Abdominoplasty, Anorexia and Ethics

[Halinja]

I'm a little disappointed in one of our surgeons. Today he did abdominoplasty on a 110 lb anorexic. Not even a recovered anorexic, but someone still strongly in the grip of the disorder. The pt doesn't even want to eat a cracker with the oral pain meds.

It feels so wrong. The pt already has a hugely distorted body image. By doing the surgery he has played into the pt's delusion. Reinforced it, even. And on a different level...the pt apparently hasn't eaten for two weeks. The patient's body was just put under the tremendous stress of major surgery. How is the patient going to heal when the body has no fuel in reserve, and the patient won't take in any fuel?

Disappointed may be a little bit of an understatement...

[TiredMD]

Fair enough.

But aren't you making presumptions when you say "I find it more likely that this is a postop nurse who made assumptions......" :)

I suppose I am, but that's because the story just doesn't add up in my head. Multiple health care professionals carrying out an inappropriate elective procedure on an inidividual who is at high risk for perioperative death? I just felt like a little more context was needed before it was accepted at face value.

It surely requires a little more details, but face value is all we get at Allnurses when patient confidentiality is involved.

I have to accept at face value that the op knows the person is an active anorexic even at a healthy weight of 110 pounds.

Hmm, I can't do that with the internet, or actually in life at all. How many times have you had a patient who said, "The last time I was in the hospital my nurse refused to give me my medicine" or "When my mom was in the hospital her nurse murdered her." I just roll my eyes unless I get something a little more substantial.

When I presume that the 110 person needs counseling rather than plastic surgery I'm taking a leap and I admit that.

I never said the surgery was unsafe or didn't meet acceptable standards of care. However, at face value, it does violate my own personal ethical values.

Actually, if this story is true (and honestly, I'm still not buying) it is a gross example of malpractice and possibly professional misconduct. That's why I'm still pushing this point. I really want to know.

[Tweety, BSN, RN]

I suppose I am, but that's because the story just doesn't add up in my head. Multiple health care professionals carrying out an inappropriate elective procedure on an inidividual who is at high risk for perioperative death? I just felt like a little more context was needed before it was accepted at face value.

I've seen a few questionable surgeries in my time, that indeed do make it by multiple health care professionals, but question my personal ethics. Such as a 100 year old who had a vulvectomy (true story) or a dying person having a total pelvic exoneration (never made it out of the hospital), just to name a few. Perhaps all these health care professionals are merely carrying out the patients wishes, but it still doesn't make it right in my mind.

Hmm, I can't do that with the internet, or actually in life at all. How many times have you had a patient who said, "The last time I was in the hospital my nurse refused to give me my medicine" or "When my mom was in the hospital her nurse murdered her." I just roll my eyes unless I get something a little more substantial.

Fair enough. We do indeed have to filter through what we accept as face value and what we blow off as b.s. :) In this case, it's a member that's been around a couple of years, with an intelligent posting history that I trust.

[loricatus]

I find it unlikely that a surgeon, anesthesiologist, and hospital would all sign off on a high-risk cosmetic surgery that clearly violates standards of acceptable care. Making a claim like this begs questions about background. I find it more likely that this is a postop nurse who made assumptions about a patient's background, rather than possessing real knowledge, which is why I asked.

I'm amazed you would take a story like this at face value.

Don't be so sure of yourself. I see it all the time where I work now. Money motivation and greed at the expense of a patient's wellbeing is the norm where I am. Can't go into more details; but, if I could, it would make the hair on the back of your head stand up!

Edited to add: ASA scores of 4 and even 5 are the norm for many getting elective procedures in my facility-scary, isn't it?

[Halinja, BSN, RN]

Thank you Tweety and Loricatus for your comments.

I did not make a diagnosis of anorexia, it is in her physical history in her chart. Some information given was chart and report based, some based on information received directly from the patient. Obviously I cannot tell every detail that I know, patient privacy is more important than me 'defending' my comments or judgments.

To assume that without exception all medical personnel have only the purest of motives might be considered naive.

I work in a for-profit freestanding surgical center. We do not have an 'ethics committee' that reviews cases for their appropriateness. As it was, a variance was filed with our safety director.

[northshore08]

Halinja, thanks for the response. That answered my questions. Good luck to you; watch out for yourself.

[Kolohe99]

My wife had bulimia when we first married. It took years of love and support and separation from an abusive step father before she started to come to grips with the problem. Even then, it was her love and the need to care for the child in her womb after she became pregnant that finally helped her to overcome the disorder. Surgery, even if she wanted it, wouldn't have been the answer. It would have been a tremendous waste of resources that could have been better used in attacking the root cause of the problem. Based on the information given, I feel inclined to agree with Halinja; I feel more than disappointment toward the surgeon.

[loricatus]

Thank you Tweety and Loricatus for your comments.

I did not make a diagnosis of anorexia, it is in her physical history in her chart. Some information given was chart and report based, some based on information received directly from the patient. Obviously I cannot tell every detail that I know, patient privacy is more important than me 'defending' my comments or judgments.

To assume that without exception all medical personnel have only the purest of motives might be considered naive.

I work in a for-profit freestanding surgical center. We do not have an 'ethics committee' that reviews cases for their appropriateness. As it was, a variance was filed with our safety director.

Work at one of those places, too. They even have a small hospital with admissions because there is no way some of those they operate on can go home.

You really don't have to explain yourself to anyone. SOME with limited exposure to what is out there will be quick to make assumptions based upon their limited perspective. It isn't your problem that they are making judgments from a narrow point of view, as they will someday learn that the world is bigger than what they can see (I hope).

[TiredMD]

You really don't have to explain yourself to anyone. SOME with limited exposure to what is out there will be quick to make assumptions based upon their limited perspective. It isn't your problem that they are making judgments from a narrow point of view, as they will someday learn that the world is bigger than what they can see (I hope).

Your veiled comment is amusing.

Sorry if asking a few simple questions made you feel threatened.

[Tweety, BSN, RN]

Your veiled comment is amusing.

Sorry if asking a few simple questions made you feel threatened.

I found your questions appropriate and they stimulated conversation, clarification and thought. Interesting how different people read the same posts.

[BBFRN, BSN, PhD]

I'm wondering if the chart just said 'anorexia,' as opposed to 'anorexia nervosa?'

[Tweety, BSN, RN]

I'm wondering if the chart just said 'anorexia,' as opposed to 'anorexia nervosa?'

Good point. Still if someone is 110 pounds and has anorexia, i.e. poor appetite is that the time to do an abdominoplasty?

[BBFRN, BSN, PhD]

I see what you're saying, Tweety- but 110 lbs isn't descriptive enough. We don't know what her BMI is (or I just overlooked it, which is entirely possible).