Derived from the idea of an auction, bidding for a surgeon over the internet will begin next month

“The essence of bid for surgery is empowering the consumer,” says Kevin Moshayedi, CEO of Medicine Online Inc. “It is designed for consumers to describe and market their personal needs and, on the other hand, for qualified surgeons to publicize their training and credentials.”

Bid for surgery deals only with elective procedures including cosmetic dentistry, cosmetic surgeries, and foot or vision surgeries. 4.6 million patients underwent cosmetic plastic surgeries last year. Another 950,000 elected to have LASIK vision surgeries, and experts predict a two-fold increase in similar procedures this year alone. As the market grows, health professionals warn that price should not govern the choice of surgeons.

“I’ll discuss my fees with patients, personally and privately, but my primary concern is getting the patient to feel better,” says Dr. Royall, D.P.M., of Salt Lake City who specializes in medicine and surgery of the foot. “Money is always going to come up, but I think it should take a back seat.”

BUSINESS AND HEALING

Health professionals clamor for close scrutiny of the bid for a surgeon website. They worry about marginalizing ethical issues like informed consent. Some sharply criticize any practice where the patient misses out on valuable information needed to make an informed decision.

Proponents claim the bidding offers enhanced choice, and therefore greater patient protection. “One of the strengths of our website will be the provision of information to the consumer,” says Mike Sussman, chief operating officer of Medicine Online. “We are going to give them more information than they get in the real world.”

The American Society for Aesthetic Plastic Surgery issued a warning about the online surgery auction in December stating, “It provides no way to verify credentials, competency, or patient satisfaction with the services offered, and is fraught with possibilities for abuse.” ASAPS surgeons are certified by the American Board of Plastic Surgery, which means they have met all the educational requirements set forth to maintain the highest standard of practice.

“Many factors are more important than cost,” says Dr. Royall. “I think when we talk about money too soon in a physician/patient relationship, we change from a physician healer and caregiver to a businessman. Those are two very defined roles, and they have to be kept separate.”

But Mr. Sussman counters that the auction process does not focus on price. “It’s not about the lowest bidder. The site is designed to offer the consumer much more information than just price. We’re are trying to improve on an inefficient referral system that’s highly fragmented to one that serves the consumer better. We will provide a library of authoritative information, including ways to click through to the professional societies that issue board-certification.”

Mr. Moshayedi points out that “Surgeons already put ads in the Yellow pages. We’re not doing anything different than what’s already happening in real life. Regarding our website, sure everyone wants to sort of ‘kick the tires,’ and that’s fine. But in a few years, bidding may lose its novelty and become routine.”

Some experts claim surgery is not a commodity to be auctioned off like an airline ticket

BEFORE SURGERY

“I have a problem with the bidding idea when the main focus is grabbing patients by price,” says Dr. Renato Saltz, plastic surgeon at the University of Utah. “Are we businessmen or are we physicians? It raises some ethical issues.”

ASAPS states its surgeons are committed to giving informed consent.” That means giving the patient a thorough opportunity to make a conscious decision about undergoing the procedure. All the facts must be completely explained in understandable language before surgery. According to ASAPS, components of informed consent go far beyond price and include:

• A summary of the purpose of the surgery and the surgical approach
• A description of the expected benefits and limitations
• A discussion about the postoperative recovery, possible complications and known side effects, including rare ones
• An explanation of the risks associated with anesthetics, analgesics and antibiotics
• A discussion of all appropriate alternatives including no treatment or no surgery at all.

ASAPS points out that, “While online auctions propose a face-to-face meeting before surgery, once a prospective patient has made plans to meet with a surgeon based on a price agreement--and perhaps traveling some distance at their own expense-- an implied commitment to the procedure has been made by both the physician and patient before they meet in person.”

ASAPS’s member surgeons also say bidding may compromise the physician’s evaluation of the patient’s physical and emotional fitness for surgery. “Aesthetic plastic surgery should not be regarded as a commodity such as an airline ticket, but rather as a medical treatment that must be thoroughly researched before being undertaken. Fully informed consent is in the best interest of both patients and physicians.”

Mr. Sussman asserts “The website will provide the consumer with clear guidelines to understand informed consent and will offer tools to check on qualifications. A patient satisfaction survey will also be included.”

	Though the concept is new, bidding for a surgeon to perform elective surgery may become routine

HOW IT WORKS

The patient posts a desired surgical need and gives his or her age, sex, occupation, location, health information and insurance coverage.

Then the website gives surgeons 72 hours to start bidding. The surgeon bids by providing the following information: board certification or other qualifications; years in practice, medical school, post-graduate training, publications, academic appointments and teaching activities, professional achievements, cost of requested surgery, a web address, and the total number of requested surgeries they have performed during the last 2 years.

Finally, the patient selects a surgeon within the next 72 hours, and requests a face-to-face consultation.

THE BEST CANDIDATES

Medicine Online designed the bidding part of its website for people considering cosmetic, foot, or vision correcting surgery. Patients may be US citizens or people traveling from abroad for elective surgeries in the United States. Some may be dissatisfied with insurance coverage and willing to pay out-of-pocket.

“When you need an elective surgical procedure like cosmetic surgery, how do you choose a qualified surgeon?” asks Mr. Moshayedi. “Referral? Phone Book? Or media advertisement? Wouldnít you prefer to be empowered to evaluate and compare the credentials and qualifications of several surgeons before you make the decision? After all, it is your decision and your body!”

CHOOSING A DOCTOR

The Mayo Clinic Health Letter offers the following guidelines for selecting a doctor, and making the most out of the visit:

• Get routine care from a primary care physician
• Check to see if the doctor is board-certified by looking in the Directory of Medical Specialties available in most libraries, or by calling +1-800-776-CERT.
• Compare costs, and choose an insurance plan that pays for care from both a primary care doctor and specialists. People over 60 should be aware that doctors at large teaching centers may or may not accept Medicare, but they can often zero in quickly on problems sparing time and expense.
• Consider convenience. A simple phone call can yield useful information like office hours, parking, and waiting times for appointments.
• Don’t arrive late and unprepared. Be ready to discuss family history, and bring a list of concerns.
• Don’t forget to tell the doctor about all medications.
• Don’t let shyness interfere with direct communication. Speak up and don’t leave until questions are answered and resolved.