I belong to two societies for Board Certified Plastic Surgeons. One is ASPS, our general society. The other is the Aesthetic Society. Both have come out with recommendations for elective surgery in the time of Covid 19. The Aesthetic Society just came out with their sample consent form. I already published a consent from the ASPS, but I write this blog because the Aesthetic Society consent was more detailed.
Perhaps because the Aesthetic Society is geared toward elective cosmetic surgery, not medically necessary surgeries like breast cancer reconstruction, they had more details on what to do before surgery to make sure you are safe, and they focused on your personal responsibility as a patient to make sure you are safe. They advocate for 14 days of sequestering. They emphasize you must comply with your doctor’s orders (masks, hygiene, distancing, testing.) And they emphasize you must be honest. This is NOT a time to make a “little white lie.”
There is a lot of hubbub in the news of people thinking Coronavirus isn’t dangerous or people are overreacting. For elective plastic surgery, I believe you must err on caution. Why?
- Intubation during a surgical procedure puts the entire OR staff at risk: Anesthesiologist, Nurse, Scrub Tech, Surgeon. There is a lot of data that a procedure which can aerosolize the virus, in a small enclosed space, in close proximity is the highest risk of transmission.
- Other surgical patients and staff are put at risk.
- Many people are asymptomatic when first infected, but then get symptoms. The symptoms can be severe: muscle aches, fevers, trouble breathing, low oxygen levels. If this hits while you are healing from surgery, you will not heal well.
- There are many indications that active Coronavirus Covid 19 may cause blood clots. This can increase your risk of heart attack, stroke, blood clot in the leg (DVT), blood clots in the lung (Pulmonary embolism), or TISSUE LOSS. This means if you are doing a breast reduction, abdominoplasty, breast lift, or facelift, you could lose some or all of your skin flap, breast tissue, or nipple.
- You need oxygen to heal. Period. If you have a low oxygen level, you are at higher risk for skin and tissue loss, poor healing, wider scars, and infection. Many people with active coronavirus have low oxygen saturations and THEY DON’T FEEL IT. There are many stories of people with oxygen saturations in the 70s who have no idea it is so low.
Some excerpts from the consent are listed below.
I don’t bring all of this up to be overly protective, or political, or anything other than to MAKE SURE YOU & MY COWORKERS ARE SAFE. If you feel the protocol we are going to follow is too restrictive, then please do not have surgery with me. I, as your plastic surgeon, am going to do everything I possibly can to make sure you have a safe, boring, uneventful surgery.
To reduce the possibility of COVID-19 exposure or transmission at my Doctor’s office, I accept that my Doctor will implement infection-control procedures with which I must comply, before, during and after my consultation and/or procedure, for my own protection as well as that of my Doctor. I understand my cooperation is mandatory, whether or not I personally feel such COVID-19 procedures and/or preventive measures are necessary.
I have informed my Doctor of any COVID-19 testing I or any person living with me during the past 14 days has received, as well as the results of that testing, and if I am tested between now and the date of my procedure, I will immediately provide the results of that testing to my Doctor. I understand my Doctor may require that I be tested, possibly at my own expense and regardless of any prior testing, and that the results of that testing must be satisfactory to my Doctor, before I may receive my procedure.
I confirm neither I nor any individual living with me has any of the COVID-19 symptoms listed by the Centers for Disease Control https://www.cdc.gov/coronavirus/2019-ncov/downloads/COVID19-symptoms.pdf, which website I have consulted; neither I nor any individual living with me during the past 14 days has experienced any such symptoms; and that I and all persons living with me for the past 14 days have practiced all personal hygiene, social distancing and other COVID-19 recommendations contained within all governmental orders issued by my city and state. I understand I must honestly disclose this information to avoid putting myself and others at risk.