ABSTRACT
Safety-The Great Intangible This chapter begins with the question: How does one achieve, or even describe, the intangible ‘‘safety’’ with lasers? Safety describes a nonevent, or the absence of an adverse occurrence. Accident rates or injury risk are described in statistics or probabilities, but as the saying goes, it’s 100% if the complication happens to you! Is a 5% occurrence of minor laser injury (e.g., finger burns) less safe than a 0.1% occurrence of severe injuries (e.g., partial blindness) Unfortunately, severe injuries such as blindness often occur to the individual under circumstances very similar to those that have never caused that particular user an injury or complication before. According to a British national study, 67% of injuries are caused by ‘‘operator error’’. Ironically, these low-probability, high-impact events occur at both ends of the experience spectrum: because expert users are lulled into disregarding safety standards or conversely because inexperienced personnel (e.g., students in research facilities) are unaware of proper protection. Dermatology has a rich founding history for medical applications of lasers and leadership in their safe use in the outpatient setting, thanks to the father of laser medicine and surgery being one of our own. Yet, increasing competition in healthcare and regulatory legislation threatens to limit office surgery, the very birthplace of most laser usage, citing flawed safety data. So it is contingent upon us to learn about and use these tools safely, and contribute to studies verifying our track record. Because the public has been conditioned by the media and marketing to expect miracles, and this may lead to dissatisfaction even with a reasonable result, we must also help our patients develop realistic expectations and obtain informed consent, and analyze likely sources of litigation for negligence or less than perfect outcomes.
