Feller/Bloxham set up

[templeloss]

I'm going to play the Devil's advocate here....Dr. Erdogan only performs the incisions. Should we ban him as well because techs perform the rest of the surgery? What about the countless other docs who have techs do the surgeries?

[Davis91]

Hi Bill

 

Sorry just a couple more rounds on this at least in my mind.

 

You equate Dr. Bloxham to the same way a technician works on every procedure. Therefore, is it standard practice for at technician to remove the strip, make the holes and basically do all of the procedure? How would this affect results? Is this a change in the way the practice was assessed by you originally? Why will it enhance his practice and make it better as you suggest?

 

I completely agree, as most people would, that if informed consent is given that is great and that issue is put to rest. The question is now one of standards that this site--as a major consumer advocacy portal that sets specific standards for membership, offers to resolve consumer complaints, and acts as a de facto watch dog for the industry--creates and follows.

 

I for one applaud the on-line hawks here who did not let the issue go once the original post was quickly archived out of public view. This is the type of consumer-led action that creates better outcomes for patients.

 

Ironically enough Bill, your old consumer-hawk, now long gone from this community due to a hard-to-watch public divorce, had put a post on his new site exactly predicting the rise of this type issue (techs vs. doctors, informed consent, etc.) in the quickly expanding universe of hair transplant physicians,and advocated exactly for this type of consumer-led action in order to lead to a better result. That is what seems to have organically happened in these posts.

 

Going forward, the HairRestorationNetwork may wish to revisit its operating procedures in terms of a) how it evaluates clinics B) reveal which objective standards and subjective ones that it uses to continually reevaluate doctors for membership (clinic practices change over time), and c) ensure a listing of all updated changes in practice standards that it deems will inform the readers of this forum (going beyond the "well they ask for consent so it is fine in our book.").

 

I am not buying a brand when I go for a HT. I am buying a procedure with all the details it entails, and it would be great to be as informed as possible in advance through sites like yours.

 

Thanks

[Stig]

Dr. Feller,

 

Thank you for providing a very detailed and thought out response. That's exactly what I and the community was looking for.

 

Guys,

 

No I do not feel that this set up should affect his recommendation or collision membership. Dr. Feller is still the supervising and leaving physician on every procedure. Blake works on every procedure as well, in the same way, technicians also work on every procedure. We don't discriminate against a physician because they've decided to utilize a particular technician in every procedure. Yes, Blake is new or two hair transplant surgery but he is working under the direct supervision of a much more experienced surgeon. Thus, as long as patients are being given informed consent and Dr. Feller isn't abandoning the procedure and putting it fully in somebody else's hands without his direction supervision, then I see no reason why any of this should affect his recommendation. In fact, it seems like it's only going to enhance his practice and make it better.

 

Best,

 

Bill

 

Bill, I appriciate your viewpoint, but what exactly is sufficient direct supervision to you? I specifically asked Dr Feller to describe exactly what his own level of involvement is when Dr Bloxham is performing critical aspects of the surgery himself, and to date this question has not been answered. Specifically, if Dr Bloxham is making incisions into the recepient area, is Dr Feller present in the room next to him watching through his own lense, or is he in a different room altogether? If it's the later, then I hardly call that direct supervision no? Not saying he has to watch every single move that Dr Bloxham makes, but shouldn't we know more information before you reach your conclusion? Dr Feller could be simply drawing the hairline and then checking in at random intervals for all we know.

[templeloss]

Stig, please see my post above. Dr. Erdogan wasn't present throughout my whole surgery. He only came in to make the incisions and left. Same with countless other doctors. Are you proposing we ban them too? I don't understand...I'm a little confused here.

[mav23100gunther]

I'm going to play the Devil's advocate here....Dr. Erdogan only performs the incisions. Should we ban him as well because techs perform the rest of the surgery? What about the countless other docs who have techs do the surgeries?

 

If this is the case then the only FUE surgeons left standing would be Dr Konior and I think Dr Vories. The rest all use techs to perform extractions and graft placements.

[Stig]

Stig, please see my post above. Dr. Erdogan wasn't present throughout my whole surgery. He only came in to make the incisions and left. Same with countless other doctors. Are you proposing we ban them too? I don't understand...I'm a little confused here.

 

The most critical aspects of the surgery are cutting of the strip during FUT and making the incisions; and for FUE it's really just making the incisions. One could argue so is extracting FUE grafts, but sadly almost all practices don't view it as such and delegate this procedure to technicians. I think we all agree though that making the incisions is the single most important aspect of any HT surgery, and my point is that Dr Bloxham could be doing this part himself without Dr Feller in the room watching him which is hardly direct supervision. Dr Doganay got banned because he admitted to not performing 100% of the incisions himself which resulted in a drop in the quality of results. In your case, Dr Erdogan performed the incisions himself, no tech. Make sense?

[HairJo]

Not to get off track here but if you go to some plastic surgeons or dermatologist for an HT chances are the Techs do the whole procedures from taking the strip out to making the sites and placing the grafts usually small cases but I know this as a fact patients meet with the doctor and then a tech does the whole procedure. So newbies beware

[Melvin- Admin]

If this is the case then the only FUE surgeons left standing would be Dr Konior and I think Dr Vories. The rest all use techs to perform extractions and graft placements.

 

Dr. Umar and Dr. Bhatti both perform their own extractions.

 

My personal opinion, is if Dr. Bloxham is going to perform my procedure, I would assume the price would change, I personally as a patient would not pay full price to have a doctor with less than a year experience work on my head. At this point, I believe what professor said to be true, based on the vague response by Dr. Feller I'm going to assume he only draws hairlines and leaves the rest to Dr. Bloxham, not saying that's a bad thing, a young doctor needs experience, but paying full price for that I wouldn't do.

[Davis91]

Hi Bill

 

Sorry just a couple more rounds on this at least in my mind.

 

You equate Dr. Bloxham to the same way a technician works on every procedure. Therefore, is it standard practice for at technician to remove the strip, make the holes and basically do all of the procedure? How would this affect results? Is this a change in the way the practice was assessed by you originally? Why will it enhance his practice and make it better?

 

I completely agree, as most people would, that if informed consent is given that is great and that issue is put to rest. The question is now one of standards that this site--as a major consumer advocacy portal that sets specific standards for membership, offers to resolve consumer complaints, and acts as a de facto watch dog for the industry--creates and follows.

 

I for one applaud the on-line hawks here who did not let the issue go once the original post was quickly archived out of public view. This is the type of consumer-led action that creates better outcomes for patients.

 

Going forward, the HairRestorationNetwork may wish to revisit its operating procedures in terms of a) how it evaluates clinics B) reveal which objective standards and subjective ones that it uses to continually reevaluate doctors for membership (clinic practices change over time), and c) ensure a listing of all updated changes in practice standards that it deems will inform the readers of this forum (going beyond the "well they ask for consent so it is fine in our book.")

 

Thanks

[LondonHTseeker]

How do we know to what extent informed consent is given? We don't.

 

It's obvious Dr Feller's recommendation stands zero chance of being questioned by Bill. Sooner or later, probably sooner, this thread will be closed and it will be business as usual.

 

It seems that these days Dr Bloxham does much, if not most, of the surgery, often unsupervised except for being checked up on at intervals by Dr Feller. As they are both being so vague about it and Bill is prepared to accept such vagueness, we can only speculate based on what has been said. If Dr Bloxham is successfully carrying out HT surgery in this way, it seems HT surgery is different to other areas of cosmetic surgery which require many years of hands on experience to become proficient; this actually makes sense when you look at the successful operations that are performed by FUE techs.

[esrec]

I just don't see how an amateur surgeon practicing less than a year who may perform up to 99% of my procedure could hold the same recommendation (and costs) as the most prestigious surgeons in the world.

 

Unless key aspects of the surgery, as previously outlined, are only performed by Feller, and clearly indicated on the consent form, the clinic's status should be under review.

[LondonHTseeker]

Except you're paying for Dr Feller's setup as whole, which includes his expertise in training everyone, including Dr Bloxham and all the techs, and supervising it to his satisfied standard. That's where the premium is, if Dr Bloxham is often doing much of the surgery.

[esrec]

Except you're paying for Dr Feller's setup as whole, which includes his expertise in training everyone, including Dr Bloxham and all the techs, and supervising it to his satisfied standard. That's where the premium is, if Dr Bloxham is often doing much of the surgery.

 

I applaud the commitment to training but reputation is based on results and unfortunately we don't have any yet. If evidence shows that Dr. Blox warrants recommended status I think everyone will be happy for him. As of now, he's just another doctor who's learning as he goes. Standards exist for a reason.

[HairJo]

What credentials does this forum have anyway to pick and choose who does what in their office ? Why do doctors have to be ruled by this organization and have their reputations torn apart. If I were a doctor I wouldn't want the every day hassle of trying to prove myself and my work on a daily basis . Is this site judged by the hair Gods and only certain doctors can get good recommendations even with sub par work. The doctor is only excellent if the forum agrees . Most people just go by good results they go to the doctors personal site and look at before and afters. Most people wouldn't even engage in this he said she said crap to me it's just attaching one doctor to make another doctor look better. to me this site confuses people it's never positive unless they choose it to be positive most of the time I think it hurts doctors who have worked so hard and all it takes is a couple of nasty posts from nasty people to hurt someones business.

[esrec]

I think you're overcomplicating the point.

 

The forum, not its members, established a recommendation process. The forum, not its members, is responsibile for upholding the standards they've created. The forum, not its members, has chosen to differentiate recommended vs non-recommended surgeons to empower potential patients with the right information. It's perfectly reasonable to review, even scrutinize these new changes. Dr. Feller and Bloxham should welcome our questions and respond accordingly.

 

Nobody is trying to "take down" the clinic. I know I'm certainly not. I don't think transparency is much to ask.

[Davis91]

Bill---really keen for you and the Forum team to reply here and quickly. This is a potential tipping point for this Forum and its future ability to provide top notch screening services for its readers.

 

Thanks

[Davis91]

Bill---really keen for you and the Forum team to reply here and quickly. This is a potential tipping point for this Forum and its future ability to provide top notch screening services for its readers.

 

Thanks

[humble1]

Not to get off track here but if you go to some plastic surgeons or dermatologist for an HT chances are the Techs do the whole procedures from taking the strip out to making the sites and placing the grafts usually small cases but I know this as a fact patients meet with the doctor and then a tech does the whole procedure. So newbies beware

 

so do I. The question is, is it legal?

[Mickey85]

so do I. The question is, is it legal?

 

As far as I am aware, this varies from state to state. It is not unheard of for surgeons/clinics to fly in techs to perform entire hair transplant surgeries. In fact, one forum member mentioned this exact scenario to me a while ago when he underwent his surgery with a surgeon that was not recommended here but was later enlisted(I should mention it was not Dr Feller)....

[Bill - Seemiller]

Guys,

 

Why is it that some of you are blowing this out of proportion? The fact that Dr. Feller provides informed consent and is the supervising physician in every procedure, is comforting to me not the opposite. While it is interesting matter of discussion to know which surgeon and technician is performing which part of procedure, as long as the end result is the same, it should have no bearing on his recommendation. Should it have a bearing on price? That's a matter of opinion and up for the clinic and each patient to decide.

 

LondonHT, despite his malicious intentions, asked some legitimate questions so I decided to leave this topic open so that Dr. Feller and Blake could answer it. I commend Dr. Feller for doing so despite his initial objections because he and I and others all know that the original posters intentions are typically to unfairly malign him like he has in many other topics. But because the questions were legitimate, I told Dr. Feller and Blake privately that I would be keeping the topic open despite their objections. And then London HT wants to curl personal insults at me despite the fact that I left open for discussion. While I have no problems taking constructive criticism, I am getting real tired of the blatant negativity and insults from particular members. Since London HT does not care whether he is banned or not, I think it is time to honor his wish.

 

The meantime, if anybody else would like to have intellectual conversation and discussion while showing respect, I am more than willing to host it and indulge in it.

 

Best wishes,

 

Bill

[Britanium]

My only question would be that it was Dr Fellers results which got the recommendation not Blakes. Is it still fair to be recommended now its Blake doing the HT? after all he is so far unproven.

Maybe when his results mature we can then see how good he is.

I'm sure hes very good but we have not seen the evidence yet.

I know hes partnered with a good surgeon but at present he seems recommended by proxy.

[esrec]

My only question would be that it was Dr Fellers results which got the recommendation not Blakes. Is it still fair to be recommended now its Blake doing the HT? after all he is so far unproven.

Maybe when his results mature we can then see how good he is.

I'm sure hes very good but we have not seen the evidence yet.

I know hes partnered with a good surgeon but at present he seems recommended by proxy.

 

Precisely. We've attempted to articulate this numerous times but we continue to dance around it. You cannot attach yourself to someone else without results and establish credility.

 

BTW it would be unfair to ban London for sarcasm. I dont see how that sends a message of fairness.

Edited January 20, 2016 by esrec

[Stig]

Guys,

 

Why is it that some of you are blowing this out of proportion? The fact that Dr. Feller provides informed consent and is the supervising physician in every procedure, is comforting to me not the opposite. While it is interesting matter of discussion to know which surgeon and technician is performing which part of procedure, as long as the end result is the same, it should have no bearing on his recommendation. Should it have a bearing on price? That's a matter of opinion and up for the clinic and each patient to decide.

 

LondonHT, despite his malicious intentions, asked some legitimate questions so I decided to leave this topic open so that Dr. Feller and Blake could answer it. I commend Dr. Feller for doing so despite his initial objections because he and I and others all know that the original posters intentions are typically to unfairly malign him like he has in many other topics. But because the questions were legitimate, I told Dr. Feller and Blake privately that I would be keeping the topic open despite their objections. And then London HT wants to curl personal insults at me despite the fact that I left open for discussion. While I have no problems taking constructive criticism, I am getting real tired of the blatant negativity and insults from particular members. Since London HT does not care whether he is banned or not, I think it is time to honor his wish.

 

The meantime, if anybody else would like to have intellectual conversation and discussion while showing respect, I am more than willing to host it and indulge in it.

 

Best wishes,

 

Bill

 

Bill, my previous questions to Dr Feller and yourself are still out there. You mention that you are comfortable in the fact that Dr Feller is supervising, but what exactly is this level of supervision, especially when Dr Bloxham is making the incisions?

 

 

"Bill, I appriciate your viewpoint, but what exactly is sufficient direct supervision to you? I specifically asked Dr Feller to describe exactly what his own level of involvement is when Dr Bloxham is performing critical aspects of the surgery himself, and to date this question has not been answered. Specifically, if Dr Bloxham is making incisions into the recepient area, is Dr Feller present in the room next to him watching through his own lense, or is he in a different room altogether? If it's the later, then I hardly call that direct supervision no? Not saying he has to watch every single move that Dr Bloxham makes, but shouldn't we know more information before you reach your conclusion? Dr Feller could be simply drawing the hairline and then checking in at random intervals for all we know."

[humble1]

As far as I am aware, this varies from state to state. It is not unheard of for surgeons/clinics to fly in techs to perform entire hair transplant surgeries. In fact, one forum member mentioned this exact scenario to me a while ago when he underwent his surgery with a surgeon that was not recommended here but was later enlisted(I should mention it was not Dr Feller)....

 

Thanks Mickey for the reply. IMO - this is very concerning and somewhat similar issue to the basis of this thread - "full advance disclosure of who will actually perform the surgery". If a patient has paid fees based on the assumption that a medical doctor (presumably experienced and skilled) will perform the surgery only to arrive and have a "technician" perform the surgery, after dealing with the "misleading borderline fraud", shouldn't there be a cost distinction? How is $8 a graft for a non-licensed, non-medical individual to perform surgery justified?

 

To me "a non-licensed, non-medical individual, credentials, experience unknown being able to perform HT surgery" is just as concerning than the present issue being discussed.

[humble1]

I asked hairjo to name one clinic that has technicians removing the strip but he hasn't. I think the closest thing to a tech would be a physician's assistant but a tech is someone usually, at best, a registered nurse, at worst a high school dropout but the point is that neither has the legal clearance to take out a donor strip. Technicians doing the whole procedure? Again, name one.

 

My comment was directly related to FUE transplants where Neograft machines are utilized. Technicians travel from clinic to clinic, state to state, as needed to perform HT utilizing these machines. Doctors rarely participate in these procedures.

Edited January 20, 2016 by humble1