Patient Empowerment is not the same as Entitlement...

Last week, here in my hometown of Orlando Florida, a young transplant surgeon was murdered by a former patient as he was leaving the hospital. Killed by someone whose life he had saved before he could go home to his young family after what I'm sure was a long and stressful day of work.

As you can probably already tell, I am more than a little disturbed by this...

Over the last 40 years or so, we have seen a general decline in the esteem and respect the general population feels towards the medical profession in general... people respect and trust doctors and scientists less and less, even as the demand for the rapid development of medical breakthroughs grows. We demand that our medical care be state of the art, be cheap, and be directed by us, and that if our outcomes are not exactly what we think they should have been, we want to be able to take it out on the doctor.

It is hard, in the end, for me to disagree with this overall decline, as I myself know better than most people how poorly some doctors behave. On the other hand, reason must prevail, and attempting to harm, injure, or kill your doctor because you didn't get exactly what you wanted is irrational and wrong.

The best outcomes, whether in my aesthetic surgery practice, or in any other type of medical practice, will ALWAYS come from healthy relationships based on mutual respect and commitment to the plan and its execution.

Having a healthy relationship with your doctors begins with a clear understanding that the relationship should be important to you, and that just as with any other important relationship, it will require work on your part to maintain. Placing an appropriate value on the relationship from the beginning will go a long way towards helping you appropriately weigh the advice you get from the doctors in your life, as well as improving the quality of the information you get- it's true... doctors are people too, and we tend to be more engaged when people are nice to us (remember the Golden Rule we learned in Kindergarten?)

You would not expect to have a long and successful marriage if it was one in which only one of you was committed to its success or the happiness and fulfillment of the other, would you? It is similarly impossible for doctor-patient relationships to be successful if patients believe that it is the doctor's responsibility to make them happy, no matter what their own behavior may be.

Just as with any other important relationship, you must communicate with your doctors- completely, honestly, and respectfully.

Too many people treat their doctor's visits like a trip to a restaurant, believing they should be able to request what they want and demand they get it, rather than understanding the partnership nature of healthier doctor-patient relationships, or the fact that the nuances of their problem may make their exact goals impossible. This leads to unreasonable expectations and irrational behavior when they are not met.

The importance of good communication cannot be over-emphasized- it is no more appropriate for patients to be demanding of unreasonable expectations for their outcomes than it is for doctors to be patronizing, condescending, and paternal in their communications with those patients.

The importance of having reasonable expectations is worth further emphasis.

The internet has brought many good things to the delivery of healthcare- patients are better educated at all stages of their care, and this generally contributes to better communication and higher rates of satisfaction. Unfortunately, in plastic surgery, it has also contributed to the occasional development of unrealistic expectations and the restaurant attitude I describe above. Some percentage of the population, when viewing the many before and after photographs available online sees them as choices available to them, or worse, as representations of what they themselves would actually look like if they had the same procedure.

The reality is that the science and art of plastic surgery are actually much more subtle, and the actual outcome any individual patient achieves will depend GREATLY on their individual preoperative anatomy, the details of the operative technique used, the skills and experience of the surgeon, the quality of the anesthesia and postoperative care, and their (the patient's) compliance with all postoperative instructions.

In other words, before and after photographs are valuable, but only as representations of the overall quality of a surgeon's work- NOT as detailed representations of what you as an individual should expect- your body is different than the patient in the photo.

It is very important that once you have found a surgeon whose work you admire, and with whom you think you could work constructively (that is, with whom you think you could have a good relationship), that you listen carefully to his or her estimation of what reasonable goals FOR YOU might be. And I do mean listen.

On the (thankfully) very few  occasions when I have had a patient dissatisfied after surgery, without fail, it has been because their expectations for what could be achieved were simply completely incompatible with their starting anatomy- despite my best efforts to educate them and their preoperative assurances of understanding (I even have one irrationally angry young woman who writes bad things about me on the internet because I could not make her congenitally deformed breasts look perfect).

The frustrating part of this is that spending a great deal of time and effort trying to help some people understand their reasonable expectations (as I did with the example patient I mention) does not seem to help if they are not listening and are only hearing what they want to hear...

And again, unfortunately, our modern attitudes towards medicine, doctors, and our unreasonable expectations for perfect outcomes sometimes causes a small and irrational subset of the population to react to the disappointment of an imperfect outcome in an unhealthy manner- like by writing ugly things about the doctor, or worse, murdering him.

I personally believe that, while there are certainly examples of doctors with inappropriate, unethical, and immoral motivations and practice patterns (indeed I write about them often), the majority of us are still honest, hardworking people who want the best for each of our patients. Even the eye doctor in town who (in my opinion) daily compromises his Hippocratic Oath by allowing patients to believe he is a plastic surgeon specializing in liposuction probably does not deserve to be shot. For this to have happened really should be inspiring more outrage among us all than is has.