CHAPTER 16
16
The waiting time should not be too long. Our staff could offer some drinks (tea, coffee, etc.) and a ques- tionnaire. On the front page there are personal data:
how the patient found our address, physical health, severe illnesses, operations – especially the cosmetic ones. The back page of our questionnaire is given as in Fig. 16.1.
A harmonic understanding should develop be- tween patient and doctor during their first meeting. A prerequisite for this is that the patient’s hopes and ex- pectations correspond with what is surgically feasible.
The outcome of an aesthetic operation can very well please both parties; the patient is happy and the sur- geon proud.
We should learn about our patients’:
– Indication – Motivation – Expectation – Incubation
We should clarify these questions in order to deter- mine favourable candidates for surgery and to be able to diagnose and exclude the less good ones. If some- body decided to undergo surgery just couple of weeks ago – perhaps just because of an emotional stress situ- ation – we should advise such a person to wait 2 or 3 months until his/her situation settles down. To rush into a decision to be operated on could afterwards be regretted.
If some woman expects from her husband who has left her that he will return home after her facelift or if somebody expects to get a dream job after becoming more attractive through cosmetic surgery, these are mostly unrealistic expectations and such patients should be advised not to undergo cosmetic surgery. I have never regretted saying “No” to a patient, but I have sometimes regretted saying “Yes”.
It is useful to remember what Jack Sheen wrote in his milestone of Aesthetic Rhinoplasty: “A psychiatrist once told me, ‘If you can’t elicit a smile from a patient, don’t operate!’”. When a smile goes and comes back, the bridge has been built.
The first contact our patients have with our office is mostly through our staff by phone. This first com- munication should avoid difficulties which could arise. Our staff should note the patient’s name and should call him/her by name when answering ques- tions. The information should be general, even aver- age costs could be given, if asked, but this communi- cation should be friendly and interesting. At the end of telephone conversation, an appointment could be politely suggested. One should assure one’s staff of the importance of telephone communication. Some pa- tients call five to ten plastic surgeons and make the decision of where to go just upon the kind, obliging voice of your secretary. Recognize it as a success of your staff if they make an appointment with this pa- tient at the end of the phone call.
The patient is sitting for the first time in our wait- ing room. The most frequent way for a patient to finds us nowadays is the Internet or his/her GP has sent him/her here after reading or hearing about our work in the medical press or from lectures and forming his/
her own well-founded opinion of us. Perhaps the pa- tient has also received recommendations from friends who have been successfully treated in our clinic or even a hairdresser told their clients where they pro- duce fine scars after facelift! Less likely, he/she has received the address after phoning the Medical Coun- cil or even less likely he/she got it from a journal which perhaps contained an article about our work, or he/
she has found the address in the Yellow Pages or in advertisements. He/she could also have “stumbled”
into the surgery having noticed the sign bearing our name and speciality.
The waiting room itself should be pleasant and bright, if possible transparent communication with our reception desk should be possible, there could be some pleasant background music, and some neutral pictures could decorate the walls; not only our diplo- mas and awards should hang there. There should be a folder with articles by our office/clinic from journals for laymen , or if we have written a book on this topic for laymen this, or at least a booklet about our clinic, should be available for patients.
Initial Consultation
Dimitrije E. Panfilov
76
Motivations for surgery should be reasonable and the expectations not unrealistically high. We only can recommend or agree with a patient’s wish for cosmet- ic surgery if we can expect a somewhat reasonable im- provement of her/his featural appearance. In the ideal case we achieve from our patient more self-satisfac- tion, more self-confidence. We do not only want to earn money, we also want to have happy patients.
If our schedule is too busy, somebody from our staff should show the patients in the waiting room our album with pictures of our patients’ “before” and “af- ter” surgeries, or should display those images with a DVD player. I prefer to show these to my patients in my consulting room on my laptop.
It is now our patient’s turn. He/she knocks, opens the door, and enters the consultation room. His/her
Fig. 16.1. Questionnaire
77 16 Initial Consultation
mind only marginally registers the furniture and medical equipment. The doctor is the centre of his/
her interest: What does he/she look like? How is he/
she looking at me? Can he/she arouse my trust? Is he/
she in a hurry?
Even if we are short of time, we should not show this to our patients. They need our whole concentra- tion and reliable explanation. It is, however, a fact that our patients remember only 30% of facts spoken dur- ing an average consultation. I show them all the pos- sibilities in modern facial aesthetic surgery on my laptop, and afterwards we discuss the special problem the patient has pointed out, to be solved in front of a mirror.
Every question the patient asks should be answered without necessarily entering into any mutual obliga- tions. On the other hand, the doctors should be given all the details which could influence the operation.
Matters of interest include:
1. Previous disorders 2. Any previous operations
3. Habits such as smoking and alcohol consumption 4. Any current medications, above all
– Anticoagulants prescribed after heart attacks, heart-valve surgery, and thromboembolic events – All medications containing acetylsalicylic acid
since they considerably increase the tendency to bleed
– Hormone preparations, including hormone contraceptives
The medications mentioned should be discontinued before the planned operation.
The first consultation allows the surgeon to assess the patient’s deformity and form a rough opinion about the patient’s skin, subcutaneous fatty tissue, and the time and effort required for the operation.
The surgeon will also take the opportunity of thor-
oughly counselling the patient about risks and possi- ble complications.
No final decision needs be made at the first consul- tation as to whether the operation will be undertaken.
After the patient has received a wealth of information, he/she should be given enough time to think things over. Sometimes questions arise afterwards which can be clarified on the phone or during a further con- sultation. If both sides decide to refrain from an op- eration, then much has been gained: worry, annoy- ance, and disappointment have been avoided. If, however, the operation is unanimously agreed upon by both sides, then a sacred trust must be generated between patient and doctor. Surgeons must be able to assure patients that they will personally carry out the operation and that they will be available during the whole period of aftercare.
Some patients bring their spouse or companion to the first consultation. This can be a beneficial sup- port, and at the end the partner is often heard remark- ing: “It doesn’t bother me, but if you think that it will help you, then go ahead.”
Less often the opposite situation occurs. For ex- ample, a woman may have an operation done secretly to surprise her husband and the surprise has quite a different effect than intended: the partner is disap- pointed and feels aggrieved that he was deprived of any involvement in deciding about such an important issue. It is therefore our recommendation to inform the partner about the intended operation, even though the decision itself ultimately lies with the patient.
Bibliography
Please see the general bibliography at the end of this book.
Fig. 16.2. Intimacy of the consulting room: the secret of gaining the trust of the patient is as unexplainable as the conception of a child or of an artistic work
