Prof. Dr. FEBOPRAS
Prof. Dr. Habil
Plastic Surgeon
President of the Romanian Association of Plastic Surgeons
President of the Romanian Ministry of Health Plastic, Aesthetic and Reconstructive Microsurgery Committee
Prof. Dr. Cristian Radu Jecan
You are a doctor with multiple trainings and international participations in your field of activity. How important is the connection to the global environment and how much time do you spend on these events?
Our specialty, known and most commonly called internationally for plastic and reconstructive surgery, has been constantly positioned at the forefront of the innovation and development front of surgery in particular and medicine in general. Among the body of the specialty we have one of the nine surgeons worldwide, who were awarded the Nobel Prize in Medicine, in the person of Prof. Dr. Joseph E. Murray (1990, for the first kidney transplant, performed in 1954). Plastic and reconstructive surgery is based on several clear basic principles and rules regarding vascular anatomy and surgical tissue manipulation. Through their individualized application, particular methods and means of solving specific ailments or special cases result. To these, recently, are added some cutting-edge technologies such as 3D tissue printing, tissue bioengineering, artificial intelligence. The amount of medical information available changes with increasing logarithmic progression. It is impossible for a single person to have access, let alone to acquire this enormous amount of information. Thus, continuing medical education, by participating in various forms of scientific events at national and especially international level, is extremely important for a plastic surgeon, who wants to be permanently connected to the latest discoveries, in terms of medical techniques and technologies vanguard. Thus, every year I sign up and participate in at least two major international scientific events and usually several, between 3 and 6, as a guest lecturer. The last years, marked by the COVID-19 Pandemic have profoundly marked this aspect; there is a transition, hopefully temporary, from in-person participation to online.
You stated that only doctors who have specific training and authentic experience are entitled to practice plastic surgery in all its forms, reconstructive and aesthetic. What do we do in this case with the young generation of surgeons who want to launch into the market as quickly as possible, without having a solid background?
I would nuance the answer a bit. In the practice of our specialty, the main concern that must govern us permanently, in any medical or surgical act is the safety of the patient. Our specialty, called in Romania, comprehensive and comprehensive, plastic surgery, cosmetic surgery and reconstructive microsurgery, has a 6-year training curriculum, which includes gradual exposure to emergency surgical pathology, burns, reconstructive surgery and cosmetic surgery. In this last aspect we are a bit deficient, because cosmetic surgery is very little practiced in state health units, for reasons related to legality, but we work together with medical universities and the Ministry of Health to regulate this deficit. My opinion is that only a surgeon who has rigorously completed the entire course of professional training and has been exposed to trauma, burns and reconstructive surgery can understand and practice cosmetic surgery at high standards, not to mention is a surgery on demand, without having in the back a medical pathology in the strict sense. Any surgeon who undertakes a surgical, reconstructive or cosmetic procedure must be prepared to prevent and especially to treat any possible complication associated with this surgical procedure. Let’s not forget that the training of a surgeon, so as to reach the level of an expert, involves an average of 10 years, after completing the residency training. My advice for the younger generation is to gradually approach the pathology, from simple cases with clear surgical solutions, to those of medium complexity and then to severe or complicated ones, possibly under the guidance and with the help of a more experienced colleague. I also emphasize the importance of the mentor in surgical training, as well as national or international experience, in centers of excellence dedicated to specific issues. Last but not least, I want to emphasize that the growing level of available knowledge, which will continue to accumulate exponentially, will impose, voluntarily or fortuitously, in our country, the overspecialization on certain narrower areas of the specialty.
What does it mean for you to obtain the EBOPRAS Diploma in 2003? With what responsibilities does this title come and what were the merits for which you obtained it?
EBOPRAS, European Board of Plastic Reconstructive and Aesthetic Surgery, represents the working group of the plastic and reconstructive surgery section a UEMS. UEMS (Union Europeene de Medicines Specialistes) is also a non-governmental organization that brings together professional associations of specialists in the European Union, with the main goal of developing unitary standards of training in the Union, reflecting modern medical practice and current scientific discoveries. Romania, through the merit and involvement of Mr. Prof. Emeritus Ioan Lascăr, aligned in 2008 (the name of the specialty) and then in 2018 (the adoption of the curriculum and the duration of training in the specialty), the European standards, as defined by EBOPRAS. For over 25 years, EBOPRAS has been organizing an annual examination to verify professional knowledge, through a written and oral test, with great difficulty, in line with the European standards in force. Following the promotion of this exam, the title of EBOPRAS Diploma is awarded, a title that certifies that its holder is prepared theoretically and practically, according to the professional quality standards recognized at European level. Following the passing of this exam in 2003, together with my colleague and friend, Dr. Cătălin Stingu, I was the first specialist to practice in Romania, who acquired this quality. Theoretically and practically, it is more of a symbolic recognition of the professional quality level, but it has an indirect responsibility, both at the level of current medical practice and at the academic level, in the process of training other specialist doctors.
Through the blog you have on your site, you also educate the market, mainly the consumer of cosmetic procedures. There is a major difference between a plastic surgeon and a cosmetic surgeon. Can you develop it for the readers of our magazine as well?
As I mentioned in a previous answer, plastic surgeon means a doctor who passed the residency exam and completed the entire training course through residency, validated by the exam for obtaining the title of specialist doctor. The title of plastic surgeon is an abbreviated variant of plastic surgery, cosmetic surgery and reconstructive microsurgery, according to the nomenclature of surgical specialties in Romania. The plastic surgeon is entitled, through his professional training and the effect of the law, to practice cosmetic surgery in all its forms and on any anatomical region of the human body. Aesthetic surgeon is a self-employed notion assumed or attributed by some doctors, unfortunately sometimes by non-medical staff, without this legal training and which in the general public is assimilated to those who practice medical procedures or cosmetic surgery. Often, these so-called “cosmetic surgeons” do not have a formal professional training, not even among the specialties that have included in the training curriculum specific aspects of medicine / cosmetic surgery. The lack of specific formal training is unfortunately reflected in the quality and lack of safety of the medical act, and in the generation of serious complications, sometimes with lethal potential. A plastic surgeon is always trained by residency in plastic surgery, cosmetic surgery and reconstructive microsurgery, has the title of specialist recognized by the Ministry of Health (following the examination of specialist doctor), is always registered as such at the College of Physicians and medical practice in a unit legally authorized in the specialty of plastic surgery.
Prof. Dr. Cristian Radu Jecan, you are the head of works at UMF Carol Davila Bucharest. How do you feel about the new generation? What are the strengths you are looking for in a future doctor in whose future you would invest?
In the meantime, I passed the University Professor exam at UMF Carol Davila Bucharest and I am the residency program coordinator within the Discipline of Plastic – Reconstructive Surgery, Emergency Clinical Hospital “Prof. Dr. Agrippa Ionescu ”. My colleagues, together with me, invest time, energy, professional knowledge and peer support in any young doctor assigned for training in our country, without individual differences. The new generation is both connected and informational and cybernetic, with innate abilities to search and collect information, and here I do not mean only the specialized ones. At the same time, I feel a desire, perhaps legitimate, to “burn” stages, to skip certain milestones in my career. I’m not saying it’s good or bad, but speeding up goals can lead to patterns of training that are sometimes difficult to correct. At the same time, apart from the general features characteristic of this generation, there are also individual characteristics that differentiate them. I would say that the desire for holistic, serious professional training, which would be a solid professional foundation on which to build a further overspecialization, is an asset. Empathy and collegiality are also important milestones in a strong and ethical relationship with both patients and colleagues. We appreciate the ability to accumulate, synthesize and process information, adaptability to the new, and the capacity for sustained effort. And last but not least, the human character, without which we can do nothing. We must understand that any of us did not create the world but found it as it is, shaped by those before us. On the shoulders of these giants, we must sit down and put some bricks, which will be support and direction for the generations to come.
How does a day in Doctor Jecan’s life look like?
This answer makes me revisit the program a bit and realize that it can be optimized. I wake up at 5:30 during the week and around 6:00 on the weekend. From 6:30 to 6:45 I arrive at the hospital, where I have a few minutes to review the current administrative documents. Between 7 and 8 in the morning, I have an appointment in the outpatient clinic, where I consult new patients and see operated patients again. Between 8 am and 2 pm I carry out the current medical, administrative and didactic activity within the section. I try to have an operating schedule planned 4 days a week, which leaves me with a buffer day for possible emergencies. Around 3 pm I arrive at the office, where I have a consultation schedule or operator, which usually lasts until 7-20 pm, sometimes even later. I also try to leave at least one day off in the afternoon. In the short time left, available in the evening, they perform academic tasks (articles, reviews, papers, administrative work for the ministry and the association). Where do I feel deficient? At the time given to my loved ones, family, friends and hobbies. I try not to neglect the physical part of the exercise as much as possible. I try, but I don’t always manage, to go to bed around 10:30 p.m. Most importantly, I’m disconnecting all notifications on my mobile phone from 8pm onwards, except for emergency calls.
At the moment, what interventions are predominant in your program? Plastic surgery, reconstructive surgery or strict cosmetic surgery?
The current practice is divided between the activity of plastic surgery and reconstructive microsurgery, including emergencies and cosmetic surgery, but not only, in the private system. Without making an exact calculation, I think that the reconstructive part represents about two thirds of the workload and the cosmetic surgery cases the remaining one third.
What do you think about the rise of medical tourism to Turkey? How does it impact the activity of doctors in Romania?
I am directly or indirectly informed of this. I can tell you a few things about our specialty. About 20-25 years ago, the Turkish authorities invested heavily in the training of doctors in recognized centers in the United States. This investment has had multiple positive results, including the increase in training of doctors, their professional connection to centers of excellence and the import of medical science, increased visibility through specialized publications (10 years ago the work of colleagues in Turkey accounted for about 1/3 of the total annual publications in the PRS Journal, the most visible specialist publication in the world). In the long term, the phenomenon has led to the development of many private or state-run centers, in which doctors trained in the USA have been active, with methods, protocols and guidelines adopted from there, in terms of a significantly reduced overall operating and financing cost of Romania. This, together with an extremely aggressive advertisement, led to the momentum you mentioned. In addition to the positive aspects related to the competence and skills of colleagues in Turkey, there are also less good aspects related to the intrinsic nature of medical tourism. I am referring to the difficult follow-up of patients during the recovery period and especially to the treatment of complications. We have encountered cases in which these complications, generated by a private system, or at least with payment, have been treated by the Romanian state system, which creates an ethical problem. In cases where, as an expert, I have been asked to analyze a case and approve a treatment in Turkey, I have rarely identified this country as the only possible solution, often this treatment being possible in Romania or in other countries from the European Union. Finally, I would like to conclude by saying that at the moment, especially because of the advertisement, which allows any statement, it is very difficult to identify a center, a cabinet in which high quality medical care is provided compared to one that is focused only on financial profit, that’s why I ask any patients to be extremely well informed before making a decision.
Prof. Dr. Cristian Radu Jecan
Do you have a specific patient profile? What kind of patients has crossed your threshold most often?
It is difficult to define a particular patient profile. If I think about it, I treated patients from all walks of life equally or as a level of education. The key is to adapt the medical language and the method of delivering information according to each individual patient, so that he can make an informed decision at his level. In general, I avoid patients who have unbalanced concerns about some minor defects, who have unrealistic expectations after the intervention, who do not want or cannot integrate the medical information provided, or those who walk between doctors, with increasing demands more unrealistic.
If you had the power to change the mindset of your patients, what would it be?
It is not the role or place of the plastic surgeon to change mindsets, but we can take major steps in terms of approaching the patient’s ethics, his correct and complete information, so that we always put the patient’s safety and well-being first. On their part, I would like them to better integrate the information provided by doctors, not to confuse their desire with what can be offered to them in a concrete and correct way, thus avoiding many awkward situations. Last but not least, it would be desirable to increase the general level of medical education among patients, thus making possible the correct and early access to prophylactic and curative health care.
Thoughts for our readers.
First of all, thank you for the opportunity to share in this interview some information and thoughts that I find useful. I would end with an approach to your readers, potential patients benefiting from the services of our specialty. Find out correctly and completely about the nature of the operation or the surgical procedure requested. Also, choose to collaborate with an accredited and certified specialist doctor, member of the national profile association, who has in his basic training in the specialty the field and who carries out his activity in a medical unit authorized according to the specialty. Choose your doctor based on the direct relationship, based on the information provided and the referrals obtained from other patients. Make sure you’ve answered all your questions, fears, and expectations. These issues can be extremely important, especially in the unlikely but possible case of complications that need to be addressed and resolved. Aggressive and ubiquitous advertising is not always reflected in the quality of professional training or surgical skills. Finally, I wish you a beautiful spring and excellent medical services, without unwanted incidents.
