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TORONTO - Family physicians are ready for anything their patients need, cradle to grave--as they say. But what if, somewhere in the second half of the journey between baby colic and elderly dementia, their patients come asking for help to look younger, prettier or thinner?
Dr. Deborah Fisher, a family doctor in the posh Forest Hill area of Toronto, doesn't have a problem offering patients non-invasive esthetic services. She has added face peels, Botox (botulinum toxin) injections and the latest wrinkle fillers to her practice, which otherwise focuses on cancer, headache and hormonal disturbances. It was demand from her urban, boomer patients--the demand for fresher faces, fewer wrinkles and poutier lips--that got Dr. Fisher started.
At first she thought it was silly to do cosmetic procedures, but then she saw some "lousy jobs" done by specialists, and decided to give it a try. "It grew out of patients' needs and demands," she says. "It was a natural progression for me. I love it. It makes people feel good."
It sounds straightforward but family doctors who do these procedures, and especially those who do much more invasive ones, are stirring up a storm of controversy among cosmetic surgeons. At the other end of the spectrum from Dr. Fisher's practice, there are horror stories of family doctors getting in over their heads. On the afternoon of April 30, 1998, Dr. Wayne Perron, a plastic surgeon in Calgary, got a call from Calgary General Hospital; a female patient who had recently had liposuction done by a family doctor had flesh-eating disease. She was in full septic shock. In emergency surgery that ended at 2 a.m., Dr. Perron removed 10% of the surface area of her skin, the area from beneath her breasts to her pubic bone. "If I hadn't intervened, she would have been dead," he says.
Dr. Perron is angry that a family doctor, who allegedly had little more training than someone could get in the local medical library, could offer liposuction. "He did not have any plastic surgery training. He did liposuction on 15 people. Four or five were hospitalized with serious problems," says Dr. Perron. "I am ticked off about all this."
His sentiments are echoed by Dr. Michael Weinberg, president of...