Woke Up From Sedation to Find Tens of Millions of Won Charged??

I recently read a news report about a dermatology clinic in Gangnam that

performed additional procedures on a patient during sedation,

and had the patient pay more than

ten times the amount originally quoted.

The patient had come in for a procedure lasting about 15 to 20 minutes,

but woke up nine hours later,

and according to the report, several more procedures had been added in the meantime.

Of course, the case is still under investigation, so we will have to wait and see what actually happened.

That said, one part of the report left me quite baffled.

According to the report, the patient personally requested additional procedures during sedation and even signed the consent form.

Any doctor who performs sedation at a dermatology clinic would immediately recognize how strange that is.

So today, I'd like to unpack this a bit.

You mean a sleeping patient can actually respond?

Many people believe that once they are under sleep anesthesia, they lose consciousness completely

and don't respond at all.

But that isn't necessarily the case.

What we commonly call sleep anesthesia is, strictly speaking, sedation.

The effects vary depending on how deep the sedation is, but

patients may talk, respond to questions,

and even move their hands well enough to sign a document.

The real issue

is whether the patient is capable of making normal judgments at that time.

Sedatives affect judgment and memory.

Even if a conversation took place at the time, some patients may remember nothing at all after waking up.

That doesn't mean that in every case where a patient can't remember, their decision-making ability was absent,

but we should at least not assume they were capable of making normal decisions.

If you imagine a heavily intoxicated person being handed a contract and made to sign it,

it may be easier to understand.

Having signed something and truly understanding and agreeing to its contents are two different things.

Doctors should be well aware of this as a matter of course.

That's why I don't perform additional procedures.

At our clinic, we decide on all procedures before sleep anesthesia begins.

Which procedure will be performed, which area will be treated, and how much it costs.

We go over everything thoroughly in a consultation and only start the anesthesia after the patient has made their decision.

Once sedation begins, we carry out only the procedures that were planned.

Sometimes during a procedure, a patient will ask us to treat other areas too.

Even then, we don't do it.

There are also times when I myself, in the middle of a procedure, think it would be better to treat other areas too.

The same applies in that case.

We complete the planned procedure first, and once the patient has fully woken up, we explain the situation.

If necessary, it can be done at the next visit.

Honestly, from the standpoint of someone who runs a dermatology clinic,

this may seem like an inefficient approach.

Since anesthesia has already been given and the patient is asking for it anyway,

one might think it would be more convenient for everyone to do it all at once.

It would also help the clinic's revenue, of course.

But I don't really want to go that far.

I don't think there's any reason to decide on new procedures

when the patient is not in a position to think clearly.

It may be a bit of a hassle, but we can simply talk again after they wake up.

On prolonged sedation,

another thing that was hard to understand in this case was the length of the anesthesia.

The procedure was planned to take about 15 to 20 minutes, yet the patient didn't wake up until nine hours later.

Of course, since I don't know the exact medication records or the patient's condition,

I can't say for certain what happened.

Drugs may have been administered repeatedly, or several drugs may have been used together.

Individual drug reactions or other factors may also have had an influence.

Still, it's not a situation commonly seen in typical dermatology procedures.

Sleep anesthesia is not simply about putting a patient to sleep.

During anesthesia, breathing can be suppressed or the airway can become obstructed,

and the patient can fall into a deeper state of sedation than expected.

That's why the patient's breathing, oxygen saturation, blood pressure, heart rate, and so on must be monitored continuously,

and the team must be ready to respond immediately if something goes wrong.

The longer a patient stays asleep,

the longer the medical staff is responsible for their condition.

But there was one more thing I wondered about.

Why would someone who came in for a 15-minute procedure need to be kept asleep for so long?

Answering this would require checking the accurate medical records.

Sleep anesthesia itself is not the problem.

I imagine some people may now be afraid of sleep anesthesia because of this incident.

But there's no need to think of sleep anesthesia itself as a dangerous procedure.

Sleep endoscopy, which is done during health checkups, uses the same sedation principle.

Of course, since it is a medical procedure that involves drugs, that doesn't mean it's entirely risk-free.

What matters is using appropriate drugs for each patient,

monitoring the patient's condition during anesthesia, and having an environment in place to respond when problems arise.

I believe the safety of sleep anesthesia depends not only on which drugs are used,

but also on how those drugs are managed.

And that management should include respecting the patient's right to make decisions.

Is it wrong to recommend additional procedures?

In dermatology practice, we often find that a different procedure would be more suitable

than the one the patient originally came in for.

For example, someone who came in for Ulthera may actually have a bigger problem with volume loss than with sagging skin,

and on the other hand, there are cases where a patient's concern doesn't actually require any procedure.

Explaining these points and recommending other treatments is, I believe, part of a doctor's job.

That's how I practice as well.

The question is whether the patient can fully understand the suggestion and make their own decision.

After all, a dermatology clinic is still a business, and we can't ignore revenue.

As someone who runs a dermatology clinic myself, I have no intention of pretending I don't know that.

However, I don't think we should take advantage of moments when a patient's judgment is not fully intact in order to boost sales.

If a patient declines, that should be the end of it. If they're still undecided, they can decide later.

After all, there are fewer cases than you might think where a procedure truly has to be done today.

Before undergoing sleep anesthesia,

I'd like to share a few things with patients as well.

If you've decided to undergo sleep anesthesia, please make sure you check, before the anesthesia, which procedures you'll receive

and how much they cost. I hope you'll confirm both thoroughly.

Please read the consent form carefully, and if there's anything you don't understand,

it's best to ask for an explanation.

During anesthesia, you can also ask who will be monitoring your condition

and how recovery will proceed.

These are routine for medical staff,

but they may not be so familiar to patients.

And if, after waking up, you find that procedures or charges you never agreed to have been added,

I'd suggest checking your medical records and the breakdown of charges first, rather than paying right away.

Of course, in a medical emergency, unplanned treatment may be necessary for the patient's safety.

But that is an entirely different matter from deciding on additional cosmetic procedures.

What I ultimately think matters most is this.

I believe most doctors are doing their best to provide the best possible care for their patients.

Since the facts of this case have not all been confirmed yet, I don't want to rashly blame anyone.

However, if the reported details are true, it is truly shameful for those of us who do the same work as doctors.

Patients cannot know everything that happens to them while they are under sleep anesthesia.

That's why they trust the medical staff and entrust their bodies to them.

I believe that trust is far heavier than it might seem.

Of course, we at our clinic won't be able to satisfy every patient.

Some patients may find the results fall short of their expectations,

and my judgment may not always be the right one.

But at the very least, I believe that while a patient is asleep,

no cosmetic procedures should be added that they haven't decided on themselves.

That's why I don't perform additional procedures during sleep anesthesia.

It's not some grand principle, but simply because I believe it's the right thing to do.

#DrChoYoungmin #DrKwonYoungshin

Frequently Asked Questions

Does sleep anesthesia completely remove consciousness?

No, not always. What is commonly called sleep anesthesia is more precisely described as sedation. Depending on the depth of sedation, patients may talk, answer questions, and even move their hands to sign documents.

Is a consent form signed during sleep anesthesia enough?

The author explains that the act of signing alone does not mean the patient understood and agreed to the contents. Because sedatives can affect judgment and memory, the author's position is that one should not assume the patient was capable of making normal decisions.

Is it okay to perform additional procedures during sleep anesthesia?

No, the author states that they do not perform additional procedures during sleep anesthesia. Procedure types, treatment areas, and costs are discussed before anesthesia, and the patient decides. Even if the patient requests more treatment during anesthesia, the author completes only the planned procedures and explains everything once the patient is fully awake.

What should you check before getting sleep anesthesia?

The author recommends thoroughly confirming the procedures, treatment areas, and costs before anesthesia. Read the consent form carefully and ask for an explanation of anything you don't understand. You can also ask who will be monitoring your condition during anesthesia and how recovery will proceed.

What should you do about charges for additional procedures you didn't agree to?

The author advises checking your medical records and the itemized charges before paying, rather than paying right away. However, in a medical emergency, unplanned treatment may be necessary for patient safety, and the author explains that this is a different matter from deciding on additional cosmetic procedures.

Is sleep anesthesia dangerous?

Sleep anesthesia itself does not need to be viewed as a dangerous procedure, but because it is a medical procedure that uses drugs, it cannot be said to be entirely risk-free. The author explains that what matters is whether breathing, oxygen saturation, blood pressure, and heart rate are continuously monitored and whether staff can respond immediately if problems occur.