Prominent Hollywood plastic surgeon tells Vogue readers that use of nurse anesthetists is "unsafe"
June 2004 -- In Ariel Levy's "Shopping for surgery," an article in this month's Vogue about how to find "safety and success" in aesthetic plastic surgery, Santa Monica surgeon R. Patrick Abergel is quoted as saying that the use of nurse anesthetists for plastic surgery is "unsafe." In fact, research has shown that care of nurse anesthetists is at least as good as that of anesthesiologists. Vogue's publication of Abergel's scientifically unfounded assertion without any response from a nurse anesthetist is irresponsible.
The basic point of Levy's piece is to remind readers that, though society in the "Extreme Makeover" era may have come to take cosmetic surgery for granted, it is still surgery, and tragic outcomes are possible. As a service to consumers, the article offers tips in four key areas: "Know your doctor," "Location," "Anesthesia," and "Full disclosure." In the "Anesthesia" section, Dr. Abergel is quoted as follows: "It's not illegal for surgeons to administer anesthesia themselves, and a lot do--or they work with nurse anesthetists. Both are unsafe." It is clear that Dr. Abergel is referring to professional qualifications, not the adequacy of the surgical facility, as that topic is addressed in the "Location" section. The piece offers no statistical or anecdotal support for Dr. Abergel's assertion. Dr. Abergel's plastic surgery business, which is heavily promoted in the mass media (as it is being promoted in this Vogue article), focuses on elective entertainment industry work.
Contrary to Dr. Abergel's statement, published studies have shown that the care of nurse anesthetists is at least as good as that of anesthesiologists. Many such studies are collected in the American Association of Nurse Anesthetists' research database. Nurse anesthetists are skilled professionals with master's degrees who provide vital anesthesia services to thousands of surgical patients daily, especially in more remote areas with insufficient business potential to attract anesthesiologists. To compare the highly developed anesthesia skills of nurse anesthetists to those of plastic surgeons with little or no anesthesia training is a grotesque insult to nurse anesthetists. Indeed, it is not clear what would qualify any plastic surgeon--who would be, according to Dr. Abergel's own statement, unfit to administer anesthesia--to dismiss an entire category of anesthesia professionals who save lives in health care settings. Vogue should have consulted a nurse anesthetist or the AANA for the facts.
In general, though the media sometimes publishes statements questioning the quality of care provided by advanced practice nurses (APRNs) such as nurse anesthetists, numerous studies have found that APRNs provide care equal to or better than that of physicians. The FAQ section of the Center's web site contains a growing list of studies comparing the quality of care delivered by these two types of health care professionals.
Dr. Abergel and Vogue owe nurse-anesthetists, who number 30,000 in the United States alone, an apology. The Center urges all supporters to seek one, and to speak out about the critical role nurse anesthetists play in modern health care.
Dr. Abergel has been sending out the following statement to those who have written letters so far. It reads:
Unfortunately, the comment published in Vogue is being taken out of context and does not represent the full scope of my beliefs. I wanted to emphasize anesthesia should not be performed by the surgeon or by unqualified assistants. Rather, anesthesia should be administered by professionals trained in the field of anesthesia, whether it is a Nurse Anesthetists or a Physician Anesthesiologist.
I had no control over the editing of this article. I have high regard for the profession of Nurse Anesthetists. My comments in no way were intended to undermine your valuable contribution to the field of health care. I apologize if that is the way it has been perceived by the article.
R. Patrick Abergel, M.D.
We appreciate Dr. Abergel's apology and his expression of regard for nurse anesthetists. As for his explanation, it is not clear to us--and Dr. Abergel does not explain--what additional "context" could reconcile the views expressed in the Vogue article with those in his email message. Dr. Abergel does not claim that he was misquoted, i.e., that Vogue printed something he did not say.
To our knowledge, no one has received a response from Vogue. The Center did reach Vogue's reader's liaison, who said that some of our letters would likely be printed in the September issue. The liaison said that an editor or the article's author might issue a response at that time.
Whoever is primarily responsible for the statement in Vogue, the impression on its 1.2 million readers will be the same: a prominent physician believes that the care of nurse anesthetists is unsafe. Only a widely distributed public apology or clarification can begin to address this problem.
In the meantime, we ask that you keep sending letters until Vogue at least makes a public apology and vows to makes amends for publishing this damaging, unsupported statement without any response from a nurse anesthetist.
During our campaign, our executive director and many of our 310+ letter writers sent the following letter:
R. Patrick Abergel, MD
2001 Santa Monica Boulevard
Suite 1250 West
Santa Monica, CA 90404
VP and Publisher Thomas Florio
Editor in Chief Anna Wintour
Writer Ariel Levy
4 Times Square
New York, New York 10036
Tel: 212- 286 -2860
Fax: 212 -286- 8169
Dear Mr. Thomas Florio, Ms. Anna Wintour, Ms. Ariel Levy and Dr. Patrick Abergel:
I am writing to express my grave concern about an inaccurate and harmful statement about nurse anesthetists in Ariel Levy's article "Shopping for surgery" in the June issue of Vogue. In the article, which discussed how to find "safety and success" in aesthetic plastic surgery, Dr. Abergel is quoted as saying that some plastic surgeons administer anesthesia themselves or "use" nurse anesthetists, but that either option is "unsafe."
Contrary to Dr. Abergel's unsupported statement, published research has shown that the care of Certified Registered Nurse Anesthetists (CRNA's) is at least as good as that of anesthesiologists. The American Association of Nurse Anesthetists' (AANA) has compiled a database of such research. See <http://www.aana.com/crna/prof/quality.asp>. CRNA's are skilled professionals with master's degrees who provide vital anesthesia services to thousands of surgical patients daily, especially in more remote areas with insufficient business potential to attract anesthesiologists. To compare the highly developed anesthesia skills of nurse anesthetists to those of plastic surgeons with little or no anesthesia training is a grotesque insult to nurse anesthetists. Indeed, it is not clear what would qualify any plastic surgeon--who, according to Dr. Abergel's own statement, would be unfit to administer anesthesia--to dismiss an entire category of anesthesia professionals who save lives in health care contexts. Vogue should have consulted a nurse anesthetist or the AANA for the facts, or at least for a response to Dr. Abergel's sweeping statement.
Many who create negative media images of nurses doubt that such images can really harm the nursing profession, which is currently suffering from a critical shortage that is a major public health crisis. However, as public health professionals at USC's Hollywood, Health and Society project and elsewhere can tell you, the media does affect how people think and act with regard to health issues. Inaccurate, unfounded negative comments such as the one Vogue printed contribute to an unattractive media image, which in turn affects how people think and act with regard to nursing. Indeed, a key reason that nursing is in its current state--understaffed, underfunded and underempowered--is that the work of nurses is undervalued by the general public and health care decision makers, all of whom are affected by the media. Such disrespect also directly discourages nurses and potential nurses.
We urge Dr. Abergel, Ms. Levy and Vogue to publicly apologize to all Certified Registered Nurse Anesthetists in the lead letter of the next Vogue's "talkingback" section. We also urge you to consult nurse experts on any future health-related articles, to help prevent problems such as this one.
I also encourage you to make amends to the nursing profession, and to help resolve the nursing shortage, by supporting efforts to improve public understanding of the profession in a tangible way. Publishing monthly articles written by nurses, or articles using nurses as the primary health experts, would be a reasonable start. The Center for Nursing Advocacy, which works to improve public understanding of nursing, would be happy to assist you. We are confident that organizations such as Nurses for a Healthier Tomorrow would also be happy to work with you.
Sandy Summers, RN, MSN, MPH
The Truth About Nursing
203 Churchwardens Rd.
Baltimore, MD 21212-2937