Your "Board Certified" Surgeon Might Not Be Who You Think

Dr. Christopher Chang (00:04):
You are listening to Secret Services where we discus the procedures nobody admits to, but everyone's curious about. I'm your host, Dr. Christopher Chang. So I'm Dr. Chang.

Jackie O'Brien (00:15):
And I'm Jackie.

Dr. Christopher Chang (00:17):
We talked a lot on the show about what patients don't ask about before surgery, but today we're going to tell you what you should ask. So Jackie, you worked across plastic surgery, trauma surgery, vascular, general surgery. We talked about some of the things you've experienced in your career and you've seen a lot of different surgeons.

Jackie O'Brien (00:34):
Yep.

Dr. Christopher Chang (00:36):
So is there any way to tell when you're in the operating room and you are getting the feeling that maybe something isn't going right or someone is in over their head? Have you had that experience before?

Jackie O'Brien (00:49):
Yes, many times. It's

Dr. Christopher Chang (00:52):
Not a good feeling.

Jackie O'Brien (00:53):
It's not a good feeling. It's a scary feeling. And it's also one of those times where your role as a nurse really comes into play because I do feel it is your responsibility to speak up and you need to put the surgeon's feelings aside. There's been times where I can tell that things aren't great and I've never regretted going to someone and saying something. But yeah, you can usually tell pretty quickly when the surgeon is definitely experiencing something that they didn't anticipate. So I think it also helps having experienced people in the room to pick up on those cues and kind of know.

Dr. Christopher Chang (01:36):
Yeah. You have to have been there before a little bit.

Jackie O'Brien (01:37):
You

Dr. Christopher Chang (01:38):
Have to know what it feels like a normal routine even in your position, not at the table if you're circulating or if you are at the table as a scrub nurse.

Jackie O'Brien (01:46):
Yeah.

Dr. Christopher Chang (01:47):
You have to know what feels routine and normal.

Jackie O'Brien (01:51):
Everyone in that room is important and having a good skill level for everyone in the room is very important. So we can all recognize and help to the best of our ability, help the surgeon do their best job.

Dr. Christopher Chang (02:06):
Right. There's a lot of people there to help and support, which is also great. But everybody handles pressure a litle bit differently and I think that's an important thing to understand is make sure you're comfortable with the people you're working with that you can keep each other safe and out of trouble as well as obviously the patient. And it's a really important skillset to have that experience to understand how to handle things that are not the smooth that sometimes it still navigate to a safe landing

Jackie O'Brien (02:35):
Essentially. And so that leads me to this anonymous patient question. My mom needs breast reconstruction and her insurance only works with a few surgeons. We don't know how to evaluate whether this doctor is actually qualified to do this specific procedure. How do I know if they're good?

Dr. Christopher Chang (02:52):
Well, a couple of things. The question has a couple parts. First is who's in my network? The insurance company's already narrowed your choices. So if you are doing something that's elective and you can choose from anybody who accepts self-cash, self-pay, that opens your choices a lot. And then if you are limited to who your insurance will cover, that also narrows your scope. Then from there you have to decide who is well-trained enough to do the surgery that you want. And this is where it comes into play of looking at the background. Are they board certified in the specialty that you're looking for? Or in this case, a breast surgeon. So usually breast cancer works in a team.

Jackie O'Brien (03:40):
Yes.

Dr. Christopher Chang (03:41):
There's the breast surgeon who's a general surgery trained, usually a breast oncology fellowship trained general surgeon. And they will usually refer to a couple different plastic surgeons that do the reconstruction that they work with. The other way would be to ask other plastic surgeons who maybe aren't in breast reconstruction. So there are some who do pediatric plastic surgery or some who do hand plastic surgery or cosmetic plastic surgery and they can say, well, these are the guys and girls who I think are very focused in that area of breast reconstruction. That's another way to get a referral. And once you start hearing the same names, those are usually the ones to go to.

Jackie O'Brien (04:19):
Well, you mentioned board certification. Can you just explain a little what that is, what goes into it and why it's so important?

Dr. Christopher Chang (04:28):
Right. So board certification gets thrown around a lot. A board is an agency that sets forth a series of qualifications that the candidates have to meet the certification. In medical specialties, there's something called the American Board of Medical Specialties or the ABMS. They certify the American Board of Cardiology, American Board of Pediatrics. And one of those boards is called the American Board of Plastic Surgery. That is the only plastic surgery board that is ABMS certified, the only one.

Jackie O'Brien (05:05):
Interesting. So there are other boards.

Dr. Christopher Chang (05:07):
You can have the board of Chang Plastic Surgery or Correctional Plastic Surgery or something and you can make a board and you could set your own qualifications, but of the American Board of Medical Specialties, that's the only one. So that is an important distinction that the American board of plastic surgery likes to make. In order to qualify for that, you have to have had a plastic surgery residency, you have to have a graduate, you have to get certain letters of recommendations, you have to be operating at accredited facilities, you have to have passed both a written exam and an oral exam. So there's rigorous standards to essentially prove that you are not only knowledgeable and competent, but you're also safe. And that's really the major focus of these boards is to make sure that their members are good but also safe. So that's really important.

(06:04):
And so there is no American Board of Breast Surgery. There's no American Board of Breast Reconstruction, but plastic surgery and breast surgery. Breast reconstruction is part of plastic surgery. So that's why you want to make sure that they are board certified. You can look that up on the website. You can ask the office essentially. You can call the American Board of Plastic Surgery and find out if your surgeon is board certified. There's also the American Board of Cosmetic Surgery. That is a

(06:30):
Different board. They have different requirements. You can not be plastic surgery trained and be on the American Board of Cosmetic Surgery.

Jackie O'Brien (06:39):
That's very interesting.

Dr. Christopher Chang (06:41):
You could be a pediatrician or an OBGYN and be part of the American Board of Cosmetic Surgery. So that is an important distinction that the American Board of Plastic Surgery likes to make that they are more focused on the plastic surgery trained members.

Jackie O'Brien (06:55):
So all boards are not created equally?

Dr. Christopher Chang (06:57):
No, they're different and they have different requirements to get there, but they all sound the same when

Jackie O'Brien (07:02):
You- They do. Yeah.

Dr. Christopher Chang (07:03):
Because people just say, "I'm board certified."

Jackie O'Brien (07:05):
It's

Dr. Christopher Chang (07:05):
Like just sort of saying very blanketly, "I have a

Jackie O'Brien (07:11):
Degree." So it's important for the patient to be aware of this and ask the right questions. Which type of board? Make the phone call, go to their website. I think it's pretty simple. You can just go to the website and just put the surgeon's name in and search and it'll come up. So for this patient, breast recon, they would be looking under the plastic surgery. They'd be looking for American Board of Plastic Surgery certification. What other questions would you suggest a patient ask to find out that this surgeon is up to par with this particular surgery that they want?

Dr. Christopher Chang (07:47):
Well, these days breast reconstruction is often specialized in by people who did a fellowship in breast reconstruction. So you might do six or seven years of plastic surgery training and then do an additional year of just specialized breast reconstruction, even though we do a ton of breast reconstruction in our training.

(08:12):
Extra specialization that you're doing literally at a giant cancer center like Sloan Kettering or MD Anderson, and you are just doing breast cancer reconstruction day in, day out, day in, day out for a whole year. So I would personally ask, are they fellowship trained and were the fellowship trained? How long ago that was done? I think there is a good sweet spot of being up-to-date with the recent and most up-to-date techniques. I think you want them to have been in practice for a while. So they've seen some of these bumps in the road that could happen either in the operating room or post-operative care and they can help you navigate through that with some of their experience. I think that you want to make sure that they have a good reputation with the community so that the breast surgeons like the results and continue to refer patients to them.

(09:00):
So those are all good indicators.

(09:05):
And if you know any nurses or people that work in the hospital, they like working with them, that's really pretty important to be honest with you. I think that the people who you don't know, you're not having a conversation with Nurse Jackie, but if you meet her in the clinic or talk a little bit, or you know somebody who knows a nurse who works at that hospital, they say good things, that's a great indicator that they are well like, well respected. So they see the outcomes, they're in the trenches with them. As you said, qualifications are really important, reputation is important. And then lastly, go on a couple consults and see what the chemistry is like. Do they explain things well? Do you feel like you connect? Do they have a plan that you believe in or that you can work together with? So I think those are very good foundational things to pick a good surgeon.

Jackie O'Brien (09:53):
I think also don't just look at straight social media. You might see someone who is projecting themselves on TikTok or Instagram as a certain type of doctor. And then if you go to their website and start looking at where they went to school, what they were actually trained in, it might not be cosmetic surgery, plastic surgery at all. So I think if you like someone's work based off of TikTok or Instagram, dive a little deeper before you hone in on like, "I want this person."

Dr. Christopher Chang (10:21):
Right, exactly. It's one thing to have a very attractive media presence and it's another thing to have the goods to back it up.

Jackie O'Brien (10:30):
Absolutely.

Dr. Christopher Chang (10:31):
I mean, even though it's fun surgery or elective surgery or happiness surgery, it's surgery. It's serious. You got to be as careful with it for cosmetic procedures as well as medical procedures and insurance-based procedures. I think it's important.

Jackie O'Brien (10:50):
So did you see about that doctor in Richmond? Let me tell you a little bit. There's a doctor in Richmond, Virginia. She is now facing lawsuits from 29 women who claim she performed complex breast recon surgeries she wasn't qualified to do. Multiple doctors warned the Virginia Medical Board about Dr. Sasa Gray Espino. The board took no action. CBS six Richmond has been investigating this for months.

Dr. Christopher Chang (11:18):
So I briefly saw parts to this. This doctor is a surgeon in a breast. She was the director of the breast unit or something at

Jackie O'Brien (11:29):
The

Dr. Christopher Chang (11:29):
Hospital. She was a breast surgeon, a general surgery trained breast surgeon who was performing cancer surgery and saying that she was qualified to perform the reconstruction as well.

Jackie O'Brien (11:42):
Yes.

Dr. Christopher Chang (11:42):
And so I'm not sure exactly what the complaints were, but people said that they ended up with essentially mastectomies that they weren't signed up for.

Jackie O'Brien (11:50):
Yeah. There was one a patient had ruptured implants and she thought she was going in to get those removed. And then the surgeon just then also performed bilateral mastectomy while she was in there.

Dr. Christopher Chang (12:06):
For those who don't know, that means that her breasts were removed as if they were cancerous or maybe they did have cancer or something, but you don't remove a part of someone's body without telling them that's the plan.

Jackie O'Brien (12:17):
That

Dr. Christopher Chang (12:17):
Would be a horrible outcome

Jackie O'Brien (12:20):
Apparently she pushed her into it.

Dr. Christopher Chang (12:23):
Oh, okay. Yeah, that's really bad. I think that the doctor obviously has to be a good doctor and recommend the correct treatment plan, but that's a problem. I think the other problem is that the doctor misrepresented herself saying that she could do these reconstructions. And that's actually a really important thing. I often say that this is the purpose of plastic surgery.

(12:51):
You have two doctors and we're treating a problem with cancer. So if I had cancer on my arm and I had an arm doctor that was like, their whole goal is to remove the cancer, well, they would want to remove as much of the cancer as possible and maybe even cut off my whole arm. If I cut off my whole arm, then the cancer's all gone. You're not going to have cancer anymore. However, the other voice is like two parents. The other voice is the reconstructive surgeon saying, "Wait, wait, wait, don't cut off so much that now they're going to have a loss of function or be disfigured. I've got to rebuild that. " So the two parties have opposite goals. One would be as aggressive as possible, the other one's to be conservative and restore and keep you whole. So you have to have those two almost as balancing forces.

(13:40):
And it's important that we think about that and why it's important to have two doctors because their ultimate goal and purpose is different. And we have to think about that it's a good thing to have two doctors instead of being, "Oh,

Jackie O'Brien (13:54):
It's a

Dr. Christopher Chang (13:55):
One-stop shop."That's not good because you can't have both interests competing in your own mind. You have to focus, "I got to get clear margins. I got to make sure the cancer's all gone." And then somebody else thinking, "Oh, I got to really focus on how to rebuild that. " And so I think that's why the two specialty model in cancer care is really important.

Jackie O'Brien (14:15):
I find it to be when a breast surgeon wants to do something like this, it's more out of convenience for them versus there's no outcome different for the patient. Your length of surgery is still going to be the same. You're still having the same procedures done. So why would I need that to be done by one person?

Dr. Christopher Chang (14:34):
Right. They don't want to coordinate their schedule with another doctor or they want, in this case, maybe they want to charge to do the second procedure.

Jackie O'Brien (14:42):
Or maybe they don't have good relationships with the other surgeons, which would be a factor.

Dr. Christopher Chang (14:49):
Well, on the news clip I saw there were other plastic surgeons in the area of Richmond, Virginia that were criticizing this person.

Jackie O'Brien (14:59):
So that's a bit of a red flag. So she was probably doing it in the sense of, "Well, no one else wants to work with me. " And then apparently other surgeons filed formal complaints.

Dr. Christopher Chang (15:09):
Right, right.

Jackie O'Brien (15:11):
And that's a lot as a surgeon to file a complaint against another surgeon, right?

Dr. Christopher Chang (15:18):
Yeah. I think that at least for me as a surgeon and a doctor, you have to have some humility. I think that it's important to understand that there's a lot of things that could happen that are outside of your control. So while I could criticize or reign on my neighbors and say, "I wouldn't have done that on my colleagues in town that may have had a complication," I could be the one that has that complication next because there are factors that are outside patient's behavior, their biology or medical predisposition or my own ability. You can also have some complications. You just have to have some humility. So for me to criticize somebody else would take a lot. It would have to be extremely dangerous, egregious, or scary or something. I would have to say, "Well, that's above my humility. I have to protect the public or something and speak up." And this is probably what these other doctors thought.

Jackie O'Brien (16:16):
Yeah. And so the medical board was notified multiple times and apparently did nothing, which is kind of a scary thought for the general public, right?

Dr. Christopher Chang (16:28):
Yeah. I think the medical board, I haven't served, but I have had many close colleagues on the medical board before and it is a complicated and scary thing because there's going to be a lot of complaints and they have to investigate each complaint, but there's not always a penalty or a sanction. And that's because there's a lot of ... People like to complain about a lot of things.

Jackie O'Brien (16:57):
People

Dr. Christopher Chang (16:57):
Complain, "Oh, I didn't get my records in time, or people complain essentially about service, or they overcharged my insurance, or I got a balanced bill," or things like that. So there are a lot of things that the medical board deals with that I think they're filtering through in terms of the volume and their goal is to keep things safe. That being said, this seems very egregious in terms of the amount of noise that was being made about this doctor. I heard she's left town though. She's been-

Jackie O'Brien (17:28):
She's been

Dr. Christopher Chang (17:29):
Ousted. ... ousted.

Jackie O'Brien (17:29):
But when I was reading all these articles and now I'm even getting ads on my Instagram like, "Have you had surgery with Dr.- Espino. Espino." And it definitely was giving me doctor death flashbacks, similar situation where people were raising concerns and it seems as though they were ignored. But I do think what you mentioned the system, it's a tricky system to navigate.

Dr. Christopher Chang (17:57):
And it'd be interesting if you could go back and see what did her old professors think?

Jackie O'Brien (18:03):
How did

Dr. Christopher Chang (18:03):
She get here? What did the other people that knew her in training say? Right.

Jackie O'Brien (18:08):
Was she a low performer that just barely made it over? I'm

Dr. Christopher Chang (18:12):
Sure there were signs that if this is a consistent thing. I mean, 30 lawsuits is not a small number.

Jackie O'Brien (18:19):
No, but it is interesting because of course we don't have access to all 29 of these complaints. We don't know what the first

Dr. Christopher Chang (18:28):
Complaint- Yeah, you're right. Board complaints are confidential,

Jackie O'Brien (18:31):
Right? Right. So we don't know exactly what the first couple wants to come in entailed. So I think if anyone is going to file a complaint with the medical board, you need to certainly have a lot of facts and figures to back up what you're saying I think to make a difference.

Dr. Christopher Chang (18:50):
Yeah. It's a difficult situation as to how loud do you have to bang the drum to be heard. And obviously at some point people went to the news, but I think that it became a story because there's probably lawsuits against the hospital system before she was

Jackie O'Brien (19:04):
Employed. Yes, I would agree. I do think before it goes to the state of Virginia, I think leadership and hospitals need to listen to their staff and because I can even personally think of situations where the staff has expressed concerns about certain individuals. So I think you just need a strong hospital staff to actually take things serious, maybe put that doctor on hold to investigate what's going on.

Dr. Christopher Chang (19:34):
Right, right.

Jackie O'Brien (19:35):
So 29 patients filed this lawsuit to stop this. What do you suggest people do if they see something like this in their own lives or experience?

Dr. Christopher Chang (19:43):
The first thing is always it's an emotional experience. Let's say you're in the ER and something happens to your loved one, they get sicker, let's get a, I don't know, a totally different example. Maybe they get a pneumonia and they have to get intubated or something. It seems like things are not going well. I think that you have to sort of ask around, "Was that right? Was that okay?" You sort of look at your, let's say your other family member that's there or your friend that's with you say, "Did I hear that right? Are you reacting to that the way I react to that?

(20:16):
" And then you can also ask the nurses or the staff around. Again, this is a good way to think about it is you say, was that as you would expect it? Because I think the chances that everybody around the doctor would say that was the right thing to do, or you'd sense the hesitancy you'd sense the apprehension a little bit. And I think that would be a good way to give you an indication of whether ... Are your emotions and is the situation kind of taking over or is there something really abnormal about the situation? Because most patients are not in the hospital, they don't live there like we

Jackie O'Brien (20:55):
Do.

Dr. Christopher Chang (20:55):
They don't have that experience and that background. So I think that's an important indicator.

Jackie O'Brien (21:01):
All right, guys. Well, I guess we have to see some patients, but leave some comments. I'm sure a lot of people have stuff to say about this. Like comments, subscribe. All right, thanks guys.

Dr. Christopher Chang (21:12):
Thanks for listening to Secret Services, the podcast where we see everything and say nothing except right here. I'm Dr. Christore Chang, double board certified plastic surgeon located in Tysons, Virginia. Follow us on TikTok at CongressionalPsurgery or on Instagram @congressionalplasticsurgery. To send us a classified message or to hear more episodes, go to secretservicespodcast.com. Links to everything we talked about on today's show are available in the show notes. Oops, patient's here. We got to go.