Eyes for Sale

The Washington Post Company
Monday, September 10, 2001; Page A20

COMMON SENSE dictates that people exercise caution when shopping for elective surgery. But they can't make informed decisions if purveyors of the surgery withhold important information, whether about the procedure itself or about the financial motives of the staff members providing "counseling" on whether to go forward. It's the latter kind of information that appears to have been withheld at one local purveyor of Lasik, the highly popular procedure that promises improved vision without glasses or contact lenses.

According to reporting by Post special correspondent Marc Borbely, "patient counselors" at the Laser Vision Institute (LVI), a Florida-based chain with offices in Tysons Corner, are instructed to stress benefits rather than risks and to make "a strong attempt" to change reluctant prospects' minds. Before receiving a medical exam, which can reveal reasons why the surgery would be risky, prospective patients must make a hefty deposit; company documents state that counselors must "close the deal" and get the deposit from 75 percent of their customers in order to qualify for bonuses. LVI's chief executive, Max Musa, defends the practice of awarding bonuses but says patients don't need to know about it, since "it isn't relevant" to their decision.

No law prevents this financial weighting of what patients might logically believe to be a genuine medical consultation. Codes of professional medical ethics, though, look harshly on such practices, and some state medical boards have slapped penalties on doctors for such medical-financial minglings as paying for referrals or being judged to put profit above a patient's best interests. In the world of optional and cosmetic surgery, rules are hard to enforce. The surgical hard sell is only the disreputable end of a spectrum of ever more entrepreneurial practices: Firms of marketing consultants have sprung up to advise doctors on how best to market procedures directly to patients, and the Lasik procedure, performed on 2.5 million people since 1998 and 1.2 million people in 2000 alone, has quickly outdistanced other such surgeries both in numbers and in the speed it travels by word of mouth.

Hard-selling medical procedures to the uncertain is flirting with trouble, particularly where the procedure in question involves slicing one's corneas with a laser. Though no evidence suggests that LVI has had worse results from its surgery than other providers, the immediate convalescence from Lasik can be painful, and complications occur in around 5 percent of cases, though less than 1 percent are classed as serious. Informed consent is a must. Medical authorities may not be able to curb the selling of surgery, but they should at least make sure that customers know when they're talking to a salesman on commission.

© 2001 The Washington Post Company