Applying Principles of Evolutionary Biology to Plastic Surgery at an Organizational Level Predicts an Extinction Event.

As an organized profession, plastic surgery struggles delivering a clear message regarding scope of practice to patients given the diversity of procedures performed. Whereas granting licensure to practice medicine resides with governmental bodies, certification rests with organizations. However, certification is not required to practice plastic surgery. Since plastic surgery operationalizes techniques rather than working within a defined body organ, competition for patients is intense. Mapping territorial interactions between healthcare providers while parsing taxonomy elucidates individual, community, organizational, and governmental levels, creating various selection pressures. Applying evolutionary biology as a framework predicts the termination of plastic surgery over time as a unique specialty. An entirely new domain, Restorative Healthcare, is proposed which circumvents an extinction outcome.

The disruptive physician: righteous Maverick or dangerous Pariah?

BACKGROUND: "Disruptive physician" is a term appearing more frequently in many hospital bylaws. It has significant negative implications that can lead to loss of privileges for plastic surgeons. METHODS: Exploring the various definitions of disruptive physician reveals palpable differences between those of the Joint Commission and the American Medical Association. These discrepancies expose plastic surgeons to potential harm when actively addressing quality issues in the hospital environment. RESULTS: The disruptive label can be inappropriately leveraged by hospital administrators against plastic surgeons who confront quality issues. Moreover, the term disruptive is open to subjective interpretation. Challenging the disruptive label in court reveals only that the justice system is concerned that the actual process leading to the disruptive charge is followed appropriately as outlined within the organizational bylaws; the courts are not interested in the actual quality issues and generally will not second-guess the judgment of peer review panels or hospital administrators. CONCLUSIONS: Plastic surgeons would benefit from familiarizing themselves with these issues. Hospitals should be required to use root cause analysis when dealing with quality issues raised by members of the medical staff. Furthermore, findings from root cause analysis should be privileged from legal discovery in all jurisdictions to permit honest exploration of quality issues. When a conflict does arise, consideration of mediation should be given to resolve disputes.

Ethical issues for the plastic surgeon in a tumultuous health care system: dissecting the anatomy of a decision.

BACKGROUND: Society anticipates that plastic surgeons will make ethical decisions that are solely in the best interest of their patients. However, a variety of competing factors exert an influence on all decision-making processes. METHODS: Multiple competing factors that commonly influence decision-making by plastic surgeons, on both conscious and subconscious levels, are identified. By exploring the ramifications of these factors, a more ethical outcome can be achieved. RESULTS: Some of these competing interests that can sidetrack ethical decision-making include personal finances (e.g., ownership of surgical centers, selection of procedures, pricing); outside regulations (e.g., Emergency Medical Treatment and Active Labor Act of 1986 and care of the uninsured); and professional duty (e.g., informed consent, discussion of error). CONCLUSIONS: Plastic surgeons who are aware of the competing interests that influence their decision-making processes stand a greater chance of achieving ethical outcomes. Nevertheless, with the growing volume of nonreimbursed care and expectations of perfect outcomes, achieving uniformly ethical decisions without burdensome self-sacrifice is difficult at best.