versión impresa ISSN 1983-5175
Rev. Bras. Cir. Plást. vol.26 no.4 São Paulo oct./nov./dic. 2011
The importance of recognizing our limits
The title is self-explanatory. There should be no need to go into detail to understand its meaning in relationship to the present status of plastic surgery in Brazil and even in the international scenario. Everybody knows. Nevertheless, we could start recording some issues that are often overlooked, even in other specialties, about how important it is for doctors to accept their limitations. This issue is directly associated with basic education, the ego, the conscience, and the importance of making a living. We sell our profession, but within the limits of dignity, the respect we gain, and our limitations and possibilities. These issues are inherent to the most logical and coherent criteria of cost and benefit. Despite the academic discussions in the field of plastic surgery for aesthetic and repair purposes and whether they are a means or an end, the logical reasoning is that it does not make sense to perform surgery to stay the same or become worse, but always to seek an improvement. As in all surgical procedures, there are calculated risks with regard to the level of quality promised before surgery and the satisfaction of offering less and obtaining more. The reverse situation can damage the doctor-patient relationship anywhere from dissatisfaction to legal proceedings.
The evolution of plastic surgery in recent decades has been continuous and uninterrupted. In particular, the so-called cosmetic surgery, which is performed on patients that are not terminally ill, has transitioned from a stage of secrecy to a topic that is openly discussed socially. To converse on the volume of one's mammary or gluteal implants has become a colloquium similar to talking or writing about fashion, leisure, parties, etc. It is difficult to tell whether we are at the phase of distinguishing what is called a trivialization or the natural integration of this culture in the human society. This behavior is obviously diverse in different countries. Generally, this topic is more widespread in countries with tropical climates and Catholicism as a religion, and much less liberal in Islamic countries and in temperate climates. However, the future evolution is not clear, and we can only wait and see.
What really matters is to recognize one's limitations not only in our professional life but also in human relationships. As mentioned before, the ego and pecuniary interests can negatively affect moral and ethical behavior. To refuse treatment and refer a patient to another professional is a noble and respectful action aimed at the well-being of those that have faith in our work. Unfortunately, we have observed, in a constraining way, the number of people who undergo surgery with poor results that do not reach the minimum standards of quality. This suggests a level of incompetence in the person responsible for the execution and the recklessness of not accepting responsibility for this behavior. The statistics of the Regional Councils of Medicine (RCM) that originate in the various States of the Federation show that the majority (about 80%) of lawsuits are directed against doctors from other specialties who perform plastic surgeries without proper qualifications, driven only by monetary interests. The Brazilian Constitution enables doctors to perform any type of treatment provided that he/she is properly registered in the RCM of his/her State, but poor performance with respect to the promised results often leads to court appearances.
The business of lawsuits against doctors has grown throughout the world because we forget that "saying no to the patient does not put money in the pocket, but increases the respect and credibility of the professional". We have referred patients who present with problems that are beyond our areas of expertise to better qualified colleagues. We have also partnered with colleagues to ensure better quality results, but always with the approval of the patients that paid the colleague for his work. We do not think that the reverse situation is acceptable.
Although we want to remain optimistic, we do not believe that things will change and that some colleagues outside the specialty will stop performing surgeries without the pressure of a malpractice suit.
Dov Charles Goldenberg