Donda West Law probably won’t change much

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In effect this month, the Donda West Law requires a patient to receive a physical exam and written clearance from a doctor within 30 days before elective cosmetic surgery. California is believed to be the first state to pass such a requirement.

via Donda West law wont boost patient safety, docs say – CNN.com.

My heart goes out to the West family.  It really does.  Donda West’s death — any unexpected death, really — is soul-crushing.  I’d like to be able to say that this new law requiring clearance for cosmetic procedures will decrease the number of unexpected deaths and prevent unspeakable grief.  I’d like to, but I can’t.

I clear patients for surgeries with some frequency.  As this article points out, preoperative clearance within 30 days is already the norm.  But the word “clearance” is rather misleading.  “Risk assessment” would be more appropriate.

As part of the preoperative clearance, I ask about risk factors:  history of heart problems, exercise tolerance, symptoms of chest pain, and the like.  Depending on the patient’s responses, this may lead to further testing, including treadmill testing and cardiac catheterizations when indicated.  Assuming everything looks okay, the statement of “clearance” for the surgery actually reads more like “patient is at standard risk for the surgery.”

I say it that way because any surgery, even cosmetic surgery, always entails risk.  We try to minimize risk as much as possible, but even in the best pre-operative health and in the hands of the most competent surgeons patients still die.  It’s infrequent, but it happens.  No one is ever truly  ”clear” for surgery.  They’re just tuned up as much as possible, and we hope for the best.

Whether Donda West could have been tuned up any better is somewhat uncertain — the family says yes, the docs say no — but a law requiring an exam before surgery only places what is already standard medical practice more solidly into the legal realm.  I doubt it will change outcomes much.