STEP 1: Find a board certified doctor
You'll want to find a board certified doctor. However, do not assume that all doctors who claim to be "board certified" have the same training. Be sure that your doctor is certified by the American Board of Plastic Surgery (the ABPS). In Canada, you'll want to find a physician who is certified by the Royal College of Physicians and Surgeons of Canada.
Don't be fooled by other professional sounding boards. If a doctor is certified by the ABPS this means that they are certified in plastic surgery and have met the following requirements:
- they have earned a degree from an accredited medical school
- they have completed 3 years of general surgery
- they have completed 2-3 years of supervised residency in plastic surgery
- they have had at least 2 years of professional practice,
- they have passed rigorous written and oral exams (only about 70% of physicians who take the test pass it).
The ABPS is recognized and overseen by the American Board of Medical Specialties (ABMS) and sets high education and training standards.
By choosing a doctor that is ABPS certified you are not guaranteed to have no disappointments, complications or risks, but it is a good starting point. You can at least be assured that your doctor has the basic training and education required. To verify that your doctor is certified, you can go to http://www.abms.org or call ABMS at 1-800-776-2378 or 866-275-2267. You may also be able to find The Official ABMS Directory of Board Certified Medical Specialists at your local library. You will also want to look for a doctor who specializes the particular area of the body that you are having work on.
Your State Medical Board will also have information about board certification, disciplinary action, education and license verification. Find your State Medical Board.
You will also want to find out if your doctor has hospital privileges. Even if the procedure will not be performed at the hospital (and 53% of cosmetic surgeries are not), some feel it is important to know that your doctor is qualified and has the necessary training to be accepted. The ASAPS states that "it is important to find out if the doctor has operating privileges in an accredited hospital for the same procedure you would like to have performed. Before granting operating privileges, hospital review committees evaluate a surgeon's training and competency for specific procedures. If the doctor does not have hospital privileges to perform your procedure, look for another surgeon."
The American Medical Association (AMA) will provide biographical information on 4 doctors for $60.00. Your local library may also have The American Medical Directory (published by the AMA) which lists the affiliations of its members. Write: AMA, Department of Physician Data Services, Dept. P, 515 N. State St. Chicago, Illinois 60610.
The surgical facility is also important. An ASAPS news bulletin in February 2002 states:
"Published data show that accredited office-based facilities have a safety record comparable to that of hospital ambulatory surgery settings. Ambulatory or office-based facilities should be accredited by a nationally or state-recognized accrediting agency, or be state licensed or Medicare certified."
To research a hospital setting, go to http://www.ahd.com. To research a surgical center, first ask the center who they are accredited by. They should be accredited by one of three main organizations:
1. The American Association for Accreditation of Ambulatory Surgery. You can call the AAAASF at (888) 545-5222 or (847) 949-6058 or look at their website at http://www.AAAASF.org.
2. The Accreditation Association for Ambulatory Health Care. You can call the AAAHC at (847) 853-6060 or at http://www.aaahc.org.
3. The Joint commission on Accreditation of Healthcare Organizations. You can call JCAHO at (630) 792-5005 or http://www.jcaho.org.
You can also call The American Society of Plastic and Reconstructive Surgery (ASPRS) at (800) 635-0635 to find out which of its members have accredited surgical centers in your area.
If you have general anesthesia, be sure your anesthesiologist is certified by the American Board of Anesthesiology (ABA). You can call the ABA at (919) 881-2570 to verify certification. If your doctor uses a nurse anesthetist, call the American Association of Nurse Anesthetists (AANA) at (847) 692-7050 to see if they are ANAA certified.
It is important that the emergency equipment and anesthesia monitoring devices in your surgical facility are equivalent to those in a hospital or freestanding ambulatory surgery center. You'll also want to be sure that arrangements are made for hospital admission in the event of a complication.
STEP 2: Schedule appointments
Ask:
- Is the doctor certified by the American Board of Plastic Surgery?
- What is the doctor's area of expertise?
- How much is the initial visit?
- Can I have a surgical estimate for the total price? (Be sure this includes surgery fee, operating room, anesthesiologist, etc.)
STEP 3: The Consultation
After you've found several doctors who are board certified by the ABPS, you'll want to set up appointments to determine which surgeon you're most comfortable with. Be very specific about what you want changed and how. Look for confident but realistic answers.
Ask:
- What are my choices in techniques and procedures?
- Explain what usually happens during the surgery? How long does the procedure last?
- Where will the incisions be made?
- How often do you perform these procedures?
- What type of anesthesia is used? If general anesthesia is to be used, who will be my anesthesiologist? Are they certified by the American Board of Anesthesiology (ABA) or the American Association of Nurse Anesthetists (AANA)? What are the side effects of the sedation? (The three types of anesthesia used are general, sedation and local. With general anesthesia you are in a deep sleep, with sedation anesthesia you are awake but relaxed and drowsy, and with local anesthesia you are mentally alert but the area being worked on is numbed).
- Where will the procedure take place? (If in the doctor's office, ask to see the surgical room)
- If at the doctor's office, is the surgery center affiliated with a hospital or licensed by the state or accredited? (See Step 1 for verifying this information).
- How much pain can I expect after surgery?
- What are the risks involved with this procedure? What are the possible complications after surgery? How common are these complications? Have you ever had a patient with these complications? How was it handled?
- Can I speak with your previous patients? (While doctors want to respect the privacy of their patients, they should be able to provide some contacts. You'll only be referred to patients with a good result, but it can be helpful.)
- Can I see before and after pictures of your other patients? (Request pictures of patients who have had the same procedure as you are planning. You may only be shown their best results. This is still informative,as you'll get an idea of what your doctor's best work is).
- How long is the recovery period? How will it be before I will be able to: be seen in public, return to work, resume exercise, etc.?
- How long does it take to see the full effect of my surgery?
- How long will my results last?
- When can I schedule surgery?
- How involved are you after surgery?
- What are the costs and payment terms? What fees will I be charged by other facilities (hospital or facility fee, anesthesiologist, medical tests, etc.)? Are there extra fees for before and after pictures?
- What happens if the results don't match my expectations? Will I be charged for any revisions? How likely is it that I will need another surgery? Are only surgical fees waived or are all fees waived (operating room, anesthesia, etc)? (Revisions due to deformity or asymmetry done in the first year should be free of charge; ask about additional fees for anesthesia, hospital stay, etc. According to The Smart Woman's Guide to Plastic Surgery, "Following rhinoplasty or liposuction, 15-20% of patients seek revision. Following face-lift or eyelid surgery, revision is sought by fewer than 2%...many deformities self-correct as they mature.").
- What is the worst-case scenario for this procedure?
- What type of medication (antibiotics/pain relievers) will I be on after surgery? For how long? What are possible side effects, reactions, complications of the drugs?
Find another surgeon if:
- the doctor tries to convince you to have a procedure that isn't related to the area or problem you've come to him for
- the doctor dismisses the risks involved in surgery or isn't open about possible complications
- the doctor guarantees results
- the doctor doesn't recommend a preliminary physical examination
- the doctor refused to show before-and-after pictures of other patients
- you did not feel you could ask questions freely
- you were not treated courteously or respectfully
- the doctor is willing to submit fraudulent paperwork to your insurance company
- the doctor does not routinely perform the procedure you are interested in
- you did not feel comfortable with her staff or the cleanliness of the office
