Plastic surgeons sometimes face challenging relationships with patients, especially those with underlying psychiatric problems. An ethical framework to administer surgeon-patient relations for the unsustainable surgeon is presented in a special article of plastic surgery approach in the February edition of Plastic and reconstructive surgery®, the official medical magazine of the American Society of Plastic Surgeons (ASP). The magazine is published in the Lippincott portfolio by Wolters Kluwer.
“Particularly when psychiatric conditions are present, plastic surgeons can be tempted to end the surgeon-patient relationship, in the risk of ethical challenges related to the abandonment of the patient,” says the member of the ASP Christian J. Verler. “We describe some strategies to handle these difficult relationships, including specific steps to achieve the best patient -centered clinical results.”
Psychiatric problems contribute to ethical dilemmas in plastic surgery
Once an operation has been performed, surgeons have the ethical obligation to take care of the patient until the treatment is completed. “However, never, there are circumstances that can challenge this patient surgeon relationship and justify the termination,” the researchers write. His article was driven by the difficult case of a patient with a psychiatric diagnosis that underwent plastic surgery to reconstruct a self-inflicted wound, followed by repeated episodes or self-mutilation.
Informed by a review of literature and the application of ethical principles, Dr. Ir. Vroccler and his colleagues describe three ways for the management of patients with complex psychiatric conditions:
- Keep the relationship and continue with surgical treatment. The demanding or hostile behaviors of the patient can express for fear of abandonment. Strengthening the surgeon’s commitment to provide the best possible care can help mitigate thesis fears, and can allow the resolution of the patient’s psychiatric problems. If so, and if realistic expectations can be established, it may be possible.
- Keep the relationship without additional surgery. Some patients can reject the recommended treatment but continue seeking attention, or related to underlying depression and anxiety. Providing non -surgical support for support can help address barriers to follow the recommended treatment: if there is a “reasonable expectation” that the barriers for attention are reversible.
- Finish the relationship. In severe cases, the termination of the patient’s surgeon relationship may be the best option, partly if the surgeon’s participation seems to contribute to the patient’s psychiatric condition. In such situations, a “high therapy”, following the established ethical principles and legal requirements to transfer responsibility to another qualified doctor, can ensure that the patient receives the cycle.
“When writing this article, our main objective was to reformulate the ethical obligation of surgeons not to abandon their patients after the operation, even when the patient’s behavior is incredible is a challenge to do it,” says Dr. Vercler. “While the described case illustrates the rare exception in which the therapeutic dysarga is requested, we hope that our document provides tools to help surgeons to fulfill their ethical response, which allows them to stay involved in patients” care care “
Plastic and reconstructive surgery® is published by Wolters Kluwer.
Click here to read “Avoid the abandonment of the patient: a way towards ethical resolution in situations of unsustainable patients – surgeons”
Article: “Avoid abandonment of the patient: a route towards ethical resolution in situations of unsustainable patients – surgery relationships” (DOI: 10,1097/PRS.00000000011735)
On plastic and reconstructive surgery
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