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2004 International Society of Hair Restoration Surgeons Conference
Article by William M. Parsley, MD.
University of Louisville Medical Center, Louisville, KY USA
Ethics Honesty & the Doctor Patient Relationship
In the past 10 years, few fields have progressed as rapidly as hair restoration. not only have we had huge advancements in the techniques and refinements of hair restoration, but we have also enjoyed the development of medications that are far more effective than anything we have seen in the past. Patients who weren't impressed with the plug method are now much more encouraged with today's results. Our stature with the public and the medical field, which was once suspect, has been riding a crest of credibility and good press.
However, we are drifting away from some of the principles of good medical care. The doctor/patient consultation is in jeopardy. The decisions as to type of donor repair, site creating instruments and decisions concerning mini grafts versus follicular unit grafts are dwarfed by the importance of the consultation. Assessing a patient's goals and creating a realistic plan, or deciding whether or not the patient should even have a transplant, stems from one of the most sacred cornerstones of medicine - the doctor/patient consultation. Consultants are now taking over this task in many offices. Why consultants? There are 3 main reasons consultants have flourished:
1) Consultations take a lot of time
2) The cancellation or no-show rate can be significant and very frustrating to the doctor
3) Many patients are a long distance from the doctor, and travel for just a consultation can be extremely difficult.
Consultants can be good or bad depending on how they are utilized. Many are used to assist the doctor but not used as a substitute for the doctor/patient consultation. With the Internet and telemetry, perhaps a reasonable compromise can be made for those patients a great distance away, but few if any doctors have tapped into these tools yet. Because hair restoration is a team procedure, many vital parts of the procedure are performed very ably by non-physicians. If we give away the graft preparation, the graft planting, the dressing changes, etc., can we give away the consultation also? Perhaps someday, the medical authorities will decide to give the procedure to non-physicians using the argument that we had already given it all away years ago.
Certain ethics problems continue to plague us. One of the main problems is that of kickbacks - to hair salons, patients, and even other doctors. This is considered unethical by all standards and is illegal in most states. In the name of competition and misguided self-righteousness, some still freely denigrate other physicians. They don't seem to realize that this hurts their image much more than the image of those being denigrated; and this activity shrinks the pool of potential patients and makes matters much worse. Additionally, there have been many unconfirmed complaints of the doctors not giving the patient as many grafts as promised and lowballing patients on the number of grafts they will require. Certainly some of these complaints stem from misunderstanding, but we should all be more sensitive to these issues.
Internet instead of Doctors
A major concern today is the proliferation of Internet sites and the often negative light being shed on hair restoration. Why are they so popular and why is the public so lacking in trust of hair restoration doctors? While they are many reasons, certainly a prominent reason is our continuing failure to address complications. Simply put - we don't address it at all to the public with the exception of showing some complications created by other doctors, never ourselves. We all know that even experienced doctors have complications, but few publicly admit it. The public seems to realize all doctors will have some complications, and this is what scares them, because they feel we are not being forthright. They want to know if they might be disfigured and feel the medical field is not supplying them with reliable information, so they turn to the Internet. We are not supermen (or superwomen) and need to project an honest appraisal to the public. At this time a newer website for the ISHRS is being planned and will address this problem.
While hair restoration has made great strides in improving credibility, certain activities are hampering this momentum and need to be addressed, for the benefit of all.
William M. Parsley, MD.
Article by William M. Parsley, MD.
University of Louisville Medical Center, Louisville, KY USA
Ethics Honesty & the Doctor Patient Relationship
In the past 10 years, few fields have progressed as rapidly as hair restoration. not only have we had huge advancements in the techniques and refinements of hair restoration, but we have also enjoyed the development of medications that are far more effective than anything we have seen in the past. Patients who weren't impressed with the plug method are now much more encouraged with today's results. Our stature with the public and the medical field, which was once suspect, has been riding a crest of credibility and good press.
However, we are drifting away from some of the principles of good medical care. The doctor/patient consultation is in jeopardy. The decisions as to type of donor repair, site creating instruments and decisions concerning mini grafts versus follicular unit grafts are dwarfed by the importance of the consultation. Assessing a patient's goals and creating a realistic plan, or deciding whether or not the patient should even have a transplant, stems from one of the most sacred cornerstones of medicine - the doctor/patient consultation. Consultants are now taking over this task in many offices. Why consultants? There are 3 main reasons consultants have flourished:
1) Consultations take a lot of time
2) The cancellation or no-show rate can be significant and very frustrating to the doctor
3) Many patients are a long distance from the doctor, and travel for just a consultation can be extremely difficult.
Consultants can be good or bad depending on how they are utilized. Many are used to assist the doctor but not used as a substitute for the doctor/patient consultation. With the Internet and telemetry, perhaps a reasonable compromise can be made for those patients a great distance away, but few if any doctors have tapped into these tools yet. Because hair restoration is a team procedure, many vital parts of the procedure are performed very ably by non-physicians. If we give away the graft preparation, the graft planting, the dressing changes, etc., can we give away the consultation also? Perhaps someday, the medical authorities will decide to give the procedure to non-physicians using the argument that we had already given it all away years ago.
Certain ethics problems continue to plague us. One of the main problems is that of kickbacks - to hair salons, patients, and even other doctors. This is considered unethical by all standards and is illegal in most states. In the name of competition and misguided self-righteousness, some still freely denigrate other physicians. They don't seem to realize that this hurts their image much more than the image of those being denigrated; and this activity shrinks the pool of potential patients and makes matters much worse. Additionally, there have been many unconfirmed complaints of the doctors not giving the patient as many grafts as promised and lowballing patients on the number of grafts they will require. Certainly some of these complaints stem from misunderstanding, but we should all be more sensitive to these issues.
Internet instead of Doctors
A major concern today is the proliferation of Internet sites and the often negative light being shed on hair restoration. Why are they so popular and why is the public so lacking in trust of hair restoration doctors? While they are many reasons, certainly a prominent reason is our continuing failure to address complications. Simply put - we don't address it at all to the public with the exception of showing some complications created by other doctors, never ourselves. We all know that even experienced doctors have complications, but few publicly admit it. The public seems to realize all doctors will have some complications, and this is what scares them, because they feel we are not being forthright. They want to know if they might be disfigured and feel the medical field is not supplying them with reliable information, so they turn to the Internet. We are not supermen (or superwomen) and need to project an honest appraisal to the public. At this time a newer website for the ISHRS is being planned and will address this problem.
While hair restoration has made great strides in improving credibility, certain activities are hampering this momentum and need to be addressed, for the benefit of all.
William M. Parsley, MD.