Secrets of a Beverly Hills Cosmetic Surgeon

Communication lapses, not technical errors, cause 70% of serious complications.

How well does your medical team communicate? It is very important that the communication route between patient and doctor be open and clear. All experienced practitioners know of stories where communication difficulties between doctors and nurses or doctors and pharmacies or doctors and patients or pharmacies and patients led to disastrous results. Things need to be checked, double-checked and re-checked. Failsafe systems must be in place.

Just today, I was discussing this subject with a nursing supervisor (also a professor of nursing at a local university) at a major hospital in Florida where my father was hospitalized. She agreed with my observations and concerns.

Today’s medical care – despite great technologic capabilities – can be very disjointed. Doctors rarely practice solo and, therefore, as part of a group, the doctors do not always have 24/7 contact with and availability to patients. When patients are hospitalized, it becomes even more difficult because, now, often internists and family practitioners do not admit and follow the patient in the hospital because of restrictive insurance rules and reimbursements. They now rely on “hospitalists.” A hospitalist is a doctor who cares for patients who have been hospitalized exclusively. The hospitalist figuratively takes the baton from the patient’s primary care doctor to care for the patient when hospitalized and returns the baton when the patient is discharged from the hospital.

The concept of hospitalists very much parallels that of teaching hospital residents providing round-the-clock care for hospital in-patients. The difference is that hospitalists themselves rotate each day or may also have emergency room responsibilities. This means that, often, each day one has a “new doctor” caring for him.

There can be serious lapses in continuity of care and this is not healthy.

In our world of surgery, staff turnover in the operating room, or the use of different anesthesiologists, can set the stage for communication errors that can have significant if not catastrophic consequences.

For all these reasons, I like to work with the same staff day in and day out. We use the same small core of anesthesiologists and the same operating room assistants and nurses. My office staff communicates well with the administrative staff of the surgery centers because in both our office and surgery center, our people have been present for many years and know what needs to be done.

So remember, when you visit an office for consultation, my friend, keep your eyes and ears open. Get a sense of how well the office works. Does the staff communicate well with each other and the doctor? Are phone calls returned promptly? Are promises fulfilled?

Typically, the doctor sets the tone both in the operating room and in the office. The office is an open barometer of how the practice functions. So before you sign up for surgery, make sure you feel you are in the right shop with the right staff with the right stuff.

- Robert Kotler, MD, FACS

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