MEDIA CONTACT:
Jody Sumrall, (650) 723-7897 or 723-6911; e-mail [email protected]
FOR COMMENT:
Dr. R. James Koch can be reached at (650) 723-6030; e-mail [email protected]
11/19/97
COSMETIC SURGEONS SHOULD USE COMPUTER IMAGING AS COMMUNICATION TOOL, NOT SALES PITCH
STANFORD -- By manipulating people's facial features on computer images, doctors can help patients envision the results of cosmetic surgery. But what if the surgical results differ from those on the screen? Does computer imaging tend to raise false hopes and invite malpractice suits?
Used conservatively and wisely, computer imaging actually protects both doctors and patients, facial plastic surgeon Dr. R. James Koch and attorney Andrea E. Chavez conclude in a newly released report examining the legal and professional implications of computer imaging in plastic surgery.
"There is potential for it to be a great tool or a dangerous tool," noted Koch, an assistant professor of surgery at Stanford University School of Medicine.
"The best use of computer imaging is for improving communication -- not for selling an operation," he said.
Koch instigated a careful review of the practice by approaching Chavez, a Menlo Park lawyer pursuing graduate studies in computer science, with his concerns. "I thought it was important for lawyers to look at the pluses and minuses and come to a conclusion about the risks," he said.
Koch and Chavez report their findings in the November issue of the journal Plastic and Reconstructive Surgery.
The benefits of computer imaging greatly outweigh the risks, they found. Surgeons can use the images to convey a sense of achievable results so that patients' expectations will align with reality. And those same images can later help surgeons prove that they didn't exaggerate.
Plastic surgeons who don't use computer imaging might choose instead to draw on a patient's photograph or make a diagram of the predicted surgical results. Many others forgo visual representations altogether and simply describe the changes in words.
Computer imaging allows plastic surgeons to show patients a range of possible outcomes. The software alters the images, but the doctor has to tell it what to do. Creating plausible pictures therefore requires expert knowledge of facial structure and the limitations of possible operations, Koch said.
"If you have a real small chin and I pull it out [on an image] to show you what you would look like with a bigger one, I have to know that I have the right implant to use -- one that won't distort the skin next to your chin," he explained. "The surgeon using the program has to know if the operation will work technically."
With today's software programs, cosmetic surgeons can choose to "wipe away all the wrinkles on a person's face, or to wipe away only 50 percent of them," Koch said. "I recommend that surgeons show a reasonable -- not a perfect -- result."
Demonstrating diverse outcomes and keeping predictions conservative can protect surgeons as well as patients, making it harder for patients to claim that surgeons induced them to undergo surgery with deceptively optimistic computer imaging.
In fact, responsible use of computer imaging can help patients figure out when they don't want surgery. Koch described one patient who had a hump on her nose that had been bothering her for 20 years. When he altered a computer image to show her what he thought he could do, she urged him to go farther. Koch explained that taking more tissue would distort other parts of her nose. "Maybe you should reconsider whether you want the operation," he told her.
Computer imaging also helps surgeons prepare for difficult cases and facilitates medical education, said Koch. "It's good for surgical planning. I can simulate the results of operations and move things around. It's also great for teaching residents -- much quicker than doing operations on people and waiting for them to heal," he said.
"Patients should understand that the technology is there and that when a surgeon uses it appropriately, it can be very helpful in terms of seeing what the possible outcome is before taking the step of surgery," Koch said.
"People shouldn't just get a surgeon who's got computer imaging, though, because it could be someone trying to sell operations," he added.
The vast majority of doctors doing cosmetic surgery use the technique appropriately, Koch said. But warning bells should go off if a doctor shows a patient a picture-perfect result.
"If the result seems unbelievable, the patient should ask the surgeon if it's technically achievable," he said.
A doctor's aggressive attempt to peddle an operation should serve as another warning signal. It's reasonable to show a person the predicted outcome of a particular surgical procedure, but sales pitches don't belong in the doctor-patient interaction, said Koch.
"The patient should make the decision. The doctor should not say, 'This is what you need.'
"The best protection for everyone is happy patients," he added. "That's what we all want." --es--
RSS