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The remarkable rise in medical tourism has brought into question the foundation of the patient–doctor relationship and is endangering many who seek low-cost surgery. We see travel agencies brokering surgery for their clients with surgeons they have never met. The patients have no assurance that their surgeon is properly trained or qualified to perform the procedure they will undergo, and all too often, little attention is paid to postsurgical care. The complication rates for surgeries performed under these circumstances are alarming. An article in the August issue of Aesthetic Surgery Journal entitled Complications from International Surgery Tourism referred to a recent U.S. study showing an increase in postsurgical complication rates among patients returning from surgery overseas. Statistics presented 3 years ago by International Society of Aesthetic Plastic Surgery (ISAPS) member, Professor James Frame (UK), during the Medical Tourism Association meeting in San Francisco reported a 20% complication rate in patients returning to the UK after surgery abroad. In quite a few cases, the complications were sufficiently serious that the patients had to go directly to a hospital for care on their return. The Patient Safety Diamond devised by then ISAPS President, Dr. Foad Nahai (US), and presented at the ISAPS Congress in 2010 bases the concept of safe surgery on four factors: the patient, the surgeon, the procedure, and the facility. The patient should be a good candidate for the requested surgery. The surgeon must be properly trained and credentialed. The procedure should be appropriate for the patient. The surgical facility should be an accredited and proven safe venue with properly trained staff and emergency preparedness. When the World Health Organization (WHO) introduced the Safe Surgery Saves Lives initiative promoting their Surgical Safety Checklist (www.who.int/patientsafety/safesurgery/en/), ISAPS was one of the initial endorsing organizations at the launch of this program in Washington, DC in June of 2008. A recent study published in the New England Journal of Medicine showed that use of the 19-question checklist reduced surgical complications by more than one third and surgical deaths by almost half in the test hospitals compared with control hospitals. This simple form is used much as a pilot uses a checklist before taking a plane onto a runway for takeoff. In 2006, Dr. Joao C. Sampaio Goes (Brazil), president of ISAPS at the time, developed key guidelines for those patients who decide to travel for their surgery. These guidelines are posted on the ISAPS website (www.isaps.org ). Several other organizations have since adapted these for their websites. Dr. Jan Poell (Switzerland), the current President of ISAPS, explains the need for this information: ‘‘Consumers around the world have looked to ISAPS for over 40 years for the most accurate and reliable information about qualified plastic surgeons and advice about procedures. ISAPS provides a worldwide standard for consumers to reference when traveling for aesthetic plastic surgery.’’ Many patients have the misconception that anyone with an MD can safely perform any surgical procedure. Legislation around the world is changing to reflect a growing concern that patients are undergoing surgical treatment by incompetent and untrained individuals—sometimes not even physicians. Several countries including Italy, Russia, Mexico, Colombia, the Czech Republic, and Canada are leading the way with new regulations controlling who can perform what specific procedures on which patients and in what facility. This is also the case in Denmark, a front C. B. Foss (&) International Society of Aesthetic Plastic Surgery, 45 Lyme Road, Suite 304, Hanover, NH 03755, USA e-mail: isaps@conmx.net

Patients Have a Right to Safe Surgery