ABPS Ethics & Professional Standards in Plastic Surgery 4 — Questions and Answers
Question 1: A plastic surgeon is asked by an employer to perform procedures on employees as a condition of their employment contract. The surgeon's primary ethical obligation is to:
- Comply because the employer is the client in occupational medicine
- Ensure each employee voluntarily consents without employer coercion (Correct answer)
- Refuse all employer-directed medical care as inherently unethical
- Perform only OSHA-mandated screenings and not elective procedures
Correct answer: Ensure each employee voluntarily consents without employer coercion
Voluntary consent free from employer coercion is essential; surgeons must ensure employees are not pressured into procedures as a job condition.
Question 2: Which practice best exemplifies the ethical principle of justice in a plastic surgery practice?
- Offering premium services exclusively to patients who can afford them
- Providing pro bono care or reduced fees to underserved populations (Correct answer)
- Prioritizing complex cases for personal skill development
- Accepting only patients whose conditions are straightforward
Correct answer: Providing pro bono care or reduced fees to underserved populations
Justice in medicine requires fair distribution of care, including participation in pro bono or reduced-fee services for underserved populations.
Question 3: A patient requests that their reconstructive breast surgery be documented only with the diagnostic code for cosmetic surgery to reduce insurance scrutiny. The surgeon should:
- Comply if the patient signs a waiver releasing the surgeon from liability
- Refuse because falsifying medical records or insurance claims is fraud (Correct answer)
- Comply if the request does not affect the patient's premium
- Ask the billing department to handle it without involving the surgeon
Correct answer: Refuse because falsifying medical records or insurance claims is fraud
Falsifying diagnostic codes constitutes insurance fraud and violates medical ethics regardless of patient request or motivation.
Question 4: When a plastic surgeon transfers care of a patient mid-treatment to another provider, the ethical requirement is to:
- Provide adequate notice and facilitate a smooth transition to ensure continuity of care (Correct answer)
- Transfer only after the acute treatment phase is complete
- Require the patient to find a new surgeon independently
- Notify the patient by certified mail and then end the relationship
Correct answer: Provide adequate notice and facilitate a smooth transition to ensure continuity of care
Surgeons must give adequate notice and facilitate care transition to avoid patient abandonment and ensure continuity of treatment.
Question 5: A plastic surgery resident performing a procedure exceeds their supervised scope and causes a complication. The attending surgeon's primary ethical responsibility is to:
- Allow the resident to manage the complication independently to build competence
- Take over management and ensure the patient is fully informed (Correct answer)
- Report the resident to the program director without informing the patient
- Document the event and defer disclosure pending outcome
Correct answer: Take over management and ensure the patient is fully informed
The attending must assume direct responsibility for patient care and ensure the patient receives full disclosure about what occurred.
Question 6: Regarding the use of non-FDA-approved fillers obtained from compounding pharmacies, a plastic surgeon's ethical and legal obligation is to:
- Use them freely because compounded products are physician-directed
- Avoid them unless a specific patient need cannot be met by approved alternatives (Correct answer)
- Use them only in accredited operating room settings
- Require patients to sign additional consent forms and then proceed
Correct answer: Avoid them unless a specific patient need cannot be met by approved alternatives
Compounded injectables should only be used when FDA-approved alternatives cannot meet a specific patient need, as they carry additional risk and regulatory uncertainty.
Question 7: A plastic surgeon maintains a teaching file of operative photographs for educational presentations. Which practice is ethically required?
- Use of deidentified images or written patient authorization for identifiable images (Correct answer)
- Institutional approval is sufficient without individual patient consent
- Patient consent is only required if images will be published in journals
- Images may be used freely within the same hospital system
Correct answer: Use of deidentified images or written patient authorization for identifiable images
Patient authorization is required for identifiable images in any educational setting, or images must be fully deidentified to protect patient privacy.
ABPS Ethics & Professional Standards in Plastic Surgery 4
A plastic surgeon is asked by an employer to perform procedures on employees as a condition of their employment contract.
The surgeon's primary ethical obligation is to: