade’ bacteria is minimized
4. Privacy far exceeds what is available in hospital
5. Customer service can be embraced in a private facility. There are too many competing needs in a hospital, and patient care can be overlooked
6. Individual responsibility of the Medical Director, Surgeon and Staff ensure greater attention to every detail of a private office

A possible disadvantage of private office surgery is the isolation of surgeons and staff from the education, over-sight and resources available in hospital.
This can be overcome to some degree by choosing a cosmetic surgeon who also maintains a hospital-based practice. Patients who choose a surgeon with a hospital practice may enjoy the following advantages:

1. Larger procedures will be performed in hospital where they belong. Some patients benefit from more complex procedures that require longer OR times and over-night stay and a surgeon without hospital privileges may try to do this in a private facility and thus expose the patient to increased risks.
2. A patient who develops complications can be readily transferred to hospital to remain under the care of their original surgeon. A surgeon without privileges may delay transfer to another doctor for fear of criticism or investigation.
3. Surgeons who work in hospitals are exposed to education in current best practices.
4. Perhaps most importantly, hospitals privileges provide an important form of accreditation for your surgeon, as there is careful scrutiny of a surgeon’s hospital practice by independent doctors, nurses and administrators in the hospital.

The Out of Hospitals Premises Inspection Program (OHPIP) was established by the College of Physicians and Surgeon of Ontario to improve the quality of care in private offices. It will undoubtedly succeed in improving some practices, and may succeed in closing unsafe facilities. Unfortunately, this program may also create a false sense of security for patients, as patients may assume that OHPIP certification is a sufficient endorsement with which to choose a surgical practice. The OHPIP inspection process is very limited, and includes observation of as little as one operation on a single day of surgery. It provides only a small glimpse into a surgical practice, and in no way can substitute for the evidence of 5+ years training and testing that Royal College certification provides. The OHPIP also does not require Royal College certification for a doctor to work in private premises. Furthermore, the OHPIP does not require surgeons who work in private premises to maintain hospital privileges.

What does this mean for you, the prospective cosmetic surgery patient? Office surgery is safer than ever, but there are still traps out there. Ask if the premises have passed the OHPIP inspection, but also be certain of your surgeon’s Royal College specialty training, determine if your surgeon has hospital privileges, and use your consultation wisely as an important learning experience as you narrow your list of possible surgeons.

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Michael Kreidstein, MD, MSc, FRCS(C)

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