Initial Consultation16

Dimitrije E. Panfilov

The first contact our patients have with our office is mostly through our staff by phone. This first communication should avoid difficulties which could arise. Our staff should note the patient's name and should call him/her by name when answering questions. The information should be general, even average costs could be given, if asked, but this communication 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 patients 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 patient at the end of the phone call.

The patient is sitting for the first time in our waiting 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 patient has also received recommendations from friends who have been successfully treated in our clinic or even a hairdresser told their clients where they produce fine scars after facelift! Less likely, he/she has received the address after phoning the Medical Council 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 diplomas 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.

The waiting time should not be too long. Our staff could offer some drinks (tea, coffee, etc.) and a questionnaire. 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 between patient and doctor during their first meeting. A prerequisite for this is that the patient's hopes and expectations correspond with what is surgically feasible. The outcome of an aesthetic operation can very well please both parties; the patient is happy and the surgeon proud.

We should learn about our patients':

  • Indication
  • Motivation
  • Expectation
  • Incubation

We should clarify these questions in order to determine favourable candidates for surgery and to be able to diagnose and exclude the less good ones. If somebody decided to undergo surgery just couple of weeks ago - perhaps just because of an emotional stress situation - 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.

Fig. 16.1. Questionnaire

Do you wear glasses LI

Have you had psychiatric tii'^ini'iii □

What do yiv want corrected whit Is disturbing to you about your appearance l>u you have a precise idea hew the outcome should looii

Why do you want [l is operation

Oft you tvoiM [lie tiperaliin for yoiKSC-lfOf for jny Other rcasor.

Koiv long Nvf you entertained the thought of having thi* correction done

Do you expect your I i fe to cha nge as a res ult an d in wlu [ ivjy

Haw you dbsetved [hat others hive noticed your defect and/or commented on it

How important to you iftheoplnlon rfnlhers

Hci vi problem - 4' woifc in in fu- ramily

Arc vuti often netypus. dcpceucd_

How many 5urK«ns have you already consulred_

  • lowdoyuo>pcud your spare1 tuner what arc your hobbles-
  • J... I ;■

Schematic representation of the disiuiii-d correction (to be marker! by the surgeon)

Schematic representation of the disiuiii-d correction (to be marker! by the surgeon)

t UJ^irlfhl l"iiif:J*v

Motivations for surgery should be reasonable and the expectations not unrealistically high. We only can recommend or agree with a patient's wish for cosmetic surgery if we can expect a somewhat reasonable improvement of her/his featural appearance. In the ideal case we achieve from our patient more self-satisfaction, 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 "after" 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. 16.2. 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

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 concentration and reliable explanation. It is, however, a fact that our patients remember only 30% of facts spoken during an average consultation. I show them all the possibilities 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 obligations. 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 possible complications.

No final decision needs be made at the first consultation 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 consultation. If both sides decide to refrain from an operation, then much has been gained: worry, annoyance, 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 support, and at the end the partner is often heard remarking: "It doesn't bother me, but if you think that it will help you, then go ahead."

Less often the opposite situation occurs. For example, 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 disappointed 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.

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