ABCS Ethics, Safety, and Patient Management in Cosmetic Surgery 2 — Questions and Answers
Question 1: A patient with Body Dysmorphic Disorder (BDD) requests rhinoplasty. What is the most appropriate action?
- Proceed if the deformity is objectively visible
- Refer the patient to a mental health professional before considering surgery (Correct answer)
- Perform a limited procedure to address the patient's main concern
- Decline all future consultations with this patient
Correct answer: Refer the patient to a mental health professional before considering surgery
BDD is a contraindication to cosmetic surgery; patients should receive psychiatric evaluation and treatment before any surgical consideration.
Question 2: Which principle of biomedical ethics requires a surgeon to act in the patient's best interest, even when it conflicts with the patient's own wishes?
- Autonomy
- Justice
- Beneficence (Correct answer)
- Non-maleficence
Correct answer: Beneficence
Beneficence obligates the physician to promote the patient's well-being, which may at times require counseling against a requested procedure.
Question 3: Under the ABCS Code of Ethics, advertising that uses before-and-after photos must:
- Only show the surgeon's own patients with documented consent
- Be reviewed by the state medical board before publication
- Include a disclaimer that results are not guaranteed for all patients
- Both A and C (Correct answer)
Correct answer: Both A and C
Ethical advertising requires photos to be of the surgeon's own patients with informed consent AND a disclaimer that individual results vary.
Question 4: A cosmetic surgeon discovers intraoperatively that the planned procedure is insufficient to achieve the agreed result. The best course of action is to:
- Extend the procedure as needed to achieve the best outcome
- Complete only what was consented to and discuss modifications postoperatively (Correct answer)
- Document the finding and cancel the case
- Delegate completion to a resident
Correct answer: Complete only what was consented to and discuss modifications postoperatively
Performing only what was consented to preserves patient autonomy; material changes require new informed consent obtained preoperatively.
Question 5: What is the primary purpose of a surgical timeout (Universal Protocol) immediately before a cosmetic procedure?
- To bill the correct CPT code
- To confirm patient identity, procedure, and site before incision (Correct answer)
- To obtain final consent from the patient
- To document anesthesia type in the medical record
Correct answer: To confirm patient identity, procedure, and site before incision
The Universal Protocol timeout is a patient safety checkpoint to prevent wrong-patient, wrong-site, and wrong-procedure errors.
Question 6: A patient who underwent rhinoplasty is dissatisfied with results. She threatens to post negative reviews unless a revision is performed for free. The surgeon should:
- Offer a discounted revision to preserve the practice's reputation
- Perform the free revision to avoid a lawsuit
- Address clinical concerns honestly, document the interaction, and not capitulate to coercion (Correct answer)
- Dismiss the patient from the practice immediately
Correct answer: Address clinical concerns honestly, document the interaction, and not capitulate to coercion
Yielding to extortion undermines professional integrity; the surgeon should respond clinically, document the threat, and seek legal counsel if needed.
Question 7: Which of the following best describes the 'reasonable patient' standard for informed consent in cosmetic surgery?
- Disclosure of information that a typical surgeon would share
- Disclosure of all information a reasonable patient would consider material to their decision (Correct answer)
- Disclosure limited to FDA-approved indications only
- Verbal consent witnessed by a nurse is sufficient
Correct answer: Disclosure of all information a reasonable patient would consider material to their decision
The reasonable patient standard requires disclosing all information a reasonable person in the patient's position would deem significant in deciding whether to consent.
ABCS Ethics, Safety, and Patient Management in Cosmetic Surgery 2
A patient with Body Dysmorphic Disorder (BDD) requests rhinoplasty.
What is the most appropriate action?