Surgery News - April 2008 - (Page 21)

APRIL 2008 • SURGERY NEWS PRACTICE TRENDS Vascular Surgeon Volunteers Serve Soldiers in Need BY DOUG BRUNK Else vier Global Medical Ne ws hen Dr. William Oppat learned about a 2-week volunteer opportunity for Society for Vascular Surgery members at Landstuhl Regional Medical Center in Germany helping soldiers injured in Iraq and Afghanistan, he jumped at the chance to serve. “I live in this wonderful country; we have everything at our access and yet I have really given nothing up to have it,” said Dr. Oppat, program director in surgery at Providence Hospital and Medical Centers, Southfield, Mich. “I wanted to participate and give back and experience what these kids are going through because they give so much so that I can continue to live my life here.” On his first day as a volunteer in October 2007, he was asked to consult on the cases of two female soldiers in their mid-30s who lost their left legs after an improvised explosive device detonated outside of a mess tent in Afghanistan. “Both of them had children and were trying to make a better life for their families by serving in the military,” said Dr. Oppat, an ACS Fellow who is also a clinical associate professor of surgery at Wayne State University School of Medicine, Detroit. “They were both going home without their left legs and it really shook me up. That was my first day there, seeing the amount of devastation and how these injuries change people’s lives.” Dr. Ruth L. Bush’s first day as a volunteer at Landstuhl in September 2007 was also sobering. She was tasked with performing an ultrasound on a soldier who had undergone a bypass repair prior to arrival at the medical center. Noticing that his year of birth was 1987, she asked, “So you’re 20 years old?” “No, I’m only 19,” he replied. “I’ll be 20 in a few months.” At that point, “I looked at him and thought, ‘this kid has been through more than people double and triple his age,’ ” said Dr. Bush an ACS Fellow with the division of vascular surgery at Scott and White Hospital and Clinic, Temple, Tex. “But none of the soldiers are bitter. They all want to get back to their buddies.” W Dr. Ronald M. Fairman explores a lower leg arterial injury caused by an improvised explosive device. Dr. Bush was the first SVS member to serve in the ongoing 2-week volunteer rotation program at Landstuhl Regional Medical Center, which was coordinated by Dr. David L. Gillespie, an ACS Fellow who is also an SVS member and chief and program director of the vascular surgery service at Walter Reed Army Medical Center in Washington, D.C. The U.S. Army pays for the volunteers’ transportation and housing, and the American Red Cross covers their malpractice insurance. As of Jan. 8, 2008, eight vascular surgeons have rotated through Landstuhl, which has volunteers scheduled through August 2008. “None of these surgeons had prior military experience, but all had vascular trauma experience through residency, fellowship, and current respective practices,” Dr. Gillespie said of the participants. Most of the definitive vascular repairs are performed on soldiers prior to their evacuation to Landstuhl, so volunteers mainly serve as clinical consultants, most often for wound examination under anesthesia for which intraoperative vascular consultation is requested. Other procedures have included IVC filter placement, thrombectomy and revision of lower and upper extremity interposition vein grafts, retroperitoneal spine exposures, and diagnostic and therapeutic carotid angiograms. “For vascular surgeons who have been looking for the right volunteer opportunity, this is clearly it,” said Dr. Ronald M. Fairman, an ACS Fellow who is professor of surgery and chief of the division of vascular surgery at the Hospital of the University of Pennsylvania, Philadelphia. He volunteered for 2 weeks in October 2007. Dr. Fairman said he was impressed by the high level of medical care and teamwork at Landstuhl, which is a level II trauma center. “It’s a wonderful atmosphere to pitch in and help because there are no turf issues,” he said. “Everybody just wants to do the most that they can for the injured soldiers. You get the feeling that nothing is spared in terms of caring for these guys.” One case he consulted on involved a young soldier who had been shot through his maxilla. Upon arrival, “he had swelling in his neck and a CAT scan demonstrated that the bullet had damaged several branches of the distal external carotid artery above where you could get to surgically,” Dr. Fairman said. “I was able to take him down to the cath lab and embolize the branches that were bleeding. So I felt like being there made a difference for that one patient, because there was nobody there at that time who had the skills to do it. For me that was very meaningful.” Another volunteer, Dr. Daniel S. Rush, remarked about the camaraderie he observed among soldiers at Landstuhl. “If you listen to the news reports back home here, you would think that everybody was jaded and burned out,” said Dr. Rush, an ACS Fellow and director of the division of vascular surgery at East Tennessee State University, Johnson City. “That is not true. Our troops and the people who are supporting them are enthusiastic, and they’re there to do their job. They want [the war] to be over, but they have a great attitude and great dedication to what they’re doing. ” To inquire about volunteer opportunities at Landstuhl Regional Medical Center, contact Dr. David L. Gillespie at david.gillespie@na.amedd.army.mil. Medical Spas Offer Range of Aesthetic Options B Y M A RY E L L E N S C H N E I D E R COURTESY DR. RONALD M. FAIRMAN Else vier Global Medical Ne ws 5 number medical spas in the United In less than450years, the States hasofgrown from about to about 2,500, according to the International Medical Spa Association, making it a nearly $1 billion business. Some surgeons are entering the marketplace, setting up spas that offer not only fillers and laser hair removal but also cosmetic procedures ranging from eyelid surgery to abdominoplasty. Dr. Monte Harris, a facial plastic and reconstructive surgeon and cofounder of the Cultura Cosmetic Medical Spa in Washington, D.C., defines his business as an “interdisciplinary medical practice in a spa setting.” In 2002, Dr. Harris partnered with Dr. Eliot Battle Jr., a dermatologist and laser surgeon, to open Cultura, which specializes in addressing the cosmetic needs of individuals with darker skin tones. Dr Harris and Dr. Battle strive to combine the cutting-edge technology of an academic medical center with the pampering of a luxury hotel. “We’re physicians first,” Dr. Harris said. But putting the medicine first can be a challenge with this type of business if a physician isn’t at the helm, he said. Since he and Dr. Battle opened their medical spa, the industry has been flooded with medical spa franchises. And more noncosmetic physicians have entered the marketplace in an attempt to tap into the feefor-service revenue, he said. Today there are many types of facilities that call themselves medical spas with varying levels of physician involvement and varying levels of training, he said. “The industry to a certain degree has grown faster than regulation and training have been able to keep up,” Dr. Harris said. Physicians who operate medical spas have to be there “educationally, philosophically, and operationally,” said Dr. Laurie Casas of Northwestern University, Chicago, a plastic surgeon and co-owner of the Turn Back Time Medispa in Highland Park, Ill. That means providing onsite supervision, being immediately available when out of the facility, and training the staff yourself. “Safety is first and foremost in any of this,” she said. One of the most important ethical issues surrounding medical spas is ensuring adequate training of the physicians involved, said Dr. Bruce Katz, a dermatologic surgeon and medical director of the Juva Skin and Laser Center and the Juva MediSpa in New York City, one of the first medical spas in the country. “It’s their duty to do the right thing and be properly trained,” he said. And proper training means more than just a weekend course, he added. Determining who performs which treatments at a medical spa should be based on the degree of risk, he said. For example, while it’s unnecessary to have a physician perform laser hair removal, a physician should be on site to supervise nonphysician practitioners. The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery have issued joint “guiding principles” on the supervision of nonphysician personnel in medical spas and physician offices. Among the recommendations is that any delegation of a medical procedure should be within the delegating physician’s areas of expertise and within the statutory and regulatory scope of practice of the nonphysician practitioner. The two organizations also advise that physicians ensure proper training and equipment certification for use by nonphysician practitioners. Physicians are also responsible for documenting that the training has been completed, according to the guiding principles. There are currently no federal laws or regulations governing medical spas. However, some states have issued regulations addressing the use of lasers or injections, and others are taking a more comprehensive look at medical spas in general. A conference call on medical spas conducted last year by the Federation of State Medical Boards was heavily attended by the state medical boards. And in Massachusetts, the legislature called for the creation of a Medical Spa Task Force, which spent the last year debating how best to regulate the industry. Instead of coming up with rules specific to medical spas, the task force decided to classify the procedures commonly performed at these facilities by potential risk to patients. They evaluated who should be able to perform each procedure and what level of training and supervision is appropriate. It was fairl

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Surgery News - April 2008 Contents Comorbidities Sway Bariatric Outcomes Database Finds Gap in Dissection For Melanoma Future Surgeon Shortage Predicted Dexterity Demo Best for Bile? Health Policy Scan Plan

Surgery News - April 2008

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