Many years ago, a mentor taught me a surgeon spends an entire residency learning how to operate. Then the surgeon spends the rest of one’s career learning how NOT to operate.
This includes when not to operate.
A plastic surgeon called me recently, and described a recent patient visit. The woman, in her mid-40’s, confessed her husband just left her. She was starting over. She wanted to look better as she re-entered the dating scene – a scene she abandoned many years earlier.
The surgeon asked her what she had in mind.
Most of his patients have detailed instructions in mind when they meet. They bring pictures. They have expectations. They may be unrealistic expectations, but, in their brain, there’s some roadmap.
In the surgeon’s opinion, the patient already looked quite good. And there was nothing in particular that seemed to be bothering her. The only thing driving her was the motivation to “tune up” for the next phase of her life.
The surgeon made a good call. He said it sounded as if she was early in the journey. If she believed that plastic surgery made sense, she should first become educated on the topic. He referred her to reputable web sites, and told her how to distinguish between hype and reality. He said she could follow up down the road.
Working with pre-educated patients makes the doctor-patient relationship more of a collaboration.
The easier, and likely more near-term lucrative path, would have been for the surgeon to subconsciously “impose” his beliefs on the patient. He could have suggested any number of procedures. Who among us wouldn’t benefit from some tuning up?
But, the patient’s angst was fueled by her recent break-up. She likely needed more time to heal. If plastic surgery was in the cards, she needed to better understand the risks, benefits, and options.
There’s a time and a place for everything. This time, the plastic surgeon functioned as a “psychiatrist” by demonstrating restraint and compassion. It was a good call.
What do you think?
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Over the years I’ve told all my new employees that they’ll soon figure out that at least a third or more of the time they’ll think they’re working in a psychiatrist’s office rather than that of a plastic surgeon. So far they’ve all agreed.
I don’t think the surgeon acted as a psychiatrist at all. Instead, I think s/he provided good listening, and the specific medical counseling about medical/surgical procedures which the patient needed at this time.
This is very different from various forms of psychotherapy that a knowledgeable psychiatrist might provide, and which this patient might also benefit from while working through this painful life transition.
I’m very grateful that the surgeon showed compassion and restraint, and made a good call. All physicians — no matter what their specialty — need skills like this in their work with patients. Equating this with psychotherapy or Psychiatry, though, shows confusion about what’s involved in that form of treatment.
I was told that you never regret the patient on which you did not operate. The plastic surgeon did a great service to that patient. She will likely refer him to her friends and come back when she is ready. Thank you for sharing.
Okay. Maybe not a psychiatrist. But he certainly, by listening, reflecting back and advising, did play a role of (perhaps) psychologist. It’s a role that dentists constantly play; some days, with certain patients, I am “psychologist” more than I am dentist. That’s all right. This surgeon followed “First do no harm,” and that’s perfect.
As far as cosmetic surgery is concerned, I wholeheartedly agree with this concept. In fact, I have written an entire book on the non-surgical, philosophical aspects to cosmetic surgery. I always tell my cosmetic patient that cosmetic surgery is unnecessary; it is more about desire than necessity. I refer to what I do as psychological surgery: changing the anatomy to affect the way a person feels. And finally, I explain to patients that the usual doctor-patient relationship is different; it is less paternalistic medicine than collaborative medicine. The stark difference in patient selection as one progresses in a plastic surgery career is seen in the resident who is so eager to operate on anyone with the slightest indication or expression of desire and the veteran who vets the patient from a anatomical as well as a psychological basis carefully weeding out the ones who are psychological at risk for unhappiness.
Good call by a good doc. We never regret procedures / surgeries not performed.
Thank you.
The practice of psychiatry encompasses understanding and assisting patients who seek your help when they have inner conflicts and concerns about self. The practice of plastic surgery helps patients who have inner conflicts and problems with their self image and physical appearance.
Such is the practice in the day of a plastic surgeon. Having training in this field would be a significant benefit.
Arch miller
“What’s in a name? That which we call a rose
By any other name would smell as sweet….”
There are lots of different kinds of psychiatry. I’ve used trance in surgery pretty much since I started doing it. I almost never called myself a hypnotist, but that’s what I was doing, maybe about 20-25,000 times.
To the degree that you do what some psychiatrist may do, you are practicing psychiatry, and are therefore being one. Just about every good patient-oriented doctor does that, even if they’ve had no formal psychiatric training.
Timely article. Aesthetic and even reconstructive surgery is really psychological surgery at its heart. All of our patients arrive with hopes, fears and expectations. We surgeons daily try to determine if our talents will really likely benefit the recipient. It is not unusual in a week’s practice for me to dissuade a prospective surgery patient from having surgery. As caregivers we hopefully use all of our or our skills-empathy, understanding, recommendations-as well as surgical skills, in helping those who seek our care. Keep up the ‘thread’.
Good information provided by the doctor. Education is a major key to making an informed decision.
Absolutely the right thing to do. Classic “red flag” for pausing before taking on a cosmetic patient is a history of a recent traumatic event such as separation or divorce. It is incumbent on the plastic surgeon especially with purely elective procedures to “first do no harm” by always evaluating the patient fully.
In such a red flag situation, the patient may be a perfectly acceptable and reasonable candidate for a procedure but the timing must be right. The surgeon should discuss his or her concerns regarding the emotional state of the patient and the potential negative psychological consequences compounding emotional trauma with surgical trauma especially if unrealistic expectations are likely.
Providing a thorough consultation including an open discussion of concerns, options and expectations then allowing the patient time to process all the information and continue to do “their homework” is best before proceeding.
Surgeons are professional medical officer, they do not only operate but also they have to read patient mind. they need to be good physiatrist. Their mind is really focused as they do big surgery thus their mind power become high and they can easily understand other minds