SAN FRANCISCO Developing rapport with someone who seeks cosmetic surgeryfirst as a person and then as a patientcan help weed out potentially problematic patients.
Dr. Roberta D. Sengelmann enters the room for a patient's first consultation "without any preconceived notion about what they're here for," and spends a few minutes asking the patient about herself before moving on to cosmetic topics, she said. "I want to know who I'm embarking on this journey with," said Dr. Sengelmann, a dermatologist in Santa Barbara, Calif. and St. Louis, Mo.
She and three other cosmetic surgeons practicing in California offered tips for managing cosmetic patients in a panel discussion at the annual meeting of the Pacific Dermatologic Association.
Have a mirror handy at that first visit, because often patients do not have a very good idea of what they want done, said Dr. David R. Harris of Campbell, Calif. Help them focus by asking, "If I were a genie, and could pop out of a bottle and satisfy one problem that you have, what would that problem be?" he suggested.
Dr. Ronald L. Moy of Los Angeles agreed that listening to patients is extremely important. He added that listing the main categories of procedures offered, for resurfacing, lifting or tightening, filling, or Botox (botulinum toxin type A) treatments, may help the patient focus.
In addition to developing rapport with patients and helping them decide which treatment to get, the panelists discussed:
▸ Care coordinators. Dr. Greg S. Morganroth of Mountain View, Calif., relies on cosmetic consultants to explain his philosophy, background, and approaches, so when he enters the room, the patient already is feeling good about being there. "It's not just your rapport with them" that matters, he said. "Make them aware it's a team that's taking care of them."
In Dr. Morganroth's practice, the cosmetic consultants not only help during the consultation by handling preoperative education and through extensive "hand-holding" in the postoperative phase. "They're the liaison for the patient throughout the entire process," he said.
The role can be filled by a dedicated cosmetic consultant, or by a nurse, medical assistant, or receptionist. "They all can be trained to do it," he said.
Dr. Sengelmann employs a nurse to fill this role of patient advocate, liaison and care provider.
If a consultant screens cosmetic patients for you, it's still important for you to get acquainted with the patient to decide whether to proceed, Dr. Harris cautioned.
▸ Duration of the consultation. Dr. Sengelmann charges for initial consultations, which last 30 minutes or as long as she thinks is needed. "This all boils down to really getting to know who you're working with and may eventually be operating on. It's just like dating," she said. Many times a patient needs to return for a second or even third consultation, or she will start with more minor treatments prior to scheduling a more involved procedure.
Before he accepts patients, Dr. Moy meets with them two or three times and makes himself accessible by e-mail.
Another strategy is to offer to take care of smaller problems such as dyschromia, an unsightly mole, telangiectasias, lumps, or bumps, and see how the patient handles that before agreeing to do a larger procedure, Dr. Harris said.
▸ Red flags. Patients treated for general dermatologic problems such as psoriasis or acne may become dissatisfied, frustrated, or unhappy with the results, but cosmetic patients in addition can become terribly angry, especially if they have unjustified expectations, Dr. Harris cautioned.
Watch out for patients who complain about every other dermatologist they've seen, or someone who complains about a previous surgeon's work that seems well done to you. "They're going to hate you next," he warned. If the horrible problem a patient complains of is a nearly imperceptible defect, don't treat it. If a patient doesn't listen well and can't focus or make eye contact, be cautious.
▸ Rejections. If you do not want to work with a patient, speak as you would in other troubled relationships, Dr. Sengelmann suggested. Start sentences with "I don't feel that I will be able to meet your expectations …" or "I'm concerned you will not be satisfied with what think I can accomplish for you."