Are Required Health Exams Before Plastic Surgery A Good Idea?

It was a headline that caught the attention of both plastic surgeons and those interested in plastic surgery: In June, the California State Legislature began work on a bill which would require that patients get a physical before they're eligible for elective cosmetic surgery. The first senate committee has already passed the bill; next, it has to pass the full senate.

The measure was introduced by Wilmer Amina Carter, a Democratic Assemblywoman from Rialto. She named the bill after Donda West, mother of popular rap singer Kanye West. Donda West received cosmetic surgery in 2007 and passed away soon after.

According to authorities, it was coronary heart disease which caused Mrs. West's death--and the weakened heart was probably not strong enough for the surgery. These same authorities said that the heart disease should have been detected.

Assemblywoman Carter, in crafting the bill, said it was targeting so-called "fly-by-night" doctors who are out to make a quick profit and consequently don't screen their patients adequately for pre-existing health conditions.

Fifteen of the 17 members of the California Medical Board are backing the legislation. However, Governor Arnold Schwarzenegger's administration opposes it. His Department of consumer Affairs says that there are adequate rules already in place.

The Assembly passed the legislation last month in a bipartisan vote. If the bill makes it all the way through, it still faces the possibility of a Schwarzenegger veto (He vetoed a similar one last year).

Meanwhile, plastic surgeons throughout the nation, and others interested in the practice, are watching this with keen interest, since medical and health issues begun in California have a tendency to spread.

So what of this bill--and this idea that plastic surgeons cannot perform a procedure unless there has been a physical done before hand? Is this a good idea or bad one? As with many issues, the answer is not so clear-cut.

First, it is absolutely true that those within this practice should take extreme measures to screen their patients. They must make sure that each patient is a suitable candidate for the procedure he or she is undergoing. This means not just a physical screening, but a psychological one as well. There are probably more people who would be disqualified on psychological grounds than physical ones.

However, adding a layer of bureaucracy onto this profession, making it our responsibility to check into the patient's current affairs, making sure they're getting proper medical attention seems beyond the scope of what we ought to be required to do. Yes, we should ask patients about their history, but I don't know if we should become government enforcers.

A better solution would be for the relevant associations, such as the ABPS, to pass guidelines requiring that plastic surgeons properly screen patients or risk losing their affiliation. This would motivate surgeons to do their job right, without forcing us into the role of government watchdogs.