24 Jun 2012

“I’m not happy, Doctor???

“I’m not happy, Doctor???
No Plastic Surgeon wants to hear this from a patient, but it is inevitable that a small percentage of the thousands of patients we see would be unhappy. How a practice responds to complaints may well distinguish a great practice from a good one.

Why are patients unhappy? Surprisingly, it most often arises from good outcomes, as bad outcomes are thankfully quite rare.
Examples (from our practice):

1. Patient seeks a more youthful appearance and facelift is recommended. Doesn’t want surgery, only injectables, despite warning that injectables like Botox and Juvederm are limited in their effect. Patient returns 3 weeks following injections, unhappy with modest effect from injections and demanding refund.

2. Patient has tummy tuck after massive weight-loss, has tight skin while standing but skin rolls appear when seated. Is not satisfied with explanation that “everyone has some degree of skin roll when seated, and loss of skin elasticity can’t be corrected by surgery”.

3. Breast augmentation consultation includes careful discussion of size. Beautiful result obtained, but patient expected to look bigger/smaller and complains about result.

4. Rhinoplasty patient is 90 % improved, but demands further high-risk surgery to achieve 100% great result.

5. Patient has consultation for tattoo removal. Lengthy assessment and discussion of pros vs. cons of each treatment option. Surgery not recommended due to prohibitive scars. Patient demands consultation fee back because ‘nothing was done’.

6. Patient has facelift, loves initial ‘tight’ appearance, is unhappy when skin relaxes and minor laxity appears, even though before/after photos show dramatic overall improvement.

7. Patient has surgery in another country with a bad result, travels great distance to see us, can only stay in Toronto for a week, and is indignant that we would refuse to take on her case.

8. Patient has liposuction of abdomen with a great result, but gets sloppy with diet/exercise and gains 30 lbs. Returns complaining that her abdomen is same size as before surgery, and refuses to acknowledge that weight-gain inside abdominal cavity explains her unsatisfactory cosmetic outcome.

Common to most of these situations is that the patient has expectations that were not met. In our practice, we recognize our important responsibility to carefully explain or demonstrate a realistic outcome from our treatment (and then try to exceed it!). We are careful to highlight the limitations (and risks) of our procedures, but ultimately there are some patients who ignore this discussion and just hear what they want to hear.

If you want to avoid being an unhappy patient, be certain to learn about the risks and limitations of your procedure, and be wary of a practice that dodges this important topic.

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Michael Kreidstein, MD, MSc, FRCS(C)

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