Concern About Quality
Hair Transplant Forum International. Volume 4, Number 3 - May-June 1994
Concern About Quality
by William R. Rassman, M.D. New Hair Institute - Los Angeles, CA
I am concerned about two areas. The first reflects the quality of the work some of our colleagues are producing. This type of work is the result of:
1) ignorance
2) poor training
3) unscrupulous promoters who are in it for the $$$ without concern for patient outcome.
Some non-physician promoters use contracting physicians to actually deliver the medical service after salesmen "sell" hair transplants ( an illegal process inside a medical practice in most states) without true informed consent. The improper use of salesmen are also commonly found in medically owned clinics despite its illegitimacy in most states. The issue I am raising here is that the quality of the work performed must be closely tied to the representations that are made. Both substandard or deforming work, or creating false expectations reflect unacceptable behavior and violate the oaths we have taken.
The time has come where we must take a stand on quality both morally and medically. I am writing this in the hope that many ethical practitioners in our field will take an active role in dealing with the issue of ethical marketing practices and quality outcomes. e.g. I recently had a patient who sought a second opinion on a potential 'malpractice' action against a doctor who performed LASER hair transplants and caused extensive third degree burns to the scalp. I agreed to call the doctor to arrange for a return of the patient's money. This diffused a malpractice action. It seems that anyone who declares themselves hair transplant specialists seem to be able to promote themselves to a vulnerable and naive public, even with little experience or training in the area.
When appropriate, we might consider what to do if we see: routine and overt false and misleading advertising; substandard work repetitively performed by particular practitioners; and evidence of a routine misrepresentation in presentation to patients (inadequate 'informed' consent)
We can be helpful by telling dissatisfied patients that they can notify the State Medical Boards if doctors or clinics are not acting responsibly. The various state licensing boards will act and conduct an appropriate investigation. I was recently investigated by the California Medical Board (induced by a complaint of a competitor of mine in Los Angeles). I made an error in an advertisement where I did not identify myself. This was a violation of California law and I stepped forward and took responsibility for the error. Having my 'wrist slapped' was a humbling experience, but I found the investigation to be fair and proper.
The second area of concern reflects the rapid changes now occurring in the Megatransplant area. With traditional grafting, quality of the grafts was a relatively easy area to control and safety of the procedure was rarely a health problem. Graft preparation takes hours of work and many, many people. Quality control mechanisms must be put into practice for 'production quantities' of grafts, something not required for 'drilled' grafts taken directly from the donor site. The safety issue, however, may be more difficult to address as bleeding, swelling, and the systematic effects of medications used in the process may take what was a simple, safe procedure into a life threatening surgery. Moving from the standard hair transplant quantities with larger grafts to very large quantities of very small grafts is a significantly more complex and intricate process than most practitioners realize.
As physicians, we have the obligation and responsibility to take such actions as are necessary to protect the public and to educate our colleagues. It is only a matter of time until unscrupulous entrepreneurs (which, unfortunately, abound in the hair restoration business) bring publicity which will damage the good work that ethical practitioners have worked so hard to establish. I believe that much of the substandard work being done reflects substandard education in the field. The extension of the Megatransplant process without adequate education will, sooner or later, cause the unnecessary death of some poorly informed patient. A proper dialogue through the FORUM might be beneficial to us all and ideas on this very important issue is worthy of our attention and efforts through an exchange of ideas. If we do not do it ourselves, the media or regulatory authorities will, sooner or later, do it for us.
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