December 11th, 2009 Dr. Kridel
Are Current Internet Patient Rating Sites of Physicians helpful?
Only Minimally. Very few patients who are happy with a doctor’s service will take the time to write in to the rating sites. The ones that do write in are usually the complainers, the disgruntled, the bellyachers, and often their complaints have little to do with the quality of care received or their medical outcome but often only relate to whether the patient had a long wait, or whether the office staff or doctor were friendly. Some of these patients are angry with the disease they have and transfer that anger on to the doctor, who may have asked them to change their lifestyle habits, go on a diet, stop smoking, stay out of the sun, or start exercising. Some are angry because the insurance company didn’t reimburse them for their costs, as if the physicians had any control over the insurance company cartel! And some of these patients are not honest about their experience and rant on in hyperbole without anyone to verify their statements. Some doctors have been crucified by angry patients who had it in for the doctor despite the good care that was provided! Doctors have little recourse to respond to such on-line attacks because of the laws of patient confidentiality and because doctors don’t have time to search all these sites to even see what’s been said about them. One angry patient can go to all 40+ rating sites and post numerous comments on each. Best thing to do is to visit the doctor yourself and draw your own conclusions and talk personally with real patients who the doctor has treated. Most offices will provide you with names of patients willing to speak to other patients.
What is most dangerous about these rating sites is that there is no verification that the person sending in a comment is an actual patient. As distasteful and unethical as it is, there have been multiple instances where competitors have sent in false reports about another doctor to try to sabotage his practice. Also, previously dismissed employees from a practice have tried to get back at their doctor employer by spreading false comments. Even previous spouses have been caught posting lies. And, on the other side, some practices have made up and submitted in positive comments about their doctor. The Federal Communication Commission has ruled that spreading lies on the internet is a punishable offense. And the American Medical Association is studying this very problem now, and a company called Medical Justice is helping doctors when they are so maligned falsely.
Some patients are turned away by their physicians because they are non-compliant with suggested care or because they have unreal expectations about what the physician can do. This is especially true in cosmetic plastic surgery. These are precisely the patients most likely to complain vociferously.
As a physician, I know that doctors often cannot control being on time. Often the complexity of the patient’s problems is unpredictable and one patient’s visit might take longer than estimated. Or else the doctor may have had extended rounds in the hospital because of patients with complex medical concerns or because of a longer than planned for surgery. Would you want the doctor to rush his surgery on the patient just so he could be on time for your patient visit? Or maybe the last patient was late coming to the office and knocked the doctor’s schedule off kilter. Only psychiatrists can consistently be on time because their visits are time set.
I often recommend patients to the doctors I know are best in their fields. And, as predicted, those are the busiest of doctors and are in high demand. I don’t mind waiting long hours for them in their offices when I’m a patient, because I know that when they see me, they will give me all the attention I need and the best in care. I have one neurosurgeon colleague who is reputed to have no bedside manner. Do I care? No, because I know that he’s the best neurosurgeon in town, and if I have a brain tumor, he’s cutting it out.
Some patient rating sites rate doctors based on how soon they could get an appointment. Again, the best are going to be in the highest demand. Often patients let an illness or problem drag on until it really gets serious and then expect to be seen immediately. It’s best to establish a relationship with a primary care doctor for a general check up and to build a well-care relationship, so that when you do get sick, that doctor will be more apt to see you soon since you are an established patient or else can get you seen more quickly by a specialist on his referral.
Also, patients often lack the scientific acumen to judge their physician, nor do they see how he treats other patients and what his practice patterns are. Other doctors often have a great idea of how their colleagues do; they see their results; they see their complications; they know their dedication or lack of; they know their attention to detail. Patients may not know that their particular case was not the ordinary and that their doctor had cured 999 out of the last 1000 patients with the same malady!
Some patients complain because they feel the doctor’s fees are too high. They don’t recognize that doctors’ incomes have been dropping steadily since the government took over so much medical care and since the insurance companies have devalued the service the doctor renders. For procedures covered by insurance, the doctors receive the amount set for that service based on what the insurance company or government dictates. Some of the reimbursements now are lower for the same procedures that they were ten years ago. If the patient is paying more now, it’s because the insurance company is requiring higher deductibles and co-pays for the patient to pay. It costs me more to have a plumber come out to my house and fix a pipe than I would pay a physician, who has a high office overhead and 6 to 10 staff on payroll, to remove my child’s tonsils, which is an operation that can lead to death if the patient bleeds afterwards! For fees on such non-insurance items, such as plastic surgery, you need to pay for experience. When the recent plane that was disabled was set down safely on the Hudson River by an older seasoned pilot, that experience was recognized. But what about the commuter jet mishaps that happen too often with young, inexperienced pilots? Every patient is different as are all doctors. I want the doctor operating on me who has done 100+ of the procedure I’m having, not 3 or 4! Re-dos aren’t fun! We’ll talk more later about experience and how we can measure this.
Other ridiculous parameters rated by these sites are where the doctor went to medical school. The current reputation of a medical school may have no relation to what it was like 20 years ago when you doctor was there. And medical school is just the preliminary step in training. What really makes the difference is where he / she did the residency training after medical school, which for a facial plastic surgeon is six more years of training. And just because a doctor was at a good institution doesn’t mean he was at the top of his class. I’d rather have a doctor from a not-so-well known residency program who finished number one, than a doctor at a well known program who finished at the bottom.
Next Blog: How to evaluate the best ways to choose your doctor.
Russell W. H. Kridel, MD, FACS
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December 1st, 2009 Dr. Kridel
Dr. Kridel- ABC 13
Dr. Kridel was featured last night on ABC channel 13 discussing how plastic surgeons require special skills to deal with different ethnicities.
Click the link below to view the video:
The Changing Face of Cosmetic Surgery
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November 16th, 2009 Dr. Kridel
Botox and Dysport and all the injectables can only be sold legally in the US only to physicians; these products must be legally approved and labeled by the FDA. Depending on state law, which varies, generally only physicians, nurse practitioners, and nurses may inject these substances. Doctors’ offices are probably the safest place to have such injectables administered; staff are trained in sterile procedures so as to avoid contamination, re-use of needles, and infections. Plus, in the rare case of an allergic reaction, staff and physicians are trained in resuscitative measures and have emergency drugs available. Not too many spas, peoples’ homes, or hotel rooms have the same standards for cleanliness and emergency care that a doctor’s office does!
Click here for video
And the products obtained must come from the US where the FDA maintains safety levels not so strictly adhered to in other countries Importation of cosmetic injectables can be a felony, subject to one year in prison and $100,000 in fines. Recently 5 physicians, a nurse and a practice manager in New York pled guilty to such charges. Therefore patients need to be cautious when injectables are offered at bargain prices, because they may have been obtained through web sites or offshore; they may be counterfeit and there’s no one to assure purity or content! Serious injury or personal harm may result when unknown substances are injected.
Individuals who decide to have their injections in spas may be putting themselves at risk. Even if the spa is overseen by a physician, is he on-site to supervise the injection? In most states the practice of medicine is defined by the diagnosis and treatment of a problem. Is an aesthetician or nurse deciding on their own what injectable is appropriate for you and how much you should get? Or is the physician first seeing you, discussing the options and then deciding, based on your medical history and his exam, what should be done—the preferable route—and is that doctor relaying on alternatives to that injectable? And what kind of physician is doing the injecting or the supervision? Is the physician one who routinely treats such conditions, for example, as would a facial plastic surgeon, plastic surgeon, or dermatologist, whose touch might be more delicate, aesthetic, and precise?
Botox parties at someone’s home are fraught with problems! Some of these parties involve the drinking of alcohol on the premises. Can you truly decide with a clear head if this is what you want to do? Also, before being injected, have you been offered an informed consent form to read and fill out? Did anyone talk with you about risks and possible complications? Did someone go over your medical history to see if you might be allergic to the material to be used? Did someone ask if you are nursing? On immune-suppressant drugs? Have taken aspirin, non-steroidal inflammatory, or herbal drugs recently, that could cause bruising or bleeding? Did someone take any pictures to document what you looked like before so that later the efficacy of the treatment could be assessed?
The DIY or Do It Yourself injections recently seen on the internet are quite simply one of the most bizarre, unsafe and unwise acts I have ever witnessed. Will heart surgery be next? Number one, you want someone with experience to do your injection; someone who’s done it hundreds of times, someone who knows the underlying anatomy and who knows how to avoid problems. Since you can’t yet get a medical degree or residency training over the internet, and you probably don’t have the time for 4 years of medical school and 4 to 6 of additional residency training, you might want to visit your facial plastic surgeon instead. Even with a doctor with an experienced hand there can be problems, albeit small. Bruising, bleeding, asymmetry, migration to unwanted areas are all possible. Who is going to pick you up off the floor when you pass out? Plus, ever try to do something in a mirror, where left to right are transposed? It’s difficult.
What is exciting now are all the FDA approved injectables that we now have (such as Botox, Dysport, Restylane, Sculptra, Perlane, Juvederm, Radiesse, etc.), giving facial plastic surgeons, and patients many choices to individualize the right treatment for them. It’s just wise to have the right physician examining and guiding you to the optimal result!
-Russell W. H. Kridel, MD, FACS
Houston, Texas
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For more information, Dr. Kridel is featured in this article talking on the same topic of DIY injectables and risks on
Aesthetic Medicine News – Consumer Alert: Safety Issues Associated with Botulinum Toxin Cosmetic Injectables.
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October 28th, 2009 Dr. Kridel
Revising Rhinoplasties (Re-doing your nose job)–Part One
-Introduction-
What patients often don’t understand is that all noses are different and so are the surgeons that operate on them. And, of all the surgeries in the discipline of facial plastic surgery, a rhinoplasty (the cosmetic reshaping of the nose) is the most challenging operation of all. On a national average, about 20 % of first time rhinoplasties undergo some degree of revision.
Noses are especially difficult because they not only have to look good but they also must breathe well. Making a nose too petite or defined may compromise how well one can breathe by decreasing the strength of the structures that keep the nasal airway open. Nose surgery is improving technically because facial plastic surgeons have learned that doing less is often preferable; over time noses change and a nose that looked good right after surgery may twist or heal irregularly with time, especially if structures have been aggressively trimmed.
The majority of surgeons will not leave the operating room until everything looks good. But no surgeon can control the healing process. When the nose is narrowed by bringing in the bones, one of the bones can settle more than another and the nose can look crooked. Or in the process of the bones healing, a bump can appear in the re-modeling process. Or the healing process can cause the tissue to contract unevenly and cause one side to look different than another. Or, if the nose was crooked to begin with, and even if the nose was straightened by the surgery, the cartilage can twist back because of intrinsic memory.
So, knowing that some noses will need revision surgery no matter how good the surgeon is, how do you improve your odds of getting a good result? Number one, we know experience counts. If you have to have heart surgery, you would want your surgeon to have done several hundred to thousand before he touches you. That desire should be even stronger for nose surgery (or revision nose surgery), since all noses are different. Choose your facial plastic surgeon well. Pick someone who also has ENT (Otolaryngology) experience as well so your breathing can be preserved or improved. And select a surgeon who performs revision rhinoplasties routinely, at least 40 or more per year. –End of part 1–
Please check back soon for part two! In the meantime, feel free to visit our website www.TodaysFace.com, or contact our office to schedule a consultation.
-Russell W. H. Kridel, MD, FACS
Houston, Texas
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