Below is the full text of the brief interview I had with the Straits Times. I am to be honest not persuaded at this point in time that liposuction needs further tightening of rules. Ideally, it should be an honest assessment of risk versus benefit. But data are so sparse here. One death is a tragedy, no doubt, but for public policy, a denominator, i.e. the total number of liposuctions performed in Singapore each year, is needed to appreciate better the magnitude of the issue. How do Singapore doctor compare with peers internationally? If we apply a retrospective test, would this death have been avoided with tighter rules imposed on the doctor performing the procedure? If plastic surgeons are indeed achieving better outcomes, why is it so? Can the factors contributing to superior outcomes be replicated in non-plastic surgeons?
I am struck by the uncanny coincidence that the article on liposuction appeared on the same page as Minister Vivian Balakrishnan’s exhortation to doctor to take care of their patients’ wallets too. Previous reports suggest plastic surgeons charge about double what non-plastic surgeons charge. A government-sanctioned specialty monopoly would undoubtedly raise prices; it must be demonstrated to improve quality commensurately.
Email Interview with Straits Times
From a health policy perspective, what is your view on the progressively tightened rules on liposuction in recent years?
I can’t comment specifically on liposuction as I am not familiar with the technical aspects. In general, as health systems attain higher levels of sophistication, standards should and do get raised. The challenge is striking the right balance between safety and quality AND regulations not being so onerous to the point that it impedes the practice of medicine or stifles innovation and improvement.
What is the likely impact on industry standards or patient safety, for example?
Well-constructed regulations and standards help uplift the entire industry and protect patients’ best interests. That said, governments need to be careful about not inadvertently creating excessive barriers to practice and specialty monopolies that would raise prices for patients.
It has been raised several times that liposuction appears to be the only practice that is subject to such guidelines, and also one of the few specialist procedures that is extended to non-specialists. For instance, a general surgeon would not be allowed to deliver babies by taking an additional one-year training in obstetrics. But this can technically be done for liposuction, where non-plastic surgeons can obtain a diploma or attend courses to offer the procedure.
In the wake of the second liposuction, do you think it will be beneficial to re-examine this rule? Could it help to prevent further mishaps?
It is always good to review rules and policies on a regular basis. In this particular case, the question needs to be asked whether a higher standard of surgical training or qualification would have made a difference. In some of the cases that have occurred, it appears that the issue is not with the surgical expertise but rather with the management of anesthesia including the airway.
If that is the case, then the policy makers need to determine whether the risks justify mandating that an anesthetist must be present or some other measures to augment anesthetic management. Such rules would raise costs naturally and be ‘overkill’ for some procedures while medically necessary for others. A balance needs to be struck bearing in mind also that contained within the term ‘liposuction’ is a spectrum of complexity and technical difficulty. It would be near impossible to completely regulate away risk in surgery.
I am researching for a lengthy analysis of the history and motivations for tightening of safety rules for liposuction and would be grateful for any comments and perspectives.