What does Board Certification mean?
Board certification means that the applicant has taken and passed a proctored, rigorous, written examination in their specialty. There are numerous boards certified by the American Board of Medical Specialties. Dr. Coverman is double board certified: the American Board of Internal Medicine (1974) and the American Board of Dermatology (1977).
In order to even be allowed to take the Board examination, there are several criteria that must be met:
- Attendance and successful completion of a university and/or medical school “residency” or “fellowship” program – usually three years (after finishing four years of medical school and a one year internship).
- Letter of recommendation from the program chairman including attestation to the ethical, moral, and academic suitability to be a physician in that speciality, and suitability to be allowed to take the Board examination.
- Actual Board testing.
In Dr. Coverman’s case, in 1977 after completing all of the above criteria he took the American Board of Dermatology exam which was a comprehensive exam covering two and a half solid days of written testing. That testing alone took more time than some of these “fake” dermatologists even spend at a weekend course.
Dr. Coverman likewise took the American Board of Internal Medicine examination and passed that as well.
There are other fake “boards” that are not recognized by the American Board of Medical Specialties. (This group is a comprehensive group that supervises all 26 major American specialty boards.) If your doctor alleges that they are certified by some other “board” – it could be an off-shore board or a board made up by anybody who just wanted to make some money by selling fake credentials to anyone unqualified enough to buy them. In other words, you attend the course, the “board” certifies you, and then you parade around with a board certification that in fact means nothing. It was just for sale.
If you have any question about a doctor’s board certification – you may always check with his or her major medical society (the American Academy of Dermatology – www.aad.org) or the board itself (the American Board of Dermatology – www.abderm.org).
Please remember – major hospitals during their credentialing process know better than to accept or even look at these fake boards. They know what the real boards are, and during hospital credentialing, they are very careful to weed out phony applicants. You can always check with one of your local hospitals.
What is a certified laser technician?
There are no nationally “certified” laser technicians! There is no uniformly recognized, uniformly accredited national body or organization that certifies laser technicians or doctors as being competent, qualified, or otherwise credentialed to use lasers at the national level!
Dr. Coverman did a Google search for laser training and found a huge number of wildly disparate sites on the internet, all with various claims of legitimacy. In fact, one such seminar specifically stated that it was “designed to meet the objectives as described by the Texas State Medical Board of Medical Examiners in the mandate that was passed in November 2003…” In fact, that mandate was NEVER passed and it was defeated by the spa industry lobbyists and the electrolysis lobbyists! Despite vigorous protestations from Board Certified Dermatologists, and the Texas Dermatological Society, and the American Society for Laser Medicine and Surgery, that particular proposal was in fact defeated. Just the fact that this website states that it was “passed” tells us that they don’t know what they were talking about legislatively, and why they would charge $1500 to be trained to pass credentialing that was never approved? In addition, the proper name is the Texas Medical Board rather than the Texas State Board of Medical Examiners. This particular company didn’t get that right either.
Also, remember that many of these laser training companies or facilities were funded or bankrolled by various laser manufacturers who want you to either train on their laser and/or specifically buy it when you are done. Hardly a neutral position.
We are not saying that the information in these classes is not accurate or truthful, nor are we saying that these classes are fraudulent or without value. We are just saying they need to get their facts straight.
So what does this mean? It means that someone perhaps took a weekend course, paid a few thousand dollars, and then got “certified” by the very people selling admission to that course. It is a win/win situation for everyone – the people putting on the course get their tuition fees, and the applicants get to go home with a “certificate.” They may proudly display this “certification” in their advertising, but it basically means no more than paid attendance. In fact, if you pay the fee up front, do they even require you to attend at all? Is roll even taken? Is there a written test at the end?
There are many advertisements in the Yellow Pages, on-line, and in local newspapers. There are statements such as “licensed technicians,” “certified laser technicians,” and the even the laughably, outrageous term “certified lasertrologist.” Please remember, if there is no national or local certifying body, then there is also no such “licensing body.” Perhaps these people are licensed in something else. There are licensed aestheticians in the state of Texas, but they should be more up front and honest about stating what their license is for.
More importantly, all of our staff using the laser in our office are trained by Dr. Coverman personally. He has been an instructor for Medical Alliance and has taught plastic surgeons and dermatologists how to use the laser with hands-on instruction in his very own office. In addition, he has lectured at a national course presented by The Laser Training Institute ™ (www.lasertraining.org) to other physicians to help them meet their own state’s requirement for laser certification. Dr. Coverman has served on the laser committee at Seton Hospital.
What about laser safety?
We have written office protocols for laser use in our office. This is for your safety. Our protocols include training; appropriate signage and wavelength specific eyewear to meet OSHA standards for both staff and patients; laser physics; and laser operation. All our staff that use the laser have periodically attended meetings of the American Society of Laser Medicine and Surgery. This course is intended to educate board certified dermatologists and plastic surgeons and frankly is the ONLY national educational body devoted solely to this purpose. This is not the one or two hour “in-service” that is offered by a laser salesman to show you how to plug in the laser you just purchased from him. In addition, Dr. Coverman is certified to use the laser at Seton Hospital, and our staff uses the Seton Hospital laser safety manual. All of our staff that use the laser have taken and passed the Seton Laser Safety course.
The laser is a beam of light. Most technicians don’t even understand that the word L.A.S.E.R. is an acronym and have no idea what it even stands for. Laser light is different from all other light, and its physics must be understood. Wavelength specific eyewear must be available for patients and staff, and a smoke evacuator and mask must be used if a laser plume is generated. The lasers are checked, calibrated, and serviced annually whether they need it or not. Did your “spa” or “clinic” mention this? Can they afford it? Do they care? Do they know?
What about complications?
Complications can and do happen – even under the best of circumstances. When you go to a spa or clinic – what are they going to do about it? Once they have burned you, do they understand the function and structure of the skin well enough to take care of it? Of course not! At least once a week, we see a patient that has been burned somewhere else and now has to take care of it. Does your spa have an emergency after hours phone number to call? If that doctor is unavailable do they have cross coverage by other doctors who will be there for you at night time or on weekends to care for you if your doctor is on vacation in Hawaii? Are you supposed to just walk into an ER with a burn, blister or infection? Who pays for that?
What does “years of experience” mean?
Years in Austin? It means nothing! Years of experience at what? ER physician? Psychiatrist? Dentist? Believe it or not, all of these people are now injecting Botox® Cosmetic, using lasers, and injecting all kind of things into your skin. “Years of experience” to you should only mean years of experience AT DERMATOLOGY OR PLASTIC SURGERY! What about “20 years of laser experience?” Again, lasering premalignant lesions on the cervix? Was this a gynecologist who suddenly “discovered” dermatology?
Which lasers should I use?
We are asked this question every day. Most of the public learns about new lasers through enthusiastic “infomercials” on their local TV news or daytime talk shows (Dr. Oz or Oprah). A laser manufacturer pays high powered public relations firms to get their lasers on these shows. In our office, we have many lasers – all paid for. Rather than asking “what laser should I use?” – We prefer to ask “what are you really trying to fix?” After all, isn’t that the purpose of your visit? Sometimes you don’t need the laser you thought you did or at least the one you saw on TV and at other times you might not need a laser at all! We will always pick the treatment that fits your needs the best. Other considerations are cost, your previous history with similar treatments, your finances, and of course safety. When a less expensive, easier, quicker, and less risky procedure will do the job – why use the laser?
Which filler should I use?
Again, we seem to have the “filler du jour” in medicine these days. Once again, excited promotional interviews on daytime talk shows or your evening news are supposed to “educate” you about what is newest (not necessarily what is best). The bottom line – Dr. Coverman feels all of the fillers are about the same – they all fill. Some of them are a little more smooth coming out of a syringe, others may last a month or two longer, but truly what is most important is injection technique. Dr. Coverman was the first doctor to inject ANY filler in central Texas when he was asked by The Collagen Corporation to do some final phase human studies on Zyderm Collagen in 1981. As late as 1990 he was the leading injector of Collagen in the entire state of Texas. Since then, he has tried almost all of them.
Admittedly, most of the fillers we now use are Restylane and Juvederm, because the public demands it. They are great fillers and that is why we use them. There are some fillers that we don’t use and this is explained elsewhere. The issue of which filler lasts longer is complicated: everyone wants their filler to last longer, if not even permanently, but that is, of course, if everything goes perfectly. If not, then permanent filler = permanent problem. If something isn’t quite right or asymmetric, or lumpy – you are stuck with it for a very long time. In addition, most of the more long-lasting fillers cost more, so it is a wash. Wouldn’t it be better to inject the filler such as Juvederm that will last around six months and have an opportunity to change, fix, or correct something next time around if you didn’t like it?
Why not use permanent fillers?
Permanent fillers equals permanent problems. Dr. Coverman feels it would be a mistake to use a permanent filler and then find out something went wrong – it was asymmetric, it was lumpy, or not quite where you wanted it. In addition, your face will change over time – most people as they age lose subcutaneous tissue and their skin gets thinner. The permanent filler will either show or no longer be where you want it. We don’t indict any of the brands – some of these include Artefill (a plastic microsphere somewhat similar to what is in plexiglass), silicone, or Sculptra (initially FDA approved for the correction of lipoatrophy in male HIV positive patients). There is nothing inherently wrong with these products nor the practitioners who chose to use them. In Dr. Coverman’s opinion, it would be a mistake if you didn’t like what you saw. In addition, some of these fillers are extremely expensive. They may last two years or longer, but by the time you spend several thousand dollars to have them injected, you could have had one of the other long-lasting fillers injected three or four times every six months instead, with a chance to improve or correct the placement at your next injection visit.
In other words – injecting one of the six month fillers four times over a two year period costs no more money than injecting one of the more “expensive permanent” fillers once. The advantage to you is that every six months will you have a chance to reposition the filler either because the last session wasn’t quite to your liking or your facial anatomy or contours may have slightly changed. After two years, the amount of money you spent is virtually identical, but at least you won’t be left with a permanent mistake. The idea of a permanent filler sounds appealing – in our opinion, the only permanent filler should be breast implants. Other than that, with changing facial contours, we don’t recommend the permanent fillers and Dr. Coverman doesn’t use any of them. If you feel the need to have this done, consult with an expert who does use permanent fillers and ask them to explain why they use them.
Who should be allowed to use lasers?
This is a very contentious issue, and the American Society of Dermatology Surgery, the Texas Dermatological Society, and the American Society for Laser Medicine and Surgery are adamantly opposed to anyone other than licensed physicians, or those under their direct supervision with appropriate training, be allowed to use any light based device. Right now, in the state of Texas, anyone can purchase and use a laser. As long as they have a figurehead doctor’s name on the door, and pretend he is actually occasionally around, they can use the laser. What this translates into is basically unsupervised laser use and many well documented laser burns. The Texas Dermatological Society has collected many documented cases and photos of severe burns and mistreatments. We are in negotiations with the Texas Medical Board right now to mandate stronger regulation and education. The salon lobby and electrolysis lobby so far has defeated our best efforts – there are no published laws, rules, or regulations! It is the Wild West out there.
Many of these clinics are staffed by people who were hired just yesterday, and they are told which button to push and to treat as many people as they can because of the extensive overhead including flashy advertising and monthly bank payments for those lasers. They don’t understand that certain underlying diseases, underlying skin colors, and medications you are taking can amplify the effect of light and burn you! Certain herbs and supplements can do the same thing. They have no clue what they are doing other than what they are told. What they are told is to sign up the client and push the button. And who takes care of the burn? We do. All these patients wind up in the offices of board certified dermatologists and plastic surgeons trying to fix scarring and burns. Few, if any of these clinics have after hours contact numbers or are available through any type of emergency paging or recall system. You are on your own, so head for the nearest emergency room where they can call one of us.
What about “sales?”
How about 20% off? 20% off what?! You will see lots of these touted in the newspaper every day, but if everyone is buying their products from a legitimate American sources, then they should be paying the same price. If you add up those costs, it can’t be done. You may notice ads that are ALWAYS 20% off, and there really is no firm fixed price that they are discounting from. It just seems that it is always on sale, but their sale price is no less expensive than our every day price. We are probably not always the cheapest and definitely not the most expensive. For just a few dollars more, wouldn’t you really rather see a board certified dermatologist?
Why can’t I reach Dr. Coverman by email?
There is a real danger here – especially in dermatology. We need to see the skin! Dr. Coverman doesn’t always check his email every day or at the time you think he might be. There is always the danger that something potentially serious was left floating around on the internet whereas a phone call directly to our office or Dr. Coverman’s cell phone after hours would have received more prompt and efficient handling. In addition, everything we do our office is HIPAA protected, but we don’t know that your end is. Personal medical information transmitted through non-encrypted sources or non-HIPAA secured sources is not a good idea. Our email is now HIPAA encrypted on our end.
Why do I have to bring a photo I.D.?
In today’s world, we need to know you are who you say you are. Federal law (HIPAA) mandates that we only give information to the patient himself or the legal guardian if called for. In order to protect the safety of your personal health information, the federal government demands and we support the need for not only privacy, but proper identification in the first place. Nothing says that better than a government issued photo ID. Our copy of your photo ID never leaves this office. When we transfer records to another doctor we only transfer health records and not any other personal identifying information including insurance information, name, address, phone number, and so forth. You have already trusted us with your health care and well-being – we hope you would at least trust us with a photocopy of your driver’s license. We are always amazed that in order to rent a copy of a DVD, patients are more than willing to go to Blockbuster and bring a credit card and a photo ID to be left on file as well as a copy of a utility bill. They are more than willing to entrust an 18 year old clerk with this information, but sometimes balk at allowing us to keep a copy of their drivers license in a HIPAA protected medical record.
In today’s world, everyone is worried about identity theft. So are we! But that can work two ways – someone could steal your identity, but someone else could also pretend to be you without any identity either! New federal regulations (HIPAA) are very strict regarding the dissemination and transfer of any identifying information about you or your medical history. At our office we are aware of that and follow all of the rules carefully. We attend meetings and conferences devoted to this issue, and thus we are careful and meticulous. On the other hand, when we do need to send information about you, prescribe medications, or otherwise deliver medical care, we do need to know it is you! Only a valid, government-issued photo I.D. will suffice. (Just like you use at the airport). Can you imagine if someone claiming that they were you came to our office to get dangerous prescription medications, and then misused them, sold them, or handed them out to minors? All that would have been conducted in your name, but how were we to know? In addition, some patients prefer to pay by check, but as per rules and guidelines of the Travis County District Attorney’s Office, we may only accept checks if we have proper identifying information, SPECIFICALLY including the information on your driver’s license.
In other words – this is done for your safety. It identifies that you are who you say you are, it makes sure that the correct medical care is given to the correct person, and prevents information about you being given to someone else. This information is kept in your medical chart, which is the protected property of Dr. Coverman, and is never given, rented, sold, or viewed by anyone else – specifically because of federal HIPAA regulations. It never leaves the office and it never leaves your chart without your written permission. Remember, when you hand your credit card to a waiter at your table he takes it somewhere else, and swipes it – do you trust him more than you trust Dr. Coverman? We would hope that if you trust us with your healthcare, if you trust us to take care of you, if you trust Dr. Coverman as your physician, then you would certainly consider trusting us to maintain this confidential information just as much as we maintain the confidentiality of your healthcare.
My last doctor said insurance would cover it. Why wouldn’t Dr. Coverman?
Many doctors are frankly committing fraud. They will use a diagnostic or procedure code on your receipt that they know is “covered” to ask the insurance company to pay for something that they know is not covered. After all, why would the patient care as long as it gets done? A small copay is all that comes out of your pocket. By fudging or bending the rules, by saying that it is covered by insurance, and then by fooling around with the codes, descriptions, or need for the procedure, the doctor gets paid by the insurance company and the patient is happy enough to have a small copay. What is the danger in this? It defrauds all of us. It causes the insurance companies to spend more of your hard earned insurance premiums on frivolous procedures for other patients, and denies them the funds to pay for serious medical problems that you may have. It will raise the rates for all of us. It is just like staged automobile accidents. It hurts us all.
Whose photographs are those?
On many websites you will see impressive before and after photographs. Be careful! Every before and after photograph that you see on my website is an actual patient treated by myself or my staff. Some physicians actually purchase photographs from outside sources, and these are patients they didn’t even treat! They were simply for sale. In addition, some laser or other device manufacturers including some of the companies that make fillers, such as Restylane, Botox® Cosmetic, or Juvederm do have stock photos available for purchase or use on websites. In such cases doctors are able to get ahold of these photographs and post them. They may represent examples of what CAN be done with these products or devices, but not necessarily what that doctor was able to do himself. If you ever see impressive before and after photographs, always ask the physician if that was his real patient or was the photograph purchased or otherwise used?
Some physicians also take photographs the day after a surgery for devices that are supposed to improve wrinkles or tighten or lift the skin. Please remember there is always immediate post-operative swelling. If you take a photograph the next day after you have cleaned up all the dried blood, the wrinkles have disappeared! Everything looks fresher, tighter, and newer, but is simply swollen. It is much more honest to wait a month, let all the swelling settle down and then see how good the wrinkle treatment really was. If possible, always check the dates on the photograph or ask the physician what the time interval was between those. Any wrinkle treatment will cause swelling and make the wrinkle disappear for the next several days.
In addition, in this digital world, any photograph can be digitally improved or altered. Dr. Coverman NEVER does any digital altering to his photographs. The photograph you see is exactly what we saw and there has been no digital post-processing manipulation.
Laser hair removal guarantee?
Some facilities that perform laser hair removal offer a guarantee. Exactly what is that? A complete money-back guarantee? A complete 100% hair removal guarantee? It can’t be done!
Of course the guarantee can be offered, but that presumes that then they will see you for the rest of your life for free if you see any hair. From an advertising standpoint that sounds great, but from a purely business standpoint it can be devastating. The reason is because medically, complete hair removal by laser is not always possible and therefore in theory cannot be guaranteed. Of course the facility could offer you any “guarantee” that they wish, but they would be at severe financial risk if they actually honored this. In fact, several years ago one very well known and very well publicized Austin facility went out of business when patients kept coming back asking for more and more free treatment because the hair never fully went away. While these people were consuming time and treatments, the facility then couldn‘t see regular cash paying patients since there are only so many hours in a day. They went out of business, and worse yet, those patients who had prepaid thousands of dollars lost all of it. In fact, many of those patients came to our office asking us to complete their treatments. If nothing else, we NEVER recommend that you prepay lots of money up front. Just like gift cards, these facilities are hoping you either forget about it, move, disappear, or otherwise not come back to cash in what you had paid for. That is why there is over two billion dollars worth of gift cards that are outstanding and never redeemed. These people know what they are doing.
Lasers are great for hair removal, but at any one point only 80% of the hair is growing. At that time, the other 20% is not growing and is therefore not amenable to laser destruction. For that reason you will need more than one session (spaced roughly 6-8 weeks apart) in order to continue the process. You will definitely need more than one session for the simple biologic reason – you can only destroy hairs that are actively growing and actively producing pigment. You will have to wait for 6-8 weeks for the other remaining hairs to recycle into that phase. Some of the hairs indeed will be permanently killed, and that is why we ethically use the term “permanent hair reduction.” It is possible that some of the hairs may never fully be able to be destroyed, but the amount that will be is generally extremely satisfactory to most patients. Anyone promising “permanent hair removal” is either ignorant or fraudulent. We only use the term “permanent hair reduction.” Some of the hairs can and will be reduced permanently, but not all of the hairs. There is no laser or technique out there that can fully guarantee this and we know this. Advertising a “guarantee” is a great way to get patients, but if that were honored with no further financial input from the patient, then the economics just don’t work. Have you ever watched TV ads that offer a “money-back guarantee?” Yeah, just try getting it. You will get hassled, delayed, detoured and side tracked but you just won’t get your money back. Only the most persistent and aggressive people even get a fraction of that.
Laser hair removal involves simple physics – the chromophore or the target of the laser is the color in the hair shaft. Dr. Coverman uses and owns the latest and most effective technology for this, and use primarily the GentleLASE. We own two GentleLASE lasers for fair to dark skin, and one Cutera CoolGlide laser for darker Asian, Hispanic, and Black skin. Candela is a recognized world leader in this technology.
If you are seduced or otherwise enticed to go somewhere with a “guarantee” by all means, do not prepay up front! If they go out of business, your money is lost. If all of your hair really doesn’t go away, and you keep wanting to return for more and more treatments until it does, you may be hassled, dissuaded or otherwise blocked from coming in. After all, why would they treat you for free when they can spend their time treating someone else who will pay?
Dr. Coverman charges a fair fee for laser hair removal. We are up front about the limitations for this procedure and we will tell you. You may pay as you go. You will need more than one treatment, and we charge a fair and reasonable fee each time. Why in the world would you take out a loan and pay someone else interest on that loan while you are waiting to complete your treatments? Why would you pay thousands of dollars for eight to ten treatments when all of you needed was four to five? Why hand a total stranger so much money? For a guarantee? Is the guarantee written in blood or stone? Remember, a guarantee is only as good as the people standing behind it. We realize that anyone may guarantee anything they wish – it is not illegal. All they have to do is back it up. Dr. Coverman has been in practice in Austin at the same location since 1978, and has always conducted his business ethically and honestly. Lasers work great, you will enjoy excellent hair removal, and sequentially more and more of it will become permanent. In some cases indeed 100% of the hair can and will be removed, but not in all cases. Sometimes it is just impossible. The hair may be shrunken in size and diameter, the residual hair may be very fine or downy, and you may in fact be completely satisfied. If we think you are making no further progress or will not be able to, we will tell you.
Just remember – if you go somewhere to ask you to put thousands of dollars up front, before even the very first treatment, immediately turn around and walk out! Consider yourself lucky. If on the other hand, you accept this guarantee, question the person offering it, very diligently, carefully, and incessantly: exactly how is that guarantee going to be backed up? Free treatments? Free treatments forever? No hassle free treatments? A money-back guarantee? All of it? Pro-rated? How? Can the “return” patients only come in on certain days, just like the hassle of actually trying to redeem airline miles? Just remember – in the real live medical world, completely 100% hair removal by the laser can never be guaranteed. In the business and marketing world, maybe it is until it is time to collect, then the trouble for the patients start.
What about franchised “laser centers?”
Franchised laser centers are just that – establishments owned and operated by opportunistic businessmen. Of course everyone wants to make a profit, and everyone needs to make a profit. Unfortunately, often the sole purpose of these “clinics” is only TO MAKE A PROFIT! You may not be greeted by a doctor or a nurse – you may be greeted by a disguised salesman – in other words a closer. They may be paid by commission only, and only paid if they make the sale. Whether or not you need the procedure, whether or not it might be safe, with or without regard to your other underlying medical problems or medications, the sale must be made. Patients have come to us telling us how uncomfortable they felt when so highly pressured at these establishments.
Often in these establishments you will find:
- No doctor consistently on site.
- No doctor ever on site.
- No board certified dermatologist ever on site. (If he was that good, why didn’t he have his own practice?)
- Initial contact with salesmen only.
- Extreme pressure to sign up for a “package” of treatments.
- Guaranteed results.
Why would you pay thousands of dollars for a package of 10 treatments when the first two treatments alone would have done it? We only charge for procedures as you need them – the rest of the money can stay in your pocket. If you only need two treatments you will get two treatments. You don’t have to be charged for five and then somehow pressured to keep all five appointments. The ultimate decision for any treatment will be made only between you and Dr. Coverman, or Brooke, our Physician Assistant, or our aestheticians. The decision will be made in your best interest only – no salesman or closer is ever employed at this office.
Guaranteed results is a tricky term – how hard will you have to push to get your money back, and does the guarantee mean money back or does it just mean free treatments forever until you are satisfied? What if you aren’t satisfied? Does it mean free treatments only on certain days or at certain inconvenient hours? Can you come in any time just like any other patient for your free guaranteed touch-up treatments? Do you get all of your money back or is it pro-rated? Who does the pro-rating? Please remember – businesses that offer “guarantees” know that 90% of the people never ask for the guarantee in the first place, and of the remaining 10% of people, they can probably bully 90% of them. That is why businesses sell prepaid gift cards – 6 billion dollars annually of such cards never get redeemed!
Who do I contact in case of an emergency?
Dr. Coverman and Brooke Stidham, PA-C are always available 24/7. If you have any life-threatening emergency always dial 911. For a dermatologic emergency, please call my cell phone number at 512-731-4063. Please remember that this is not for prescription refills or appointments – just for dermatologic emergencies.
It is doubtful that a “medspa” has anyone covering them after hours. If you call after hours for a problem with your treatment, you will probably get a recorded message instructing you to go to the emergency room. This will of course be at your own expense and you will have to fight with your insurance company to get reimbursed.
What about medical emergencies in the office?
Dr. Coverman is Board Certified in Dermatology and in Internal Medicine. Dr. Coverman, Brooke Stidham, PA-C and our entire medical staff maintain annual certification with the American Heart Association. We have all been trained by an American Heart Association certified instructor in basic cardiac life support. (BCLS). We are trained in adult and child CPR, and we have an automatic electronic defribrillator (AED) always on-site and available. We keep adequate and freshly dated medicines consistent with this level of training, and all of our equipment is checked periodically to make sure it is charged and ready to work. Our certificates are available for your review. Your safety is important and we have gone out of our way to be properly trained for our level of surgery.
Who is an expert?
The term expert is often self-proclaimed, self-aggrandizing, impossible to document or quantify, and frankly is frowned upon by the Texas Medical Board.
Dr. Coverman has been asked to serve as an expert witness in malpractice cases both by the defense and prosecution. He has appeared on local T.V. for interviews regarding various lasers and procedures that we use, and has lectured at national conferences regarding lasers. He has been asked by several laser companies to train other doctors in how to perform laser surgery in our office and has trained other dermatologists and plastic surgeons at their request.
Still however, Dr. Coverman does not advertise anywhere on my website or other literature that he is an expert. That is something that the public will have to decide both from their experiences at our office and in inquiries about his reputation in the medical community. This is best ascertained by asking other doctors, nurses, and pharmacists about any doctor you wish to see – the truth soon gets out and one doesn’t have to make up false, erroneous, or self-flattering titles. If a doctor proclaims that they are an “expert” or “premier” – go somewhere else! Their reputation alone should have sustained how good they are and whether or not you should go to them. Their own proclamation of “expert” should make you wonder about their ethics and their need for glorification. Such doctors probably ought to be avoided and you should go to someone more humble and more recognized for their achievements rather than their bragging.
Safety – Is it safe to enter a medical office?
Lots of people think it is not safe to enter a hospital because of mistakes, germs, the wrong medications, and so forth. In our office, all OSHA guidelines are followed. OSHA regulations that are published in the Federal Register are available in print with our OSHA officer and all employees receive OSHA training and annual updates. All of our instruments are handled according to very strict OSHA guidelines. In some offices you may find them shining a “black light” on their instruments. The mistaken presumption is that it may kill germs – not enough! What if there is pus or other debris? How does the light get through the pus? It is a completely worthless method.
In other offices, instruments are simply cleaned and put back in a tray with a “germicidal” solution. Although that solution may be OSHA approved, it is not good enough. In our office, all instruments are first cleaned with normal soap and water, and then left to soak overnight in instrument milk to preserve them. ALL INSTRUMENTS ARE CLEANED THEN AUTOCLAVED FIRST, and only then are they placed in the instrument tray with germicidal solution for storage. In other words – they were already sterile when they went into the tray and this tray was simply used for storage. It is a mistaken belief to think that simply placing a contaminated, used, or dirty instrument in that tray will sufficiently clean it or sterilize it.
What about the sterilizer?
You may be told that a sterilizer or autoclave is being used. THAT IS NOT GOOD ENOUGH! Just because it turns on, just because it gets hot, just because the lights glow may mean nothing! In order to kill certain germs, there must be enough heat: it must be hot enough, it must penetrate deep enough, and it must last long enough. Our instrument packs are all wrapped with a tape indicator that can instantly be seen on the outside of the pack. If it turns color, the heat was hot enough on the outside. In addition, we always place an indicator strip on the INSIDE of the pack – this confirms that in fact the heat INSIDE the pack was also hot enough to change the indicator color.
But that is still not good enough. There are certain germs or spores that at very difficult to kill. Once every month, we purchase a bacterial spore test strip from a company who’s only job is to check autoclaves. We place these spores in a typical instrument pack in the autoclave. We then run the full cycle. We then take those spores and mail it back to the company. If those spores are able to be grown, the sterilizer did not work good enough. If the spores cannot be grown, it proves that our autoclave is able to kill the most resistant bacteria, fungi, and viruses. These records are kept at the autoclave and are available for your review. No detail is left to chance. Most “spas” and salons, if they use an autoclave at all, have never heard of this back-up procedure. They just turn on the machine and hope it works. They have never checked it and have no idea if it ever really did kill anything – in other words, the instruments used on you were not sterile and may have contained AIDS or hepatitis C.
Should I go to a medispa?
NO! In an article in AMA News dated March 12, 2007, Pamela Dolan, a staff writer indicated that there has been a 33% growth in the number of medical spas in 2007. She stated “experts say that laws require that a physician medical director be on staff, although in many cases the physician is not required to be on-site.” She states that several former franchised medispas, in separate cases, have sued a very large nationally franchised spa chain “…claiming they couldn’t make it financially under “flawed” business plan. It is interesting that the lawyer representing this large national company stated that “none of the suing franchisees were physicians…” Isn’t that interesting – these people were complaining they couldn’t make money running a spa, and yet none of them were physicians in the first place! A Minneapolis attorney who in fact owned one of these franchises claims “…it wiped him out financially.” This same attorney is now in the business of manufacturing lasers but specifically states “he will only sell his products to physicians.” He says “this is a business for physicians. Entrepreneurs have no business doing it.”
The reason these spas can’t make it is that they buy very expensive lasers which in turn require that they be used constantly in order to make the payments. In order to be constantly used, they need patients, and in order to do that they need to spend a lot of money on advertising. After all of this up front money is spent – they go broke. Remember if you visit one of the nationally franchised spas, there will be huge pressure on you to have some type of procedure performed whether you need it or not – after all, they have to make their payments.
In dermatologists offices, we see patients all day long for medical, surgical, and other non-cosmetic events. We certainly don’t need to be pushing our lasers or procedures on someone who doesn’t need it. We are physicians – not businessmen. We take an oath to do what is best for our patients only, and certainly in Dr. Coverman’s office, that oath is adhered to and respected.
Should I go to a clinic to have my tattoo removed that advertises that is all they do?
NO! Such clinics typically are run by businessmen or physicians who have never done any work with the skin. They go to a trade show, purchase a laser, set up shop in a strip mall, and advertise that they are tattoo removal experts. Some of these entrepreneurs only have enough money to buy one machine. Unfortunately that usually means just one wavelength. Dr. Coverman uses two different lasers, and uses the 532 nanometer, 755 nanometer, and 1064 nanometers wavelengths to cover all the colors including the normal blue, black, and green. These spa owners don’t go to any of the national meetings, they know very little about the skin, and their only training was the in-service given by the technician who installed their laser. By advertising that “tattoos is all we do” they are trying to get you to assume they must be specialists at this. Of course that statement is their downfall – if that is all they do, then that is probably all they know. They may not understand that certain patients should not be treated in the first place, and if there is an infection, or scar, or other such problem they have no clue how to treat it. They are happy to see you on the front end – they have no clue what they are doing on the back end. They often send those patients to us to fix their problems.
Worse yet, some of these spas advertise they have some special magic chemical or liquid product that “draws” the tattoo pigment out. They are somehow trying to get you to believe that this product that they apply is some type of magnet or sponge for the tattooed pigment. In fact, it is often a potent glycolic acid which simply burns your skin. During the process of healing they hope that some of the pigment will float out of your wound with the pus. They don’t even understand what they are doing. The problem is just that – the burn is completely non-selective. It burns the epidermis, the dermis, and then the tattooed pigment within the dermis. Everything gets burned and hence you will have a scar. We see these scars all the time and try to help these unfortunate people recover. There is no liquid that can be applied or any other such substance that will draw tattooed pigment out or in any way get the tattoo to fade or shed. All they are doing is creating a wound. You could have done this yourself at home with sandpaper.
Dr. Coverman has been removing tattoos with the laser in his office for over 30 years. In the last 10 years alone he has removed over 1500 tattoos. No one in Austin even comes close.
Some spas advertise that “their girls” treat tattoos with lasers all day long – more than Dr. Coverman! But are they consistently the SAME GIRLS? Were they only there two weeks, then back to flipping hamburgers again? Dr. Coverman has personally treated more tattoos with the laser than any single person in Austin over the past 33 years!
Why does Dr. Coverman charge for tattoo consultations?
When you see Dr. Coverman for your consultation you will get just that. The accumulation of over 30 years of dermatologic wisdom and advice. He will examine your skin and your tattoo and discuss with you how it was applied, what type of ink may have been used and what laser will be best for you including what wavelength. He will discuss other surgeries that you may have had and how your body tends to heal. You will be given a brief lecture in laser physics and in the function of macrophages and other “scavenger cells.” All of this requires time, skill, and knowledge. Some patients might come to his office to learn all of this and perhaps go somewhere else to have their tattoo removed at a cheaper price. That is fine, but Dr. Coverman feels he deserves to be paid for his time, judgement, and knowledge. In fact, he has literally told several patients over the years NOT to have their tattoo removed! In their case, the potential risk of scarring or other complications was worse than the tattoo and every single one of these patients has thanked him profusely for his decision to leave well enough alone. Dr. Coverman specifically urged them not to have their tattoo removed by him or anyone else. He was honest.
When you come to our office you are paying Dr. Coverman for his time, knowledge, and judgement. The most critical thing in medicine is often judgement – the decision NOT to do something can be as valuable or life-saving as the decision to do it. If for any reason we feel you are not a candidate or there might be a complication that should dissuade you from having this procedure performed, he will tell you. Every day we see patients that have had their tattoos treated elsewhere and they should have never been treated in the first place or had it treated with the wrong laser.
Dr. Coverman does not offer free consultations and never has. He values the years that he has put in. He is ethical, hard-working, and honest. We realize that our competitors have no consultations at all or don’t charge for it. The best advice we can give you is – you get what you pay for!
Why doesn’t Dr. Coverman offer free consultations?
Nothing is free! You get what you pay for. Usually, when you go to a “medspa” to have a free consultation, you are probably going there to learn what you have, learn what can be done about it, and possibly learn of some simpler, easier, or safer alternatives. That is on your end – on their end, you will typically meet a salesman perhaps disguised as a consultant or counselor. That person is only paid on commission, and therefore is ONLY paid if you sign up for the procedure. You may not need it, it may not fit your budget, it may not be medically appropriate, or there may even be an actual medical contraindication – this person is not trained to know that, just to make the sale. They may even engage in fee splitting with the doctor if you sign up. In other cases, you may meet a doctor or other figurehead who still has the same incentives – after all, you consumed ½ hour of his time and yet you may leave and sign up for nothing. If he keeps wasting time like that all day without getting paid, he will go out of business. He has every incentive to at least sign up some of the inquiring people – somehow he has to make a living and pay for those expensive lasers. If you do consume too much time, and the doctor senses you may not be too inclined to sign up in the first place, you will be cut short. Once again, it is human nature. Somehow, some way, your time spent with that doctor will not be “free.”
When you visit our office, Dr. Coverman charges you for his time and does not offer free consultations. Knowing that, he will answer all of your questions: he will make sure to suggest the procedure that is right for you whether it is a high dollar laser or a low cost light acid treatment. Sometimes Dr. Coverman actually gets quite a bit of pleasure telling a patient they don’t need anything at all. If they don’t need it – they don’t need it and he will tell them. Our only interest is your well being, and since he is being paid for his time anyway, he does care that your money was well spent. All of our lasers and equipment are paid for, so we are not pushing you to sign up for something just to make next month’s lease payment.
Some patients are actually afraid to walk into these medical spas. A child may walk in with an acne or a wart, and their parent is highly pressured while they are there to sign up for some other cosmetic procedure which they didn’t even want or need. There is always that underlying tone of pressure. In our office you will pay a normal office visit fee like everyone else, and you will be given what you need – no more, no less. Some patients actually come in asking for a laser by name, brand, and model number. Maybe they saw it on T.V. Dr. Coverman politely asks “what is the problem you are trying to treat” rather than what laser do you want to use? At that point we can then step back and fix the problem appropriately with no undue pressure on me or the patient.
Now that you understand it – you can choose. If you feel need a free consultation somewhere else, then please feel free to go there. You will be happier
Why doesn’t Dr. Coverman offer financing?
For your own protection! Dr. Coverman has always believed that because cosmetic procedures are generally elective, a patient should be fully prepared to do them – emotionally, intellectually, and financially. If you can’t afford it – don’t do it!
We do accept credit cards in our office, and you are always welcome to pay for any procedure with a credit card. On the other hand, our office is bombarded daily with offers from companies who want to establish “in-office” financing set-ups for our patients. They will offer to do all the financial arrangements through our office, and then bill the patient directly. Their come-on is that it will improve cash flow, get patients to sign up for more procedures, and they will handle all of the billing. That is just the problem – ethically Dr. Coverman has always believed that if you are not ready to do something financially, then don’t do it. We don’t want to make it “easy for you” if it is not the right thing for you to be doing at that time. You can always pay for something with a credit card, check, or cash, and for the very same reason we don’t like to put patients on a payment plan either. You are either ready to do it emotionally and financially or you aren’t. If you aren’t – then wait until you have made enough of a mental and financial commitment to have saved up the money and then pay for it up front. We do not want to be in a position of offering you an easy way out, or allowing you to make an emotional decision because you want something right now. This prevents you from doing something that you shouldn’t be doing or can’t afford.
Many clinics with in-house financing will give you an elaborate sales pitch, and after you are all excited they will even make it very easy for you to pay. They forgot to tell you about the finance charges that you will accrue later on, and why do you think these finance companies are in business? Dr. Coverman thinks it is foolish, dangerous, and frankly unethical to be running a finance company out of a doctor’s office, even if it is administered by a third party. There are many such national firms offering these in the offices of plastic surgeons and other cosmetic dermatologists. We do not recommend them under any circumstances. Only have a cosmetic procedure performed when you are 100% ready to do it and 100% ready to afford it.