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From The Ethics File

Surgical removal of xanthalesma _ is it cosmetic or therapeutic?

A patient had xanthalesma surgery done on eyelids by a plastic surgeon in a restructured hospital. The surgeon subsequently stated in a memo to the patient that the procedure was "not cosmetic surgery". The company doctor however stated that the surgery was "cosmetic in nature" when asked for his opinion by the company who was submitted the bill. The patient wrote to request the SMA Ethics Committee to rule against the company doctor in favour of the plastic surgeon as she felt strongly that the surgery done on her "by the Specialist in Singapore General Hospital is a Medical procedure" and that she "strongly feels that any professional would accept the statement made by the plastic surgeon instead of the Company Doctor, a General Practitioner" who did not even see her prior to the operation.

The Ethics Committee’s opinion is that there is no universal or standard criteria by which one can distinguish a therapeutic procedure from a cosmetic one. Generally, one could define a cosmetic procedure as one which is done in the absence of disease and only improves physical appearance without improving function. A therapeutic procedure is done to remove or heal disease or correct any form of medical or mental (including emotional) disability caused by a change in body appearance or function. The decision whether the xanthalesma surgery is a therapeutic procedure can only be determined on a case by case basis, according to the severity of disability in that individual. The medical opinion can only be given by the doctors with clinical knowledge of the patient’s physical and psychological background.

The Committee noted that the reason for asking for a ruling appeared to be related to a claim for reimbursement from the employer. This is outside the purview of the Ethics Committee as it is in the nature of contractual arrangements between the complainant and employer. The Committee suggested that the complainant should request the plastic surgeon to give a detailed report based on the principles given. The employer can then use it as a basis to decide whether that procedure is in the medical benefits entitlement of the complainant.’

Use of professorial salutation

The SMA has received six complaints regarding the use of professorial salutation on a medical doctor in private practice, in the broadcasting media, newspaper, professional journals and press releases over a few months.

The Ethics Committee has obtained confirmation from the National University of Singapore that the doctor concerned does not have any current appointment in the university and is not an emeritus professor. The Ethics Committee brought the matter to the attention of the doctor concerned and he confirmed that he had been "misrepresented in those reports by the title of Professor" and he disclaimed responsibility for their publications. At his request, the Ethics Committee has written to the publishers and media concerned, on his behalf, to clarify the matter.

Members are reminded that unless they are so entitled, they should not use salutations such as the professorial title.

The Ethics Committee is of the view that it is prudent for any medical practitioner who has contact with the lay press to ensure that he/she has been correctly addressed. The inappropriate use of Professorial title as in the case mentioned above may leave the practitioner concerned vulnerable to a charge of seeking undue advantage or suggestion that he/she is superior to his/her colleagues.