Dr. Joel Aronowitz |
Dr. Joel Aronowitz: “Hi everybody and welcome back to the channel. I want to do a quick video about a case that we posted on Instagram recently. This is a case of Dr. Roxy. I think her real name is Katherine Gruel or Gru, an Ohio plastic surgeon who lost her license. The Ohio Medical Board revoked her permanently very recently in a case in which they considered her behavior unprofessional and below the standard of care. What was she doing? She was a TikTok star who did TikTok videos in the operating room. She also live streamed from the operating room while she was doing surgery, answered questions from her audience and met with widespread popularity. But from the standpoint of the Ohio Medical Board, they had sanctioned her or warned her at least two or three times previous to the most recent incidents. She had at least three serious complications of her surgeries. They considered her to be someone who shouldn't have a medical license in the state of Ohio.
So I want to deal with just three or four of the issues involved and also get your feedback. So the first issue is the issue of patient privacy. This was something that the Ohio Medical Board brought up, but it's a little bit unclear what the problem is from their standpoint basically. I don't have access to all the facts in this case. It's really mostly news media reports that are widely available. But it sounds as though everyone treated in her practice had signed a release for social media, use of their images in social media. And it sounds like her practice was made well aware everyone who all the patients who participated that social media was a significant portion of the practice and they would be exposed in social media. And I would assume that patients had the option of opting out if they wanted to preserve their medical privacy. So if a patient gives permission for use of their images during surgery, during an exam, whatever, I don't see how the patient's medical privacy is an issue. Although on a personal level, I think that one should think twice before participating in that sort of thing. I think that the reality is a lot of people go to practices like Dr. Roxy specifically so they can be in the media. The next issue that the Medical Board brought up was this issue of professionalism. So professionalism is often misunderstood. And from my standpoint, it really involves the attitude and on the part of the professional, the doctor in this case, as well as the credentialed professionals, nurses and scriptects involved in the surgeries. And the attitude should always be oriented toward the first priority being the care and welfare of the patient. So the patient is paying a fee to the doctor.
The doctor in return promises to use his or her best professional judgment to deliver the best possible care to the patient. The professional obviously can't guarantee an outcome, but the professional can guarantee to be professional. That is to use the best of their judgment only in the cause of helping the patient and not for self-serving purposes, not for some secondary purpose that isn't revealed to the patient. So that should be the transaction and that's the nature of a professional. Whether you're going to a professional who's an attorney or an electrician or a doctor, that you're paying that person to use their education, their knowledge and experience only to help you with that problem that you present with and not to be doing something that is self-serving in a way that is not communicated to the client or the patient. In this case, we're mixing apples and oranges because we have a patient in surgery and we also have this other business going on that has to do with social media. The TikTok channel or the YouTube channel like this one or there's some other activity going on that has nothing to do with the care of the patient.
So there's a opening here for unprofessional conduct and that's what bothered the Ohio Medical Board and I think it bothers me too, frankly. Although the patients all know what is going on and they're many times attracted to this kind of activity like moths to a flame, it's incumbent upon the professional to maintain a professional atmosphere at all times. So what do I mean? In this case, we have a patient who is in the operating room. They're literally in a medically induced coma. The patient literally has no means of self-protection. They can't even cough or gag if they swallow the wrong way in the course of surgery because all of those reflexes are lost. It's really dependent upon the professionals in that room with that patient to protect the patient at all times and to keep their minds on their responsibility to protect that patient and by creating a carnival kind of atmosphere or an atmosphere in which you're creating social media content and that's a whole other sort of thing that has nothing to do with the surgery, are you putting the patient at risk of having a complication because somebody's mind is on something else?
That's the issue with unprofessional conduct and in this case, it could be. I think that it's very judgment call. Another issue that came up in the case of Dr. Roxy is the accusation that she was practicing below the standard of care in certain cases. So there were three cases that I was aware of from the news media reports, one in which a patient had an open wound after breast reduction surgery and I thought, well, that can happen in any breast reduction surgery and certainly if as surgeon you do enough breast reductions, you're going to have open wounds. Some are small, some are large, but it's a recognized complication of breast reduction surgery. There's a lot written in the medical literature about how to prevent it, what are the different causes and how to best treat it, but it happens in the best of hands and it's certainly not in and of itself below the standard of care. Another case, however, was involved a patient who developed sepsis or serious infection inside the peritoneal or abdominal cavity because of a penetration by the cannula, the metal tube that sucks out fat during liposuction. So the cannula entered the abdominal cavity instead of staying in the subcutaneous fat during the surgery. When it entered the abdominal cavity, it went into the wall of the intestine and perforated the wall of the intestine. The patient, the injury wasn't recognized and the patient got sick, very sick it sounds like, about a week later, was hospitalized and fortunately survived, but may have had long-term sequelae from the complication.
This is a much more rare complication and I think that in experienced hands, performing the surgery in a cautious, judicious way, it should almost never occur. So this may be an example of the unprofessional conduct causing the surgeon to make a technical error in the middle of surgery in the performance of the surgery and not recognizing the complication because of the other social media activities that were going on. I don't know that, I'm just speculating and this could have entered into the medical board's decision-making process though. The case does call up the into, call to mind the whole issue of standard of care and we should realize there isn't one thing that is the standard of care. You can't open a book and say the standard of care is X, Y, and Z. That's really an opinion and it's based, it's a legal concept and it's based on the concept that what would a similarly trained, educated surgeon in this case, but doctor, do in the medical treatment of a patient, a similar patient in this community. So if a similarly educated, trained, experienced surgeon in this community would never live stream, for example, or would never perform liposuction in this sort of a patient, then when Dr. Roxy did it, perhaps it would be below the standard of care. That's the idea and so in our adversarial legal system, she would have an expert that would say, would give an opinion and the opposing side would have a medical expert who would give an opinion about what the standard of care was at that time in those particular circumstances. So in medicine, we throw around that concept pretty widely, but we should bear in mind that it is a legal concept, not a medical concept and there isn't one accepted standard of care. Okay, final comment I'd like to make about the case of Dr. Roxy involves her personally.
So Dr. Roxy, I don't know personally and I don't know a lot about her, but I know that she sounds like she was well trained. She went to reputable schools and training programs. She was board certified. She was an ambitious, successful woman. She had a sounds like a large practice and employed many people and had been in practice for around 20 years. So this was a woman who was a substantial woman and it sounds like she was doing her best to be relevant in, you know, this age of social media and as a way to educate the public as well as to promote her practice. So it's easy to gang up on her and that's certainly what the news media seems to have done from looking at the many news reports. I don't see even one who gives another side to the case. I don't see any effort to paint her as a reputable professional woman, as a human being who has her own problems and has probably suffered a great deal in the course of this entire ordeal. Not to take anything away from the patients who are affected. That's a whole separate issue, but just from the standpoint of her as a human being, not only her but her family and all of the people whose livelihoods depended upon her.
And that was probably somewhere between 20 and 40 people, I would guess, by looking at the news reports of the type practice that she had. There are also a lot of patients who were very satisfied with her care and were looking forward to having future surgeries with her whose care will be affected because nobody will know their bodies in the same way that Dr. Roxy did because she had been the one who operated on them to begin with. So the Ohio Medical Board did from their standpoint of service for the community in restricting Dr. Roxy from ever practicing medicine again in the state of Ohio, but they also took away the ability of Dr. Roxy to take care of all of these patients that she's known for years and whose continuity of care will be disrupted because of this. So I would just like to put out there that there is another side to the and it would be appropriate to mention that and think about that side of things in the context of the whole case. So I hope you enjoyed these comments. I hope it opened your mind to a little bit different perspective and I'm very open to hearing your perspective as another doctor or doctor in training, nurse or patient.
The issues that this case brings up are not simple issues. They're not cut and dry and I think it's good to bring them up and talk about them freely so we can exchange ideas and hear other people's perspectives about it. I know I always learn something from hearing from you and I very much appreciate you leaving a comment letting me know what you think. Let me know if this sort of content is appealing to you or I think I should stick to surgical things more, something I know more about. So anyway, I hope to hear from you soon. Until then, I will be here working away in Aronowitzland."
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