Why do some people think doctors do FUE better than tech's?

[olmert]

They have done studies comparing circumcision by surgeons vs. Moels. A Moel has no degree and is basically a rabbi who every day does a circumcision. No surgeon does circumcisions nearly as often. The studies are unanimous that the Moels do it better.

 

There is a good story for why. The Moels do it more often, and medical school does nothing to help you with circumcision. I will take a retard with practiced manual dexterity over a genius without as much practice.

 

Anyone will tell you that nurses and flabotomists draw blood better than doctors do, for the same reason. They do it more often, and medical school doesn't help with it.

 

So why do some people assume that doc's do FUE better than do tech's who have a narrower job and more specialization?

 

Maybe they think because in the US a tech is not allowed to do FUE, this means a doctor can do it better. No. The US is simply always the last to adopt everything. You would have been a moron in the 80s to refuse the AIDS drugs that Europe approved simply because the US had not approved it yet.

[Blake Bloxham]

Olmert,

 

Strange, I learned how to do circumcisions in medical school. Learned how to do blood draws as well. I don't do either any more, but the pediatricians I know do hundreds of them a year. In fact, they are meticulously trained how to do them in their 3 year residency (this is after 4 years of college and 4 years of medical school).

 

What did the mohels use in the studies? Mogen clamp? Plastibell? Do they switch methods depending on what is best for the patient? The peds and uro docs I know are trained in both - and the variety of other methods. What do the mohels do when they run into adhesions between the glans and foreskin? What is the protocol after a meatus laceration? What about cases of epispadias or hypospadias - both of which are more complicated circumcisions? Any data on how they sterilize their tools?

 

Not trying to sound like an ass here, but I'm trying to make a point: this idea of seeing a doctor do something, assuming it looks simple, and believing someone else can do it is not new. In fact, it's been happening in medicine for decades. My point, however, has to do with the above; people who think you can replace surgical training, anatomical knowledge, emergency skills, and thousands of hours of clinical practice with route repetition "don't know what they don't know." Circumcision, for example, seems simple when you watch it done and nothing goes wrong. However, what happens when the untrained practitioner runs into a problem like one of the examples I listed above? This is why things like medical school, medical/surgical residency, certifying boards, and malpractice insurance exist.

 

Furthermore, I don't know why we're continually falling back onto the same extreme scenario here - one where the doctor is an over-trained academic with no real experience and the technician is an phenomenon. There are loads of doctors out there with thousands upon thousands of FUE hours. Not only that, they have the training and knowledge on top of it too. You think a guy like Dr. Lorenzo doesn't have the manual dexterity, experience, and the knowledge on top of it? Why not let this guy do the operation? Doesn't he seem best suited?

 

To an extent, I agree with you. Like Malcolm Gladwell says, the key to perfecting a skill is performing it again and again - he believes it takes 10,000 times. I feel like a physician who has the training, skill, experience, AND the background to handle difficult situations and best treat the patient is the perfect person to perform hair transplant surgery. HOWEVER, I will not deny that hair transplant surgery is a team effort. No doctor can do it alone, and great techs are crucial. I think the perfect mix is a team of physicians and technicians working together to achieve a solid result. However, and I may be naturally biased, I still believe a physician should be leading this team and performing the surgical aspects of the surgery.

[Squatch]

You sound like a guy that has a messed up @#$%, that got Aids from a dirty needle, hates America, and people with special needs. If a doctor works on you the whole time, why would he not be as good as any tech? Free country go wherever you want. Very few travel restrictions right now! Have some cooth dude.....Why not just ask the question without the offensive stuff?

Edited January 7, 2015 by Squatch

[Squatch]

olmert,

 

strange, i learned how to do circumcisions in medical school. Learned how to do blood draws as well. I don't do either any more, but the pediatricians i know do hundreds of them a year. In fact, they are meticulously trained how to do them in their 3 year residency (this is after 4 years of college and 4 years of medical school).

 

What did the mohels use in the studies? Mogen clamp? Plastibell? Do they switch methods depending on what is best for the patient? The peds and uro docs i know are trained in both - and the variety of other methods. What do the mohels do when they run into adhesions between the glans and foreskin? What is the protocol after a meatus laceration? What about cases of epispadias or hypospadias - both of which are more complicated circumcisions? Any data on how they sterilize their tools?

 

Not trying to sound like an ass here, but i'm trying to make a point: This idea of seeing a doctor do something, assuming it looks simple, and believing someone else can do it is not new. In fact, it's been happening in medicine for decades. My point, however, has to do with the above; people who think you can replace surgical training, anatomical knowledge, emergency skills, and thousands of hours of clinical practice with route repetition "don't know what they don't know." circumcision, for example, seems simple when you watch it done and nothing goes wrong. However, what happens when the untrained practitioner runs into a problem like one of the examples i listed above? This is why things like medical school, medical/surgical residency, certifying boards, and malpractice insurance exist.

 

Furthermore, i don't know why we're continually falling back onto the same extreme scenario here - one where the doctor is an over-trained academic with no real experience and the technician is an phenomenon. There are loads of doctors out there with thousands upon thousands of fue hours. Not only that, they have the training and knowledge on top of it too. You think a guy like dr. Lorenzo doesn't have the manual dexterity, experience, and the knowledge on top of it? Why not let this guy do the operation? Doesn't he seem best suited?

 

To an extent, i agree with you. Like malcolm gladwell says, the key to perfecting a skill is performing it again and again - he believes it takes 10,000 times. I feel like a physician who has the training, skill, experience, and the background to handle difficult situations and best treat the patient is the perfect person to perform hair transplant surgery. However, i will not deny that hair transplant surgery is a team effort. No doctor can do it alone, and great techs are crucial. I think the perfect mix is a team of physicians and technicians working together to achieve a solid result. However, and i may be naturally biased, i still believe a physician should be leading this team and performing the surgical aspects of the surgery.

 

+1000

[hadenough2014]

They have done studies comparing circumcision by surgeons vs. Moels. A Moel has no degree and is basically a rabbi who every day does a circumcision. No surgeon does circumcisions nearly as often. The studies are unanimous that the Moels do it better.

 

There is a good story for why. The Moels do it more often, and medical school does nothing to help you with circumcision. I will take a retard with practiced manual dexterity over a genius without as much practice.

 

Anyone will tell you that nurses and flabotomists draw blood better than doctors do, for the same reason. They do it more often, and medical school doesn't help with it.

 

So why do some people assume that doc's do FUE better than do tech's who have a narrower job and more specialization?

 

Maybe they think because in the US a tech is not allowed to do FUE, this means a doctor can do it better. No. The US is simply always the last to adopt everything. You would have been a moron in the 80s to refuse the AIDS drugs that Europe approved simply because the US had not approved it yet.

 

 

I don't think it's so much about questioning the skill of a great technician. I suppose some of them are even better than the doc. But how am I, as a patient, to know who is the great technician on staff vs. the one who started performing extractions just yesterday? Is their reputation on the line with a bad result? No, it is the doc. The doc is always the brand, regardless of who does the work. So I think a good doc would always do everything possible to protect that brand. Many technicians may as well, but some may not...and I would not want to roll the dice that I get that one technician out of 100 who doesn't really care that much about the brand or is in the learning process. So yes, I want the doc doing my FUE extractions, incisions, and hairline design. Techs can do placement.

[olmert]

Olmert,

 

Strange, I learned how to do circumcisions in medical school. Learned how to do blood draws as well. I don't do either any more, but the pediatricians I know do hundreds of them a year. In fact, they are meticulously trained how to do them in their 3 year residency (this is after 4 years of college and 4 years of medical school).

 

What did the mohels use in the studies? Mogen clamp? Plastibell? Do they switch methods depending on what is best for the patient? The peds and uro docs I know are trained in both - and the variety of other methods. What do the mohels do when they run into adhesions between the glans and foreskin? What is the protocol after a meatus laceration? What about cases of epispadias or hypospadias - both of which are more complicated circumcisions? Any data on how they sterilize their tools?

 

. . . .

 

However, and I may be naturally biased, I still believe a physician should be leading this team and performing the surgical aspects of the surgery.

 

Blake correctly realizes that he may be naturally biased, which may have caused him to commit the error that is common among newbie doc’s, to breach the medical school principle to avoid citing as evidence your own subjective reasoning ("anecdotal evidence") in place of a formal scientific study that actually exists. The New York Times does not make this error when it writes:

 

SCIENCE WATCH

Gentler Circumcisions

Mohels, the deft practitioners of the ancient Jewish rite of circumcision, appear to inflict less pain on newborns than most doctors.

The secret could lie in the different tools they use, said the study's leader, Dr. Hema N. DeSilva, director of neonatology at St. Francis Hospital and Medical Center, a Catholic hospital in Hartford where the competing techniques were put to the test.

In a study involving 48 newborn boys, the clamp used by mohels, called a Mogen, was found to be much quicker to deploy and less painful than the one favored by most doctors. Those babies suffered less stress, Dr. DeSilva said.

The results of the study were published in last month's edition of The Ob/Gyn News and described earlier this year at the annual meeting of the Pediatric Academic Societies in Washington.

The findings were no surprise to Rabbi Yehuda Lebovics, a Los Angeles mohel who has performed more than 10,000 circumcisions. ''A mohel is used to working with a grandmother breathing down his neck,'' he said, laughing.

 

See weblink: Gentler Circumcisions - NYTimes.com

 

 

In sum, doctors are supposed to avoid anecdotal evidence, when there is a study. The physical process is too complicated for reasoning to be reliable. Blindly following the studies is objective and more reliable.

 

And incidentally as far as who is best at drawing your blood, the answer is similar: Take an experienced phlebotomist over a doctor who has not drawn as much blood. “Laboratory personnel (including phlebotomy services) under the supervision of the laboratory director performed ‘significantly better’ than those in other categories, reports Bruce A. Jones, MD, director of clinical pathology at St Johns Hospital and Medical Center and coauthor of the study.” https://www.bd.com/vacutainer/labnotes/pdf/Volume7Number1.pdf

 

Incidentally, let me give my own anecdotal evidence. A doctor once drew my blood, and it was pretty bad. In my experience, nurses do it ten times better, and phlebotomists do it ten times better than nurses -- all of which correlates with who has drawn blood more times in the past. Drawing blood or doing circumcisions for 1% of your time in medical school cannot compare with the experience in the specialty of a phlebotomist or Mohel. And the emergency scenarios that Blake cites as the reason for needing a doctor instead of a Mohel reminds me of how Joan Rivers died. Rivers was being operated on by a celebrity throat doctor. What did the celebrity doctor do when the surgery started going bad? Mid-sugery the doctor dialed 911, and let the specialist EMTs handle it because these specialists with 6 months specialized training knew better what to do in these emergencies. A Mohel can dial 911 the same as a doctor would.

Edited January 7, 2015 by olmert

[KO]

I do not think that people believe doctors do it "better" than techs by default. However, when you are being treated by the doctor, you know exactly who is responsible for surgery, with techs, clinics rarely disclose that information. The tech who operates on you may be great, or he/she may be a total newbie, you can't know that.

 

I'm assuming you're referring to the extraction step only, because if you're talking about techs doing the whole surgery, then I'm with Blake here.

 

Also congrats Blake, what residency are you off to now?

[fisher4man]

Like attracts likes.

 

I believe good, experienced, skilled doctors who are responsible for the surgery only work with the qualified, professional, skilled and experienced technicians or nurses. The patients (smart ones) acknowledge and legitimate the responsible surgeons, not the technicians.

[PupDaddy]

Olmert,

 

Can you please clarify your question? Are you asking:

 

1. Why do some people think doctors perform FUE excisions and extractions better than tech's?

 

2. Why do some people think doctors layout and create FUE graft recipient site incisions better than tech's?

 

3. Why do some people think doctors perform FUE implantation/seating of grafts into recipient sites better than tech's?

 

These are three distinct tasks (except in the case of implanter pens, which combine tasks 2 and 3). Does your question include all three? One of them? Two of them? Which one(s)?

 

Also, does your question assume that the country's or state's medical laws and regulations permit techs to perform the tasks encompassed in your question, or does your question consider the legalities irrelevant?

[scar5]

But how am I, as a patient, to know who is the great technician on staff vs. the one who started performing extractions just yesterday?

 

You don't.

And how are you to know that Dr X just changed his extraction motion from a toggle and twist plus downward motion to a straight sharp punching action because of fatigue to his tendons.

 

Manual extraction is taxing. We should all be aware that a doc's life span is limited. The father of FUE - Dr. Dare-you-mention-my-name-on-HTN- suffered from this affliction and many FUE docs have given up manual extraction. Please do not assume that the doc you saw doing nice manual FUE on youtube is still doing it today.

 

Techs can be hacks.

i swear to you that I have had some techs on the payroll of clinics that are paying for these forum owners' kids college fees, that techs can be well-meaning robot hacks with drill in right hand and pay check in the left.

 

But docs get fatigue, so go figure!

[hadenough2014]

You don't.

And how are you to know that Dr X just changed his extraction motion from a toggle and twist plus downward motion to a straight sharp punching action because of fatigue to his tendons.

 

Manual extraction is taxing. We should all be aware that a doc's life span is limited. The father of FUE - Dr. Dare-you-mention-my-name-on-HTN- suffered from this affliction and many FUE docs have given up manual extraction. Please do not assume that the doc you saw doing nice manual FUE on youtube is still doing it today.

 

Techs can be hacks.

i swear to you that I have had some techs on the payroll of clinics that are paying for these forum owners' kids college fees, that techs can be well-meaning robot hacks with drill in right hand and pay check in the left.

 

But docs get fatigue, so go figure!

 

Fatigue was my biggest worry about FUE for my 4000+ planned grafts needed, and I didn't want 3-4 techs switching off all day to do the work. Believe me, I wanted FUE but pretty quickly realized that single-procedure recipient zone success was more likely with FUT.

 

I don't really like the idea that I have to endure a scar with FUT, but I was certainly willing to tolerate a good donor scar rather than a poor FUE recipient zone result. No one has ever scoured through the back of my head looking for anything underneath the hair, and I don't expect they will in the future either. I just thought my case was too big for FUE. I like FUE for 2000 grafts and under, where the doc can do the work without getting burned out. It's expensive, but worth it.

 

Techs or docs, people get fatigued and then they get sloppy. To protect their brand, docs may just know where that limit is a little bit better.

[scar5]

Nah,

I don't agree.

Choosing strip because of the economics of FUE - I mean assuming that docs and techs just cash in on the strip scar terror is BS.

 

The scum-bag techs, docs, sweet-smiling desk girls etc.. in the FUE clinic are just as bad as the strip shop correlates.

 

They are all in it for the $, so just look at trends, and the trend is FUE, and the trend is well-intentioned docs doing manual FUE but these docs are getting fatigued and morphing into either strip clinics (aka Dr (_)BC in Delhi) or moving into tech driven FUE, (Dr (_ _ _)in (__)

 

It is very difficult to tell the truth here, but use deductive learning and fill in the gaps.

 

FUE for sure, but manual FUE is only a docs friend for 4 years, if that.

[Sean]

FUE extraction is a deep surgical process and there are reasons why US does not allow techs to do this. It is punching holes into your donor tissue, cutting through nerves, over a large span of donor area, for a surgical procedure that needs proper aftercare and antibiotics and healing to recover from. Some folks may recover slower then others and some may have long term adverse effects. Your are making numerous incisions risking scalp to possible necrosis and numerous chances for screw ups by the person doing the scoring.

 

As with what most FUT docs do, they extract the strip from the patient and give it to techs to separate and prepare, FUE docs should extract grafts and give it to their techs to prepare and review under microscopes for proper extractions maximising yield. This is where techs should be used to reduce fatigue.

 

Docs should also create incisions and may use techs to shove those extracted grafts into the recipient site the docs have created. This will reduce fatigue if that is a concern.

 

But the issue is that some docs have 2 or more surgeries they want to do in a day. One patient they may do 5000 grafts and another they may do 3000. Regardless, they will be tired even from making incision sites,but no one seems to realize that.

 

Then there are surgeons who do extract FUE themselves and create recipient sites and even implant themselves,but they are willing to do one patient per day or multiple days. This helps reduce fatigue.

 

Then there are docs who do extractions and create recipient sites and have techs implant and still do one patient a day or 2 if cases are small. This helps reduce fatigue.

 

It seems like where docs like performing megasessions, they rely heavily on techs to maximize profit. This is a risk to the ptient and their outcome and yield.

 

Medication, Intricate FUE extraction and creation of artistic recipient sites should be the bare minimum requirement for docs to be responsible for if they are to be recommended. Techs could assist in other things. Doctors should make choices for what is best for patients success as hairloss is a major form of distress to the patient. Even if it means breaking a 3000 graft procedure into 2-3 days to maximize graft yield since it is known grafts extracted too long out of the body may die,also possibly impacting overall yield.

[hadenough2014]

Nah,

I don't agree.

Choosing strip because of the economics of FUE - I mean assuming that docs and techs just cash in on the strip scar terror is BS.

 

The scum-bag techs, docs, sweet-smiling desk girls etc.. in the FUE clinic are just as bad as the strip shop correlates.

 

They are all in it for the $, so just look at trends, and the trend is FUE, and the trend is well-intentioned docs doing manual FUE but these docs are getting fatigued and morphing into either strip clinics (aka Dr (_)BC in Delhi) or moving into tech driven FUE, (Dr (_ _ _)in (__)

 

It is very difficult to tell the truth here, but use deductive learning and fill in the gaps.

 

FUE for sure, but manual FUE is only a docs friend for 4 years, if that.

 

 

That is not what I said at all. Most clinics are not looking to "cash in". They won't last long if that is their approach. I have no problem with FUE being more costly - it is for good reason. Both FUE and FUT have a place in today's industry, and the right one to use is dependent on each patient's situation and goals.

 

As I have said a number of times on this forum, FUT and and FUE are what the industry currently has to offer, but the best solution will probably look different in 10 years. I waited 10 years for a better solution, and while FUE got better, it is still not the ultimate answer. Hopefully stem cell and cloning will be the answer for the next generation. I chose not to wait any longer for the perfect solution.

[olmert]

You sound like a guy that has a messed up @#$%, that got Aids from a dirty needle, hates America, and people with special needs.

Yes, I thought I did a good job hiding these things, but Squatch figured me out.

Olmert,

Can you please clarify your question?

My question assumes legalities are irrelevant. My question certainly assumes that US law prohibition on FUE extractions by tech’s does not prove doctors do it better. It just proves that the US is always the last country to adopt legal changes.

I meant to ask Why do some people think doctors perform FUE excisions and extractions better than tech's? As far as who could plan the “layout” better, planning out the layout only takes a few minute, so there is less reason to think tech’s will have more practice at this. With time consuming and joint damaging excisions, there is much more reason to think there will be tech’s with more practice than doctors.

Fatigue was my biggest worry about FUE for my 4000+ planned grafts needed, and I didn't want 3-4 techs switching off all day to do the work. Believe me, I wanted FUE but pretty quickly realized that single-procedure recipient zone success was more likely with FUT.

I don’t see what is so bad about tech’s switching off. And why couldn’t you break up the 4000 grafts over a few days. You could even have gotten a 1000 graft FUE and then two months later the same thing, on and on. One thing nice about FUE is it is easy to segment. You cannot break up FUT into a series of 1000 graft surgeries.

 

 

 

There are parallels in other fields.

 

The issue is a bit like the cosmetic dental world. The lab the dentist goes to for making your crowns is more important than the dentist himself. But the patient world has not heard of the labs, so thinks it is dentist skill that matters.

 

Yet there is some value to over-paying a man, not for his skill, but because he may be less sloppy to keep getting overpaid. A lawyer in a fancy law firm spends his first five years mostly photocopying and changing dates on old documents to create this year’s documents. They pay him $150K/year to do this. The job takes no skill. They could pay a high school dropout less but someone else will be sloppy about it. The lawyer has too much at stake in his career to be sloppy. So there is some truth to paying a doctor a big premium to do what he cannot do as well as any tech with more experienced at the specialty upon the ground that the doctor has more at stake, so if you pick a tech, you might get a lazy one.

[scar5]

My question assumes legalities are irrelevant. ....

 

.....there is some truth to paying a doctor a big premium to do what he cannot do as well as any tech

 

Well, sorry to say, that assumption turns makes the discussion into existential acrobatics.

 

The legal question is primary, fundamental and it is the backbone that holds all the other spin and BS together. The US is a libel-friendly environment and any lawyer will take your cash to put Dr. X in the local newspaper for having white-coats on $15 an hour drill holes in your head. So much flows from this. So many thousands of wasted hours on forums like this in the name of "HT education", in the name of objective science, all twisted around one striking fact, like moths circling a light bulb. Techs can't extract in The States. That's it. Simple. And so strip has an extended life-span, and so we go to Turkey, India etc..simple as that. Everything else is a rationalization aimed at disguising this.

 

As for Blake's comments, yes, I shudder at the thought etc...why do docs so often fall over themselves to tell me stuff like, "Well, to be frank, they (being the techs) are better than me at it" with an expression on their foreheads designed to impart a sense of "Wow, what do you know, I'm such a frank guy, I can't believe I just told you that, but it is because it's all about you...not me"

 

Now, steady on, you probably wanna say, "Scar 5, it is because you are a vain and you are immature and you are an HT victim with an HT victim complex - hence you stand ready to be manipulated and you want to be treated like a bitch..and anyway...I have kids and I want them to have a good life...and sorry buddy, ",

 

But none of that alters the facts.

 

In my last FUE, I was staggered, absolutely shocked beyond my comprehension, after all my experience, to see the techs do the extractions. I protested and what did the doc say? Again, with that familiar look in his eye brows, "Well, frankly, they do it better"

 

Medically trained, yes. Professional, yes. Ethical? Who am I to say? I am gaffed in the name of science.

 

Readers be aware - Techs can't extract in The States..it is a good thing, no? It makes America what it is. A place of freedom but a place where decent standards can be upheld..upheld in court - all for a price.

 

You can blow up mountains and poison the water table with natural gas fracking techniques, and the world will buy it. You make a stand for globalization at the expense of a lower middle class in the mid-West, but you can't allow techs to extract grafts, because that is fundamentally wrong. Bravo...no?

 

One rule about HT is that the landscape is changing...always. You can't establish the facts through education. By the time you realize it has changed. But somethings change faster than others.

 

How can we make an educated guess about the validity of,

a) Techs doing extractions generally

b) Tech A or tech B doing it?

c) Tech using device A or device B?

 

By the time you work it out, you are either bald, broke or so bent out of shape you don't even care.

 

It's always changing. Try to keep your eye on the bits that move less and the bits that move more. Techs can't extract in the states, so...use your head.

[1966kph]

Classic post scar.

It is indeed a cut throat business that can eat people and spit them out in a far worse state than they started in.

You have a good day

 

 

Well, sorry to say, that assumption turns makes the discussion into existential acrobatics.

 

The legal question is primary, fundamental and it is the backbone that holds all the other spin and BS together. The US is a libel-friendly environment and any lawyer will take your cash to put Dr. X in the local newspaper for having white-coats on $15 an hour drill holes in your head. So much flows from this. So many thousands of wasted hours on forums like this in the name of "HT education", in the name of objective science, all twisted around one striking fact, like moths circling a light bulb. Techs can't extract in The States. That's it. Simple. And so strip has an extended life-span, and so we go to Turkey, India etc..simple as that. Everything else is a rationalization aimed at disguising this.

 

As for Blake's comments, yes, I shudder at the thought etc...why do docs so often fall over themselves to tell me stuff like, "Well, to be frank, they (being the techs) are better than me at it" with an expression on their foreheads designed to impart a sense of "Wow, what do you know, I'm such a frank guy, I can't believe I just told you that, but it is because it's all about you...not me"

 

Now, steady on, you probably wanna say, "Scar 5, it is because you are a vain and you are immature and you are an HT victim with an HT victim complex - hence you stand ready to be manipulated and you want to be treated like a bitch..and anyway...I have kids and I want them to have a good life...and sorry buddy, ",

 

But none of that alters the facts.

 

In my last FUE, I was staggered, absolutely shocked beyond my comprehension, after all my experience, to see the techs do the extractions. I protested and what did the doc say? Again, with that familiar look in his eye brows, "Well, frankly, they do it better"

 

Medically trained, yes. Professional, yes. Ethical? Who am I to say? I am gaffed in the name of science.

 

Readers be aware - Techs can't extract in The States..it is a good thing, no? It makes America what it is. A place of freedom but a place where decent standards can be upheld..upheld in court - all for a price.

 

You can blow up mountains and poison the water table with natural gas fracking techniques, and the world will buy it. You make a stand for globalization at the expense of a lower middle class in the mid-West, but you can't allow techs to extract grafts, because that is fundamentally wrong. Bravo...no?

 

One rule about HT is that the landscape is changing...always. You can't establish the facts through education. By the time you realize it has changed. But somethings change faster than others.

 

How can we make an educated guess about the validity of,

a) Techs doing extractions generally

b) Tech A or tech B doing it?

c) Tech using device A or device B?

 

By the time you work it out, you are either bald, broke or so bent out of shape you don't even care.

 

It's always changing. Try to keep your eye on the bits that move less and the bits that move more. Techs can't extract in the states, so...use your head.

[Squatch]

Well, sorry to say, that assumption turns makes the discussion into existential acrobatics.

 

The legal question is primary, fundamental and it is the backbone that holds all the other spin and BS together. The US is a libel-friendly environment and any lawyer will take your cash to put Dr. X in the local newspaper for having white-coats on $15 an hour drill holes in your head. So much flows from this. So many thousands of wasted hours on forums like this in the name of "HT education", in the name of objective science, all twisted around one striking fact, like moths circling a light bulb. Techs can't extract in The States. That's it. Simple. And so strip has an extended life-span, and so we go to Turkey, India etc..simple as that. Everything else is a rationalization aimed at disguising this.

 

As for Blake's comments, yes, I shudder at the thought etc...why do docs so often fall over themselves to tell me stuff like, "Well, to be frank, they (being the techs) are better than me at it" with an expression on their foreheads designed to impart a sense of "Wow, what do you know, I'm such a frank guy, I can't believe I just told you that, but it is because it's all about you...not me"

 

Now, steady on, you probably wanna say, "Scar 5, it is because you are a vain and you are immature and you are an HT victim with an HT victim complex - hence you stand ready to be manipulated and you want to be treated like a bitch..and anyway...I have kids and I want them to have a good life...and sorry buddy, ",

 

But none of that alters the facts.

 

In my last FUE, I was staggered, absolutely shocked beyond my comprehension, after all my experience, to see the techs do the extractions. I protested and what did the doc say? Again, with that familiar look in his eye brows, "Well, frankly, they do it better"

 

Medically trained, yes. Professional, yes. Ethical? Who am I to say? I am gaffed in the name of science.

 

Readers be aware - Techs can't extract in The States..it is a good thing, no? It makes America what it is. A place of freedom but a place where decent standards can be upheld..upheld in court - all for a price.

 

You can blow up mountains and poison the water table with natural gas fracking techniques, and the world will buy it. You make a stand for globalization at the expense of a lower middle class in the mid-West, but you can't allow techs to extract grafts, because that is fundamentally wrong. Bravo...no?

 

One rule about HT is that the landscape is changing...always. You can't establish the facts through education. By the time you realize it has changed. But somethings change faster than others.

 

How can we make an educated guess about the validity of,

a) Techs doing extractions generally

b) Tech A or tech B doing it?

c) Tech using device A or device B?

 

By the time you work it out, you are either bald, broke or so bent out of shape you don't even care.

 

It's always changing. Try to keep your eye on the bits that move less and the bits that move more. Techs can't extract in the states, so...use your head.

 

I still say if your don't like what your country is doing......Go somewhere else. I prefer a Dr. working on me. I prefer to stay warm in the winter with Natural gas. I'm not going to complain a Dr. is ripping me off for a job I agreed to have done. What's with the hostility with professionals. Most have sacrificed in life to get where they are at now. Do you guys think a so called "monkey" or some other derogatory name can do what you do better in your own profession? I bet we could give an example of one that could. Why can't the Dr. and the tech just be a well oiled machine/team?

[1966kph]

I don't know much about the law in the USA but am I right in assuming that the laws regarding the use of techs is the same in every state as I know there are others laws that differ state to state.

I don't understand why that within one country the law should differ from one region to another.

You are within the law then go a mile down the road and your busted.

Have a nice day

[Rootz]

But how am I, as a patient, to know who is the great technician on staff vs. the one who started performing extractions just yesterday?

 

Just ask the doctor who your technicians will be and request that all the ones that will be working on you have X amount of experience. If he can't accomodate, you can find a new doc or reeavlauate your expectations.

[KO]

Just ask the doctor who your technicians will be and request that all the ones that will be working on you have X amount of experience. If he can't accomodate, you can find a new doc or reeavlauate your expectations.

This is not true. In at least one case, one of Lorenzo's patients was told that technician X, and the doctor would be doing his extractions, however as it turned out, none of them did, it was a brand new tech with little experience.

 

 

Actually, on Lorenzo's website it says that techs do not participate in the surgery. So even if you have "full disclosure" and information about the clinic's practices you still don't know what you're getting.

 

There is a reason many are uncomfortable with techs being heavily involved. It's easy to say, "just get the experienced techs", but harder to do in reality.

[1966kph]

I think that you ask the your dr if he would be prepared to agree in writing who will be doing your ht.I do not see any good reason why they could not do this if it is a concern you have.

We all differ in what we deem to be acceptable and if we have concerns the dr should be willing to try and alleviate these concerns with his signature on a peice of paper agreeing what will transpire during your procedure.

Have a good day

 

Just ask the doctor who your technicians will be and request that all the ones that will be working on you have X amount of experience. If he can't accomodate, you can find a new doc or reeavlauate your expectations.

[Blake Bloxham]

Olmert,

 

I hate to argue, but I definitely wanted to address a few issues here.

 

 

Blake correctly realizes that he may be naturally biased, which may have caused him to commit the error that is common among newbie doc’s, to breach the medical school principle to avoid citing as evidence your own subjective reasoning ("anecdotal evidence") in place of a formal scientific study that actually exists.

.

 

Actually, I'm very familiar with subjective versus anecdotal versus objective evidence. Believe it or not, I had to take multiple courses on data collection, analyzing articles, utilizing data, and practicing evidence based medicine as a pre-med in college and in medical school (and residency). In fact, it's worth noting that 1) an opinion piece published in the NYT isn't peer reviewed or possess a high level of evidence; 2) the "ob/gyn news" wouldn't hold much scientific weight either; 3) a single study with an N = 48 isn't enough evidence to make sweeping claims regarding circumcitions; 4) the article appears more focused on the use of the Mogen clamp - which I mentioned earlier - as a method of circumcision; not so much on the "mohel versus doctor" debate; 5) The article is from 1997; generally, anything older than 10 years shouldn't be highly referenced.

 

 

The New York Times does not make this error when it writes:

 

SCIENCE WATCH

Gentler Circumcisions

Mohels, the deft practitioners of the ancient Jewish rite of circumcision, appear to inflict less pain on newborns than most doctors.

The secret could lie in the different tools they use, said the study's leader, Dr. Hema N. DeSilva, director of neonatology at St. Francis Hospital and Medical Center, a Catholic hospital in Hartford where the competing techniques were put to the test.

In a study involving 48 newborn boys, the clamp used by mohels, called a Mogen, was found to be much quicker to deploy and less painful than the one favored by most doctors. Those babies suffered less stress, Dr. DeSilva said.

The results of the study were published in last month's edition of The Ob/Gyn News and described earlier this year at the annual meeting of the Pediatric Academic Societies in Washington.

The findings were no surprise to Rabbi Yehuda Lebovics, a Los Angeles mohel who has performed more than 10,000 circumcisions. ''A mohel is used to working with a grandmother breathing down his neck,'' he said, laughing.

 

See weblink: Gentler Circumcisions - NYTimes.com

 

Let me show you an example of a well describe meta-analysis (level 1-A evidence) compiled by the CDC:

 

Neonatal herpes simplex virus infection following Jewish ritual circumcisions that included direct orogenital suction - New York City, 2000-2011

 

Abstract

Herpes simplex virus (HSV) infection commonly causes "cold sores" (HSV type 1 [HSV-1]) and genital herpes (HSV-1 or HSV type 2 [HSV-2]); HSV infection in newborns can result in death or permanent disability. During November 2000-December 2011, a total of 11 newborn males had laboratory-confirmed HSV infection in the weeks following out-of-hospital Jewish ritual circumcision, investigators from the New York City Department of Health and Mental Hygiene (DOHMH) learned. Ten of the 11 newborns were hospitalized; two died. In six of the 11 cases, health-care providers confirmed parental reports that the ritual circumcision included an ultra-Orthodox Jewish practice known as metzitzah b'peh, in which the circumciser (mohel, plural: mohelim) places his mouth directly on the newly circumcised penis and sucks blood away from the circumcision wound (direct orogenital suction). In the remaining cases, other evidence suggested that genital infection was introduced by direct orogenital suction (probable direct orogenital suction). Based on cases reported to DOHMH during April 2006-December 2011, the risk for neonatal herpes caused by HSV-1 and untyped HSV following Jewish ritual circumcision with confirmed or probable direct orogenital suction in New York City was estimated at 1 in 4,098 or 3.4 times greater than the risk among male infants considered unlikely to have had direct orogenital suction. Oral contact with a newborn's open wound risks transmission of HSV and other pathogens. Circumcision is a surgical procedure that should be performed under sterile conditions. Health-care professionals advising parents and parents choosing Jewish ritual circumcision should inquire in advance whether direct orogenital suction will be performed, and orogenital suction should be avoided.

 

Neonatal herpes simplex virus infection following Jewish ritual cir... - PubMed - NCBI

 

 

For those who don't want to read the entire abstract, it's a piece discussing 11 cases of mohels passing on the herpes virus from their mouths to the genitals of newborns by using their teeth in the circumcision procedure. This resulted in hospitalization of 10 babies with serious viral infections (HSV infections in children of that age can result in permanent brain damage via inflammation in the temporal lobe of the brain) and the death of 2 newborn children.

 

The study's conclusion: circumcision is a surgical procedure that should be performed under sterile conditions in an appropriate medical setting.

 

This goes back to my first post. Circumcisions seem simply from an outside perspective. Take some excess skin, remove it, and you're done. Do it a thousand times and you're a pro, right? What could go wrong? Like I said before though, this is a perfect example of what can go wrong when people - and I don't say this to be offensive - "don't know what they don't know."

 

HSV transmission and the severe neurological consequences of HSV encephalitis in a newborn is something taught during the first quarter of infectious disease/microbiology in medical school. The mohels don't know anything about this, and why should they? They are religious leaders, not doctors.

 

And incidentally as far as who is best at drawing your blood, the answer is similar: Take an experienced phlebotomist over a doctor who has not drawn as much blood. “Laboratory personnel (including phlebotomy services) under the supervision of the laboratory director performed ‘significantly better’ than those in other categories, reports Bruce A. Jones, MD, director of clinical pathology at St Johns Hospital and Medical Center and coauthor of the study.” https://www.bd.com/vacutainer/labnotes/pdf/Volume7Number1.pdf

 

This is where I think your argument has some issues: you're assuming the role of the technician is to do hair transplant surgery and the role of the hair transplant surgeon is to ... well, I don't know; do something else?

 

Let me explain: a phlebotomist is better at drawing blood because it is their job. If you take a dermatologist who hasn't drawn blood in 20 years, then yes, he likely won't be as good. Even if he has a better knowledge of anatomy, hematology, etc. However, phlebotomy isn't his job. Hair transplant surgeons are trained to do hair transplant surgery. It is their job. They aren't random physicians who learned how to do a hair transplant procedure 20 years ago and only do a few every decade. They are doctors who trained for YEARS to master the procedure and do it every day. It seems like you're trying to compare two different things here: technicians who do hair transplantation daily and physicians who learned about the procedure, but don't practice it. This shouldn't be the comparison. The comparison should be: technicians who practice hair transplant daily versus doctors who practice hair transplant daily. My argument: why not utilize the doctor who has just as much practice and technique, but also has the medical, surgical, emergent, and anatomical knowledge to handle the difficult cases, avoid pitfalls, and keep patients safe and happy?

 

Drawing blood or doing circumcisions for 1% of your time in medical school cannot compare with the experience in the specialty of a phlebotomist or Mohel.

 

Again, I don't think you're comparing "apples to apples" here. Hair transplant surgeons didn't spend 1% of their time in medical school learning about hair restoration and then never do it again. They practice it daily. They have the skills inherent in these practiced technicians AND the medical/surgical knowledge on top of it.

 

It's like the circumcision example I discussed in my first post. Everyone who graduates medical school learns, practices, and - most likely - does a few circumcisions in medical school. They then go out and specialize and 95% of them don't go into urology or pediatrics and never do a circ again. However, the 5% that do specialize in either of these fields do thousands of them in a highly intense training program where they must meet standards set forth by medical and surgical boards.

 

In your above example, you can't compare the radiologist who did 2 circumcisions in medical school to the mohel has done 10,000. You must compare the pediatrician who did 1,000 in residency, earned privileges to do them in hospitals, passed their pediatric boards (which included circumcision knowledge) and then did 10,000 more in their first 5-10 years of practice. Your argument has to be: mohel with 10,000 circumcisions to pediatrician with 10,000 circs; and hair transplant technician who's removed 10,000 grafts versus hair transplant surgeon who's removed 10,000 grafts - and likely trained the tech how to do so.

 

This is the only fair way to compare because frankly, it's the reality. When it comes down to this point, I, again, say: why not use the doctor??

 

 

And the emergency scenarios that Blake cites as the reason for needing a doctor instead of a Mohel reminds me of how Joan Rivers died. Rivers was being operated on by a celebrity throat doctor. What did the celebrity doctor do when the surgery started going bad?

 

Sorry, must disagree again. When Joan Rivers started coding in the GI suite, the doctors didn't call 911 or activate a code like they were trained to do. Trust me, there was a board certified anesthesiologist in that suite who is ACLS certified and fully capable of runing a code. These doctors panicked and stalled. They didn't want to end up on TMZ for goofing up Joan River's surgery so they piddled around and stalled instead of calling a code. I'm not sure what you think an EMT would have done differently, but I assure you that the anesthesiologist is more than qualified to intubate the crashing patient or obtain an emergency airway (something the EMTs couldn't do). They are also more than qualified to do chest compressions, push the appropriate drugs, and stick the defibrillator paddles on her chest while the machine analyzed her rhythm and determined whether or not she needed a shock. Who do you think is responsible for training the EMTs? 99% of the time, the EMS director of any given training program is either a board certified EM doctor, ICU doctor, or an anesthesia trained critical care doctor.

 

 

A Mohel can dial 911 the same as a doctor would.

 

Circumcisions done in a hospital setting under sterile conditions don't result in 911 calls. Trust me ; ).

[olmert]

I think that you ask the your dr if he would be prepared to agree in writing who will be doing your ht.I do not see any good reason why they could not do this if it is a concern you have.

We all differ in what we deem to be acceptable and if we have concerns the dr should be willing to try and alleviate these concerns with his signature on a peice of paper agreeing what will transpire during your procedure.

Have a good day

 

It sounds very logical to stipulate that the doctor sign that he will not start the surgery in the event he is fully drunk. But just actually try to get any doctor in the world to sign such a statement, even a third world doctor that just graduated.

 

Pure naivety.Pure inexperience with the real world. A most uninformed and theoretical perspective. It reminds me of those who theorize that a doctor should be presumed to be better than a tech, with no empirical evidence.

[Blake Bloxham]

There are parallels in other fields.

 

The issue is a bit like the cosmetic dental world. The lab the dentist goes to for making your crowns is more important than the dentist himself. But the patient world has not heard of the labs, so thinks it is dentist skill that matters.

 

A lawyer in a fancy law firm spends his first five years mostly photocopying and changing dates on old documents to create this year’s documents. They pay him $150K/year to do this. The job takes no skill. They could pay a high school dropout less but someone else will be sloppy about it. .

 

Olmert,

 

Did you go to medical, dental, or law school or do you work in any of these fields?

 

Not trying to be smart, but you seem to have a lot of steadfast opinions about a lot of different fields, and I'm wondering if you have some inside knowledge the rest of us don't?