Just another day at the beach

One of the things about my job that I never take for granted is the wonderful flexibility that Dr. Weintraub and I have built into Duet - not just in terms of schedules, but also the spirit of our "giving back" philosophy.


Volunteerism is such an important part of our identities, and it doesn't have to start or end with plastic surgery or medical mission trips. The fabulous thing is that there are so many different ways to contribute.

And we're lucky here in the Bay Area to have OneBrick, an organization with a mantra of "volunteering made easy", which does just that - they sift through the hard stuff and find a spectacular array of events that need able minds and bodies. I've participated in a few OneBrick events over the last two years and have enjoyed each and every one.


These photos are from this weekend's habitat restoration at Pacifica State Beach. It was another gorgeous day in Northern California, watching the fog get chased away by the late morning sun. And as any of the day's OneBrickers could tell you, wrestling the surprising firm grip that the invasive ice plants have on the sandy dunes becomes strangely hypnotic, addictive, and therapeutic...

Us vs. them

I was reading through the New York Times Health section today, and I came across some provocative statistics buried deep in one of their articles. Originally sourced from the Center for Studying Health System Change, a report was published in August 2007 describing some of the changes in the landscape of physician demographics.

Interestingly, there has been a decline in the number of physicians taking on solo/small group practice - overall, about an 8% decline from 1997 to 2005. In 2005, only 32.5% of all physicians were in solo or two-person practices. The percentages get even smaller when you look at specific age groups; for physicians under the age of 40, only 24.8% are in one- or two-person practices.

I suppose it's not that surprising after all. Many of our classmates and colleagues congratulated Dr. Weintraub and me when we declared our intentions to hang up our shingle. They admitted that they were impressed by our bravery and courage (which is a funny thing to hear from other physicians and surgeons, all of whom are pretty unflappable and heroic folks); nearly all of our friends had opted to join an academic hospital-based practice or Kaiser-type entity, both great options here in the Bay Area. There is a lot to be said for the ease of mind that comes with a built-in patient base and referral system, guaranteed salary, and benefits.

But here at Duet, we are happy to continue to buck the trend - a two person private practice, plastic surgeons that work together as a team, two female plastic surgeons... Perhaps one of a kind, and certainly here to stay.

Already on the outs

Alas, this article in the NY Times tells me that Twitter is the new Blogger... And just when I was getting used to blogging. That noise? Oh, that's just me sticking my head back in the sand.

Twitter, let me know when you do pictures.

Ready for my close up

With all the medical-themed shows on TV these days, as a physician it's always fun to chat with "normal" people (i.e. those of us who don't spend their waking hours immersed in the medical field) and trade impressions. They always wonder, Is it really anything like what we see on TV? And I tell them, Yes, but a conditional yes.

Probably the first show to become a national phenomenon, at least in the time of Generation X, was ER (well, that era also brought Chicago Hope, if anyone out there is keeping track, and I'm not going so far back as those before-my-career-began classics MASH or Marcus Welby, MD).

ER was especially riveting to any person out there who devoted even half a brain cell to the consideration of the medical professions - from middle-schoolers to seasoned attending physicians. I know of medical students who formed regular Thursday night viewing parties - faces glued to the screen, sucked in by the drama, exchanging insiders' winks over the technical parlance, and of course, swooning over George Clooney and his Caesar-style haircut.

But then there was the problem of the Hollywoodization of medicine; accuracy was sacrificed for optimizing storylines, facts changed to move the plot along, visuals modified for viewer palatability - raising eyebrows and inducing groans from medical professionals across the nation. But I suppose that is part of the joy of watching television - it's a magical escape to a different world, and with a finite allotment of time, there isn't room for the slowness of reality or the dead weight of pesky fine details.

As the entertainment industry began to realize what an appetite the American public had for medical shows, they multiplied and mutated. Talk to anyone in the medical field, and we'll all admit to watching - and seeing a little truth in each of the shows.

ER definitely captured much of the drama of medicine. Scrubs highlights how much humor is a critical part of the workday and night. Grey's Anatomy brings out the soap opera plot twists that often surface in the hospital. House sometimes says the things some doctors wish they could say in real life.

And yes, I must admit that the plastic surgeon in me was totally engrossed by Nip/Tuck Season One, and maybe even Season Two, before the wild plot twists and turns lost me forever. But even Nip/Tuck has some professional commendation due: their depiction of surgery (at least the visually sensational parts where the scalpel slides through the skin) is perhaps the best out there.


Photo courtesy of NBC.com

Something for every season

As all of us in the Bay Area struggle through another "unusually" hot and humid July week (is it fair to call it "unusual" when these bouts of weather seem to be a regular part of summer now?), I start to think a little about passing time - both the little and big things that happen every year, giving us a way to mark days gone by and to anticipate the enjoyment of fleeting pleasures.

In grade school we learn to name the four seasons, the delights of which are perhaps not fully appreciated here in the year-round pleasantness of the South Bay - speaking as a born and bred Midwesterner (not that I miss having to wake up a half hour earlier to scrape ice off my windshield).

And in plastic surgery, there are trends you notice as the years go by - a different kind of seasonality. Even at my office in Mountain View, I've noticed definite ebbs and flows of cosmetic patients as the seasons change.

Late fall and winter bring in patients interested in little tweaks and touch-ups, with special attention to the face and skin. In November and December at the office, Dr. Weintraub and I go through a lot of Botox and fillers, like Juvederm and Restylane. I think many folks like to do a little something for themselves in the winter, perhaps to look especially ravishing at all those holiday parties.

After the holiday season, it gets quieter. People seem to be recovering from all those parties - or trying to give their wallets some recovery time after the big flurry of buying gifts. Things pick up a little as you approach Valentine's Day - again, who doesn't want to look good for the holiday of love and romance?

Spring continues to stay busy, until mid-April: Tax Day. That ominous day tends to start a slowdown; everyone tends to get a bit more serious when they're thinking about what they owe the IRS.

And then you transition into summer - always a fun and exciting time. At Duet, we've had a rush of people interested in "tummy tucks" and breast augmentation. I think it's swimsuit season that makes everyone think a little more about plastic surgery and body procedures. We're seeing a lot of women, who are so happy to be talking to a pair of female plastic surgeons who truly understand what it's like to wear a bikini.

All of a sudden, it's fall, then winter, and the cycle begins anew.

It's a different perspective by a plastic surgeon's calendar - a neat and unique way to watch the days go by.

Traveling for a smile

Some of my favorite moments in plastic surgery have been on medical mission trips. In previous posts, I've talked about the breadth and depth of plastic surgery, and I think that these trips have added sparkle to those dimensions. Most of the time, the focus is on repairing cleft lips and palates, but we always try to take on anything that comes our way.

Above is a scene from my 2007 trip to a tiny little town in Guatemala called Nuevo Progreso. A long flight to Guatemala City, followed by a long bus ride into the southwestern corner of Guatemala, up a narrow winding road to the Hospital de la Familia. The colorful crowd in the photo is an energetic yet serene assortment of patients and their families, waiting to be seen in the busy surgical clinics.


The photo above is from my 2007 trip to Guanajuato, Mexico. These little ones were enjoying a reception the staff throws for their honored patient-guests every year. The babies are always incredibly sweet and inevitably end up stealing your heart.

Partially sponsored by Smile Train, two intense days of cleft lip and palate surgeries were tempered by our gallant host, Dr. Abel de la Pena, who organized a fun international crew of surgeons.

A few satisfied customers in Mexico. It is such a privilege to be a plastic surgeon, and you never feel it more intensely than on these trips. For more photos, including some of Dr. Weintraub's trip, you can click here.

I am very excited to be going on another cleft trip soon, this time to China: two weeks at a hospital in Hunan province, with a team of almost forty American medical providers and about twenty more local Chinese staff. There were rumors of internet access, so I'll keep my fingers crossed on being able to blog from the trip.

Some of you might wonder, How is there time for me to spend two weeks in China? I would be tempted to respond, How is there not time?

I am very grateful to Dr. Weintraub and to our shared philosophy of giving back at Duet Plastic Surgery. We fiercely believe in the good that these mission trips achieve, and we have chosen to incorporate its spirit into our practice.

Why private practice?

Another popular follow up question is, "Why private practice?"

There is a long answer to that question. Here's a somewhat condensed version:

Jennifer and I had been talking about the idea of "Duet Plastic Surgery" for years. We met when we were medical students, interviewing for plastic surgery residency positions. Luck (and frankly, a lot of hard work) brought us together at Stanford, and we developed an amazing friendship through the trials and travails of residency.

Our training created a hard edge that neither one of us liked, and we both were afraid that it would become permanent if we continued our careers in an institutional behemoth of a hospital. We were also dying for some modicum of freedom, which simply was not an option during surgical residency.

But those difficult days also brought us hope - I can't tell you the number of times female patients have sighed in relief when they saw a woman surgeon come through the door. We female plastic surgeons are still a rarity, even though the vast majority of plastic surgery patients are women.

We felt that there was a definite need - many women are curious about plastic surgery but are not comfortable discussing such private and personal matters with the stereotypical older male plastic surgeon. We embodied a different perspective - and aesthetic - as women; there is something to be said for truly understanding a woman's psyche and physical being, inside and out. We also strongly believe in finding flexibility and balance, not just in our work lives - by giving back through medical missions and volunteerism, but also in our personal lives.

And so, flying in the face of the conventional wisdom and advice offered by those very same older male plastic surgeons, Duet Plastic Surgery was born.

Why plastic surgery?

I often get asked this question when people find out what I do.

A lot of impressions of plastic surgery have been formed thanks to the popular media: you know which TV shows, magazines, and websites I'm talking about. People can't imagine why anyone would choose such a vapid life of handing out gigantic breast implants and wild nose jobs, dealing with superficial, looks-obsessed people, and feeding into unhealthy "addictions." And it surprises me when people are surprised to find out that life at Duet Plastic Surgery isn't exactly like what goes on at Nip/Tuck (yes, we are plastic surgeons; yes, there are two of us; yes, we do see patients together; NO, that is where any similarities end). . .

Plastic surgery is an incredible field, and it is a privilege to be a part of it. Neither Dr. Weintraub nor I can imagine doing anything else.

There is such breadth and depth to plastic surgery, which challenges your technical skill and artistic creativity every day. One day in the operating room can offer a remarkable range of stories: a small child who fell off his bike and needs his nose set back in the right place; a young woman who has saved money from all her summers as a nanny so that she can have breast surgery; a mom of two active boys who has lost 40 pounds through sheer willpower and can't wait to fit into "regular" jeans again.

Every day we are inspired by our patients, from the present and the past. Vivid memories of taking care of the tiny Guatemalan baby whose mother shed tears upon seeing her cleft lip repaired, the heartbreakingly charming 6 year old who survived the house fire started by his family's Christmas tree, the stoic young man who needed his fingers reattached after a shop class accident, the ecstatic silver-maned lady whose only regret was that she didn't have her breast reduction sooner.

It is amazing to meet these patients, to get to know them as people, to participate in their lives for a sliver of a moment, but to carry their stories in your heart forever.

The new year begins, for some of us

Every summer in any academic teaching hospital is punctuated with a little bang on July 1st. The traditional start date for nervous interns, tired residents, and anxious fellows, the first of July is when hordes of well-educated, hard-working physicians descend upon hospitals for a period of their lives marked by intense learning, teaching, and taking care of patients.

It's a very interesting time in the hospital: those last few weeks of June and the early part of July. Because interns, residents, and fellows turn over relatively quickly (due to the length of their programs, usually between 1 and 7 years), many of the hospital staff (who often sport pins rewarding decades of service on their scrub uniforms) turn a jaundiced eye toward the flurry of activity before the Independence Day holiday.

At the end of the "academic" hospital year, trainees feel good about their knowledge and skills; they've finally discovered their comfort zone and how to get into it quickly. They know their own duties and the expectations of their attendings ("attendings" = the veteran doctors who supervise, instruct, and mentor - all while doing their own jobs as physicians) so well by June 30th that it becomes a little disheartening to see the calendar tick over to July 1, because that means starting over.

But it's also exciting, to move on, to finish, to start something new. For some, that just means another year out of many checked off on the torturous route to the finish line. For others, it means a new life of freedom and (hopefully) a salary that lingers above the minimum wage for once.

Often, around this time of year, the media turn their attentions to this transition time in the hospitals. The pendulum of public opinion swings back and forth regarding trainees and patient care. There are some who would never think to have their care anywhere but a "name brand" Ivy League-type hospital; others look distrustfully at the thought of being "practiced upon".

Even the so-called experts disagree. Some think that community hospitals (where there are only attendings, no trainees) provide better care for patients, while others think that academic institutions are safer or more effective.

As someone who has been in both worlds, I would be hard-pressed to issue a sweeping opinion. I know so many excellent physicians - and they're not all in academic institutions or all in community hospitals. If it were a matter of making a medical decision for my loved one, I would want them to have the absolute best care, of course. But the "best" depends on so many variables: the patient, the problem, the specialists, the procedures, the location, the aftercare...

Honestly, I think that all else being equal, this is a situation to go with your gut. Seriously. Perhaps the most important thing for patients is to be able to trust their doctors - and you can't do that unless you feel comfortable with them, their staff, their hospital - academic or not.