ASPS Patient Safety, Ethics & Management 3 — Questions and Answers
Question 1: A patient requests a procedure that the surgeon believes is not in the patient's best medical interest. The most ethically appropriate response is to:
- Perform the procedure since patient autonomy is paramount
- Refuse without explanation to avoid encouraging unrealistic expectations
- Discuss concerns openly, explain the risks, and decline if the procedure is medically contraindicated (Correct answer)
- Refer to another surgeon without disclosing the reason
Correct answer: Discuss concerns openly, explain the risks, and decline if the procedure is medically contraindicated
Surgeons must respect autonomy while upholding beneficence; open discussion and refusal if medically contraindicated is ethically appropriate.
Question 2: Which of the following best describes the Caprini Risk Assessment Model in plastic surgery?
- A scoring system to predict postoperative infection rates
- A validated tool to stratify patient VTE risk and guide prophylaxis decisions (Correct answer)
- A measure of anesthetic complexity for office-based procedures
- A scale for assessing patient psychological readiness for cosmetic surgery
Correct answer: A validated tool to stratify patient VTE risk and guide prophylaxis decisions
The Caprini model is a validated preoperative scoring tool that stratifies VTE risk and guides chemoprophylaxis and mechanical prophylaxis decisions.
Question 3: Which medication interaction poses the greatest risk of intraoperative bleeding in a facelift patient?
- Acetaminophen combined with ibuprofen
- Aspirin continued through the perioperative period (Correct answer)
- Topical vitamin E applied to the skin postoperatively
- Oral antihistamines taken the night before surgery
Correct answer: Aspirin continued through the perioperative period
Aspirin irreversibly inhibits platelet cyclooxygenase, significantly increasing intraoperative and postoperative bleeding risk and should be stopped 7–10 days preoperatively.
Question 4: A surgeon discovers intraoperatively that the anatomy differs significantly from what was discussed with the patient preoperatively. The correct action is to:
- Proceed with the original plan regardless of the anatomic finding
- Complete the procedure using the surgeon's best judgment and disclose postoperatively
- Stop the procedure, close safely, and obtain updated consent before proceeding at a later date if indicated (Correct answer)
- Ask the anesthesiologist to contact a family member for telephonic consent
Correct answer: Stop the procedure, close safely, and obtain updated consent before proceeding at a later date if indicated
When unexpected significant findings change the nature of the procedure beyond the original consent, the safest ethical course is to close and obtain proper updated consent before proceeding.
Question 5: According to ASPS guidelines, advertising for plastic surgery services must NOT:
- Include before-and-after photographs with patient consent
- State board certification in plastic surgery
- Guarantee specific outcomes or use misleading before-and-after images (Correct answer)
- Mention financing options available to patients
Correct answer: Guarantee specific outcomes or use misleading before-and-after images
ASPS prohibits advertising that guarantees results or uses deceptive imagery because surgery outcomes vary and guarantees create unrealistic patient expectations.
Question 6: A patient with a documented penicillin allergy requires prophylactic antibiotics before breast implant surgery. The most appropriate alternative is:
- Cephalosporin administered without concern since cross-reactivity is rare
- Clindamycin or vancomycin as penicillin-allergy-safe alternatives (Correct answer)
- No prophylaxis since implant surgery carries minimal infection risk
- Double-dose oral amoxicillin to overcome the allergic threshold
Correct answer: Clindamycin or vancomycin as penicillin-allergy-safe alternatives
Clindamycin or vancomycin are recommended for penicillin-allergic patients requiring surgical prophylaxis, with vancomycin preferred when MRSA coverage is needed.
Question 7: Which principle of medical ethics is most directly violated when a surgeon performs an elective procedure on a patient who has not received adequate preoperative information?
- Justice
- Non-maleficence
- Autonomy (Correct answer)
- Beneficence
Correct answer: Autonomy
Informed consent is the procedural mechanism for respecting patient autonomy; operating without adequate disclosure violates the patient's right to self-determination.
ASPS Patient Safety, Ethics & Management 3
A patient requests a procedure that the surgeon believes is not in the patient's best medical interest.
The most ethically appropriate response is to: