This tweeterview was between:

Tweeter: @diariomedico
Tweetee: @rlbates
Ramona Bates
Date: Jun 16, 10
Time: 07:00
Category: General Interview
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The tweeterview as recorded:

"Welcome to our twitterview. Remember you can read this live on Twitter or at (no signup for reading). "
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Send @diariomedico a question if you wish. We can't guarantee we'll have time to ask it, though.
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Today our guest is Dr. Ramona Bates MD, @rlbates, "a Plastic Surgeon who quilts" by her own definition, from Arkansas (USA).
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Good morning, Dr. Bates.

Good Morning /

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How long have you been practicing Plastic Surgery now?

It will be 20 years this August /

"What has been the major change in the field in this two decades, if you had to chose one (you have!)"

Health insurance changes have been major. Though I don't do them: face transplants/

"How crucial is Plastic Surgery in new operations like face transplant? Here it is seen mostly as transplant not plastic surger.."
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Very -- skills in caring and transplanting the tissues, reconnecting the nerves and vessels, getting a cosmetic result/

But with facial transplants so many other specialties are important too/

"As for health insurance... What do you think about healthcare reform in the US? How will it impact your work?"

When I began my practice it was much easier to know who qualified for say a breast reduction and who's insurance would pay

Now, it is a matter of do they have the proper referral, can they see you (are you in their network), and other barriers/

Reconstructive surgery is becoming more difficult to get covered as it is often seen "as un-necessary"/

"Is it seen as a frivolous spending? By who, also other doctors?"

Often, yes. The biggest reason is "it's not necessary for improving function or life saving" even though ...

...patient may become a "shut in" due to facial deformity or scar/

other examples are panniculectomies (to remove the excess lower abdominal skin, not a full tummy tuck) which improves hygiene

Things like keloid scars may trouble people, but often are not life threatening even though ugly/

"There is also reconstruction after breast cancer surgery. Are there metrics of the psicological impact of Plastic Surgery in t.."
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..his case?

Studies are just now being done to look at the psychological aspects of reconstructive breast and facial surgery

There was a law passes in late 1980's which made insurance companies have to pay for reconstruction after breast cancer

In the day of fewer dollars and society trying to cover more people, it may be tough to justify reconstruction rather than..

... diabetic or hypertensive care/

"Do you think women will have to pay for reconstructions out of their own pockets?"

No. I don't think that law will be changed. Too emotional of an issue. Political suicide. :) /

"What's the most difficult operation you've performed and why?"

The first one I did in solo practice. :) It dawned on me that I had no backup that day. It was just me.

I quickly got over that fear, thankfully. The most complicated I remember was a latissimus dorsi muscle flap used as a ...

transfer (not flap) used as a replacement for the biceps muscle. Worked wonderfully. Young man had almost lost his arm/

"What are Plastic Surgeon's new challenges right now?"

Reconstructive: new tissue replacements, improved safety of flaps, improved outcomes.

Cosmetic: safety of products for wrinkles (fillers, Botox), safety of Lasers, safety of implants, improved outcomes/

"What about Lasers? Remembers me of eye surgery. What's their most common use in Plastic Surgery?"

Most common use of lasers in plastic surgery is resurfacing of the face as in removing wrinkles and evening out skin tone.

Another use is tattoo removal. Now being added to liposuction as a "tightening of skin" /

It (Laser) is also used in treatment of hemangiomas/

"And why are there safety concerns? Does it cause unexpected outcomes?"

Safety concerns with Lasers involve using undertrained personal to do the procedures (most common in medical day spas)

Lasers can result in deep than intended burns to the skin being treated and result in less than cosmetic scars/

"Have you ever treated burnt patients?"

Yes, but it's been years. Most burns here get sent to the burn center/

I actually enjoyed treating burn patients/

"Isn't this a field (burnt patients) in which major improvements are being made in treatments? What can we expect in the future.."
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Yes. It is an exciting area with burn products and replacement skin being developed/

"Do you believe taylor-made skin samples grown from stem cells will be a reality any time soon?"

I don't have the answer to that, but it would be nice. /

"Why did you start blogging?"

I began blogging after reading a few and finding that often my comments seemed to be long. I decided I needed my own

Also, because it seemed difficult to find a source of "good" information to refer patients to. This is changing/

"Are you still an exception among your colleagues, or is blogging frequent?"

Local colleagues, yes. Not many blog /

"And how would you convince them to change? Why should doctors blog?"

I haven't managed to do get any of them to begin their own. I tried to get a local emergency doc to blog, no go/

"So it's a lost battle? Patients will have to look somewhere else for blogs?"

Well, fortunately with the internet it doesn't matter where they are, does it? I follow blogs from South Africa, India, ..

..Norway, Great Britain, and all over the United States. I follow many different specialties, not just plastic surgery/

"But MDs still tend to be a minority among bloggers worldwide or is this changing?"

I don't have any numbers, but I think perhaps the number of physician bloggers has increased./

"What's the best and worst you've got from blogging?"

The best for me is the community of medical bloggers. The worst -- spam commenters /

"As for good sources of information for patients, what are the ones you find more useful?"

Professionally, Medscape, Plastic and Reconstructive Journal website, eMedicine.

For patients: some of the medical blogs, WebMD, Centers for Disease Control and Protection, and others have good info/

"Why do you use Twitter? What does it add?"

Twitter for me is the personal conversations between friends. It is also the sharing of information I might miss/

"What new technology will be more important for Medicine's future?"

Not sure. I think electronic medical records have great potential. Improved lasers, remote surgical systems, all leave .. in awe/

"I'm affraid we just ran out of time and we'll have to finish here. Thank you so much Dr. Bates, it was a pleasure!"

You are so welcome. Thank you for inviting me. Have a great day!