Delegation of Laser Services can be Problematical

Dr Christopher Zachary, guest speaker at the 2010 annual meeting of the Florida Society of Dermatology and Dermatologic Surgery, expressed concern that some physicians are trivializing the potential complications associated with laser surgery by delegating all such procedures to nursing or other staff instead of performing the surgery themselves.  “Any device that can induce serious benefits can also be asssoicated with serious complications”, said Dr Zachary.  “I have no problem with properly trained staff using these devices under the supervision of a trained physician ….. but I have seen enough complications from unsupervised situations that it’s time to review the licensing requirements in this regard.  I believe patients really need to know that those who will be treating them are appropriately trained, and that there is adequate supervision”. He went on to say that the supervising physicians can’t simply be ‘caretaker supervisors’; they have to be experts in the use of these devices, fully able to advise, support, and review the patients before, during and after the procedure.

Other problems to be avoided include the development of bulk heating by poor scanning techniques. “It is critical that the spatial separation of fractionated laser pulses is not lost by overlapping the scan or stamp patterns”.  Bulk heating can and will lead to full thickness loss of skin leading to significant scarring.

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