me over

On November 29, 2002 the Health Foundation organised the third Forum on German Medical Law in Hamburg. One of the issues was to classify the intensity of how patients are briefed in aesthetic surgery. Some said only by means of "unsparing clarification" could doctors mitigate their risks of liability for "beauty surgeries".

Lawyers, doctors and representatives of the medical and the dentist association participated. Wolfgang Frahn, judge at the Oberlandesgericht Schleswig said: "Doctors must warn their patients that roughly 40% of all operations involve complications of some sort, ranging from minor healing irritations to permanent physical disfigurement." Therefore a surgeon had to "make clear that the desired result may not be reached, that things could even get worse - and that the patient will have to take that risk."

There was no particular emphasis on the fact that risks are significantly higher with badly trained, inexperienced surgeons. Not even the luminaries of the world can free themselves completely from all complications; though well-trained and experienced plastic surgeons in principle only come across so-called minor complicatons which are less frequent and we are trained in ways to work against them. It's a question of legislation as any doctor in Germany can carry the title "beauty surgeon". This is what most so-called "black sheep" do. The shadow of operational failures however spreads across the entire profession.

In any - not only aesthetic - operation, the surgeons themselves are the highest risks. If they are not well trained or without experience, if they are not aware of their own shortcomings - maximum caution must be taken.

We also have to tell our patients about the possibility of death. Not only can a person die, for example, of thrombosis-embolism, but also of thrombosis prophylaxis itself (HIT Heparin-induced Thrombocytopenia) 2-3 in 1,000,000 cases die. Though statistically tiny, the surgeon has an obligation to make sure their patients are aware of this. Logically we should fear our own bed most - as most people die in their own beds.

I have integrated into my agreement form a fairly comprehensive list of complications which are read out to every patient at the end of the consultation as a "legally prescribed shock list". I thought I had thus covered all possible complications. One patient once told me otherwise. At the end of the consultation she asked me: "And, Doctor, what will happen if you die during the operation?" - "Well, you will have to shed tears for me."

In fact, even this is taken care of by state concession rules: A hospital, no more than three kilometers away, is by contract obliged, if necessary, to take over the intensive treatment of our private clinic's patients.