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Falc,
I don't think you are getting the point. I am not the one in power in this scenerio. I am admitting just the opposite. It is the patient's physiology that is in control, not me.

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I am charging to ATTEMPT to do the surgery. The price is a mixture of the skill and experience I've accumulated over the years in FUE as well as the amount of money I would have made if I had signed a strip patient up for that very same day.

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Market forces and simple economics determine my price in order to stay competative and viable. I don't have any choice in the matter.

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Unfortunately, many people just FEEL it's wrong for physicians to make money off of people's misfortune...

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Originally posted by falceros:
Dr. Feller (and all),

Great posts from all of you. Indeed I shared my honest thoughts about this to generate discussion on the topic, so I'm glad that it did just that and that nobody took it personally.

I want to make clear that I don't have any ethical issue here with what Dr. Feller is doing. Dr. Feller is clearly stating to his patients what he intends, and his patients either agree or disagree to the terms. I do, however, have a personal problem with it...as I'll define further below by addressing some of the points Dr. Feller has made. These are just my opinions, and anyone can take them or leave them.

Just to hit a few of Dr. Feller's points and reply to them

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1. FUE procedures are no longer experimental. They are now a proven entity and have entered the mainstream of modern hair transplantation. Body hair FUE has NOT. The two are not comparable.

Yes, I am aware that they are not experimental like BHT (sorry if I used that word by mistake), so perhaps comparing the two isn't completely fair, however, since the success rate is still much lower than strip, those patients that undergo FUE should be aware of this (which seemingly, you present to them in some way, hopefully in writing), so there is no problem there.

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3. What I have learned from practicing FUE from 2002 to now is that NOT everybody is a candidate, and even fewer are candidates for FUE megasessions. Any doctor claiming that they can do FUE on everybody is doing one of two things: a. They are lying about the actual number of grafts they report
or
b. They are switching up to larger punches beyond .9mm in diameter which takes the procedure out of the FUE realm and into the old "plug" territory.

Since I refuse to do either of the above, I would rather tell the patient before
hand that they simply may not get the number of grafts desired.
.

I think this is good...I am aware that not everyone is a candidate for FUE, and it takes an ethical doctor to refuse surgery on someone who is not an FUE candidate...so this is good. I've read about too many doctors doing surgeries on patients that are not candidates and it turns out to be a nightmare. Regarding ethics, I do not question you.

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4. I want to make it clear that I am an unabashed and unapologetic capitalist. I absolutely love performing surgery , but I am also in business to make money and I, like you, strive to work in the most efficient manner toward that end. This hardly means that money is "everything" to me. On the contrary, I have been donating my services for years and have a waiting list for my pro bono patients well into 2007. But I can't afford to lose valuable days of surgery on a hit or miss procedure like megasession FUE, particularly when I know I could have scheduled sure-fire strip surgeries on those days. Yes, it IS about the money as such days like those can add up.

This is more of a personal problem with me rather than an ethical one. I simply suspect that patients (even though they know the facts) can be exploited, even if unintentionally (which I truly believe Dr. Feller, that you would not do it intentionally). There are certain states that people can be in which "clouds" their ability to make an informed decision, typically those states are normally those in desperation. There were big controversies way back when whether it was ethical to perform medical experiments on prisonors even though they agreed, because their "state of mind" was said to be clouded. Inevitably, medical experiments were mandated to be stopped on prisoners. Though it's not a perfect comparison by any means, someone going into get an HT by a well known doctor who constantly yields excellent results could be "clouded" with excitement with hopes and dreams of a new head of hair and agree to anything just so you'll perform the surgery on him. So in the event of a failure of the FUE surgery, this patient COULD argue that he let his excitement cloud his judgement and get the best of him. Now I'm not stating that this is your problem Dr. Feller, at least, not entirely...a patient MUST own up to their own decision making...however, I just see this as a potential issue, that could arise and come back to bite you.

And as one who is not a strong advocate for unabashed capitalism (simply because it's easy for the little guy to get stepped on), I'd like to see the PATIENT win out rather than the DOCTOR in the event of a failure. This is a personal opinion. I agree that you are doing everything to inform the patient of the situation, and if he agrees, it's on his head...however, it's the philosophy I have a problem with. The bigger guy can afford the loss...the little guy can't. So I think the bigger guy should let the little guy win in the event of the failure.

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5. While I may not be able to perform a megasession FUE on a particular patient, it doesn't mean they have thrown away $4,000. They always have the option to switch it to a strip procedure on that very day and apply every dollar of the $4,000 to the strip. In this scenario I make no money for attempting the FUE megasession.

In most cases yes...but think about those people who want FUE:

1. They are trying to avoid a strip scar
2. They might be like me and wanting to tap into reserves when they are stripped out
3. Want faster healing time

Since you've only ran into this situation one or two times (which is good), we don't really know if it happens again which patient might be the bombshell who will set off based on my above points. Again...I rather see the little guy win over the bigger guy, if things don't work in the little guys favor.

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I do all of this not because I want to make money for doing little or nothing, but because I want to see the best results possible.

I know you care about your patients and want the best possible result for them...but:

1. "unabashed and unapologetic capitalist"
2. "can't afford to lose valuable days of surgery on a HIT OR MISS procedure like megasession FUE, particularly when I know I could have scheduled sure-fire strip surgeries on those days"
3. "Yes it IS about the money as such days like those can add up".

I'll add a few more opinions here.

1. If the surgery is HIT or MISS...why do you offer it when you know very well the patient MIGHT come out disappointed and lose $4000? He might not opt for strip or even have the option for it.

2. When you say you "can't afford it", I'm assuming this is the capitalist side of you that wants to make the most money possible talking. Surely you CAN afford it since the percentages of this happening are obviously extremely small, as you said one or two. But I think most likely who CAN'T afford it is the patient who might be stuck shelling out $4000 and get nothing in return IF they can't opt for strip or choose not to.

3. I know you love your work...and you do it well. I also know that as a business, it's important to make money, and I don't question your desire to make money...after all...that's the main reason why we work isn't it? If I could...I'd retire and I'm only 29

My entire post can be summed up in this statement: It's good to make money, it's great that you love your work, but I think sometimes it's better to give the little guy the victory when in doubt. In business, sometimes it's better to cut your losses in order to keep the customer (or patient in this case) happy. Heck, after all, the patient is already going to be disappointed enough that FUE won't work for him...let him have his money back and take it as a loss. Surely...any doctor in your fiend CAN afford it with a heavy clientele like yourself. In the longrun, I think you'd be even MORE respected if a failure like this does come up, and you give the patient his money back IF he strongly objects to strip.

Anyway...on a brighter note...I think you do great work and I still believe that you have taken FUE a long way. I'll be interested to see when and if this will evolve even further in the coming years.

Falc

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Now you may not enter my home again because you are a socialist haha I am just kidding

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I think this is good...I am aware that not everyone is a candidate for FUE, and it takes an ethical doctor to refuse surgery on someone who is not an FUE candidate...so this is good. I've read about too many doctors doing surgeries on patients that are not candidates and it turns out to be a nightmare..