Every parent knows the feeling. You would really like to say “Yes”; it would be easier but you know it is just not the right thing to do. You say “No” and deal with the backlash hoping that at some point later in their lives your child will understand that they are better for it.
Strangely enough, it is not that different from the plastic surgeon having to say “No’ to the patient. The patient knows what they want. They often have been hoping and working on getting to this day for years. It may even be their dream. And you, the plastic surgeon, know that what they are asking for is not the right thing to do for the patient.
Hopefully, the patient understands that the decision is made in their best interests. Let’s face it; declining to perform a procedure doesn’t help the plastic surgeon’s bottom line so the doctor is not benefiting financially from saying “No.” In the past, if the plastic surgeon did the right thing, the unhappy and disappointed patient, feeling rejected at worst, would leave the office and perhaps “bad mouth” the doctor amongst their friends. But now things have changed! Now we have the internet and a host of “rate a doctor” sites. Now the patient can get on the internet and blast away; all from the position of anonymity and free to tell “their side” to the world. Make no mistake about it, these sites can and do real damage to medical practices. What can the doctor do to explain “their side of the story?” Actually, very little since it does no one any good to get into an internet version of “He said-She said” and there are those troubling HIPPA Laws to worry about.
So what should the plastic surgeon do?
The answer is simple and timeless: do the right thing. Just like the parent, the plastic surgeon has to look objectively at the patient and their desires and using their training, their ethics, and their “instincts” make the right call. It may not be popular and it is certainly not easy but it needs to be done. Telling a patient that they need to lose weight before an abdominoplasty, that the breast implant size is too large for their body build and will in the future actually cause more harm than improvement, that it is not safe to perform the requested procedure on a smoker, etc. are the “right thing” to do. The plastic surgeon knows it is the proper and correct decision but also knows the patient may not see it that way and there may be a price to pay for sticking to their guns.
So the next time you read a “rate a doctor” report, realize that there are two sides to every story and the reasons for the patient’s reaction may not be as clear as it seems. Perhaps the plastic surgeon made the right choice and just like the parent, has to deal with the backlash. Hopefully, some day the patient will realize the decision was done for their own good.
Herluf Lund M.D.
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