ABCS Ethics, Safety, and Patient Management in Cosmetic Surgery 3 — Questions and Answers
Question 1: A surgeon is asked by a pharmaceutical company to include their implant in all augmentation cases in exchange for travel sponsorship. This arrangement is best classified as:
- A legitimate professional development opportunity
- A conflict of interest that must be disclosed to patients (Correct answer)
- Standard industry practice requiring no disclosure
- Permissible if the implant is FDA-approved
Correct answer: A conflict of interest that must be disclosed to patients
Financial relationships with device manufacturers constitute conflicts of interest that must be disclosed to patients and, where applicable, to institutions.
Question 2: Which ASA physical status classification is generally considered the upper limit of acceptability for elective outpatient cosmetic procedures?
- ASA I
- ASA II
- ASA III (Correct answer)
- ASA IV
Correct answer: ASA III
ASA III patients (severe systemic disease) may be acceptable in a fully equipped surgical facility, but ASA IV represents prohibitive risk for elective outpatient cosmetic cases.
Question 3: A patient signs a consent form but later states she did not understand the risks because they were explained in medical jargon. The consent is most likely:
- Valid because the signature is on file
- Invalid because true understanding was not achieved (Correct answer)
- Valid if a witness co-signed the form
- Invalid only if the patient is non-English speaking
Correct answer: Invalid because true understanding was not achieved
Informed consent requires comprehension, not just signature; consent obtained without patient understanding is ethically and legally insufficient.
Question 4: When is it ethically permissible to share identifiable patient photos with a colleague for educational purposes?
- Always, when shared within a professional setting
- Only with the patient's explicit written consent (Correct answer)
- When the face is blurred or cropped
- When the educational benefit outweighs the privacy risk
Correct answer: Only with the patient's explicit written consent
HIPAA and ethical standards require explicit written authorization from the patient before identifiable clinical images may be shared, even for education.
Question 5: A patient discloses active cocaine use at the preoperative visit. The safest course is to:
- Proceed if the patient promises to abstain 24 hours before surgery
- Postpone surgery and refer for substance use evaluation (Correct answer)
- Reduce the anesthetic dose to compensate
- Perform the case under local anesthesia only
Correct answer: Postpone surgery and refer for substance use evaluation
Active cocaine use markedly increases cardiovascular and anesthetic risks; surgery should be postponed until sobriety is established and medically cleared.
Question 6: Which documentation practice best protects against allegations of inadequate informed consent in cosmetic surgery?
- Having the patient initial each page of a pre-printed form
- A detailed note confirming the discussion of risks, benefits, alternatives, and patient questions with the patient's own words recorded (Correct answer)
- A witnessed consent signature obtained on the day of surgery
- Use of a standardized consent form approved by the state medical board
Correct answer: A detailed note confirming the discussion of risks, benefits, alternatives, and patient questions with the patient's own words recorded
A contemporaneous, detailed physician note documenting the consent discussion is stronger evidence than a form signature alone.
Question 7: Under what circumstance may a cosmetic surgeon ethically perform surgery on a patient who cannot provide their own consent?
- Never, cosmetic surgery is always elective
- When a legally authorized surrogate provides consent and surgery is in the patient's best interest (Correct answer)
- When the patient has previously expressed general desire for the procedure
- When family members unanimously agree to the procedure
Correct answer: When a legally authorized surrogate provides consent and surgery is in the patient's best interest
A legally authorized surrogate (e.g., healthcare proxy or guardian) may consent for an incapacitated patient if surgery is deemed in the patient's best interest.
ABCS Ethics, Safety, and Patient Management in Cosmetic Surgery 3
A surgeon is asked by a pharmaceutical company to include their implant in all augmentation cases in exchange for travel sponsorship.
This arrangement is best classified as: