Tuesday, March 27, 2012

A Patient Care Coordinator Story


"Hi, I’m your consultation coordinator giving you the answers!  I’ll give you the lo-down.  I’ll give you the scoop on how to choose a plastic surgeon; what to ask and how to ask it. The information here will be beneficial in helping you determine if surgery is right for you and then how to look and where to look for the right plastic surgeon.  So what really goes on behind the scenes in a typical plastic surgeon’s office?  Read on to learn what you can do to help make the decision on which surgeon is right for you and the correct mindset and approach that one must have that is most conducive to having a great experience; what is realistic to expect and what is totally unrealistic.   But first, it will be very helpful to learn where the current mindset of the general patient is who wants plastic surgery and ask yourself…Is this me?
It’s scary out there and if you have been looking for awhile, you may be on the verge of just giving up or, even worse, just picking the surgeon that is the cheapest and the closest location to you.  Let’s face it, money, or lack thereof, is a real driving force in our lives and we are constantly comparing all the services we buy. We pick and we choose and think of ways to possibly drive the cost down on services that we need and especially in these economic times we are constantly looking for more bang for our buck, which one of us wouldn’t?  It’s a human condition.  So we do a little manipulation to get even one more dollar off the price of the cost estimate we’ve just been given so we can spend it elsewhere.  We want to haggle and cajole and then we tell our friends what a great deal we just got.  Admit it, it makes us feel good to think we have saved some money for ourselves and a lot of times we are very much in competition with our friends and acquaintances (…and secretly, our enemies, too!) and that’s ok!

But this is where we make the mistake when choosing a plastic surgeon for elective or even reconstructive surgery.  It’s a big one, and a very dangerous one.  Looking at ‘having a procedure done’ ( I call it ‘SURGERY’) as if it were like buying a car or getting our nails done is very, very dangerous.  Just using the words, ‘having a procedure done’ makes it benign…like, ‘Having your hair done.’ The concept of plastic surgery has now become equated on the same par as having a facial at the day spa around the corner or going to get our legs waxed or our ‘hair done.’  Don’t fall into this trap! These are all services we are familiar with and because humans are social in their nature, we tend to want what the other guy has.  We gather together and we compare. It’s primal.  We use the experiences of others to help us decide.  Technology that is available to us moves at an amazing speed; we text, we twitter, we constantly have a phone in our ear and we make ourselves available 24/7 to our jobs, our family and our friends.

The range of patient demographic for a Plastic & Reconstructive surgeon has expanded enormously. It encompasses the widest range it has ever been, mainly because of the baby-boomer generation.  We’ve all heard the saying, “Fifty is the new Thirty.”  There’s a reason for that.  Baby boomers who, during the sixties, used to say, “Don’t ever thrust anyone over thirty!”, have now turned fifty!  My, my!  This generation have introduced the country and society as a whole to naturopathy, ergonomics, whole body wellness, mind-over-matter, massage therapy, you’re only as old as you feel, real body age, yoga, yogurt, whole foods,  hypnotherapy, mysticism, body-building, jogging; power walking; I could go on and on, but you get my drift.

The baby-boomer generation has singlehandedly taken the stigma out of having Plastic Surgery.  The “Giggly, post-pubescent, young person, who is uneducated about their own body but who has just seen what they want on their friend and they want it too; who have some graduation money set aside or may have parents that still have deep pockets because they are getting good grades, and so breast augmentation plastic surgery is within their reach” to the “Scared 35-45 year old, who has just looked at themselves in the mirror and have seen for the very first time, a floppy neck, crinkled skin or bags under their eyes.  They just raised their arm up to brush or comb their hair and realized in horror that their upper arm was flapping with each motion they made.  They may have no money problems because they are a two income family or they may have a good job, but they haven’t been able to save like they wanted and are now looking at an aging and unfamiliar face looking back at them in the mirror and start to ask their friends, do they see it too?  If that’s what my face looks like, what must my body look like to other people? They might need financing; they have a good work ethic and are knowledgeable about paying-off a debt and are anxious to just get it done now so they can reap the benefits of looking and feeling younger, before they get old” to the “Retired or almost retired; yes, I’m old but I’m not gone from this world yet; I still have sex, I want to have fun, pre-geriatric baby-boomer who is just as much at home parasailing and riding a motor cycle as they are taking care of their grandchildren” all have contemplated consulting with a plastic or cosmetic surgeon, having surgery or have actually had this surgery in their lifetime.  

Yes, it’s expanded, but you see, it’s not so much that the patient demographic has expanded that makes it a "iffy" situation but it is how we view and think about cosmetic or plastic surgery that makes it dangerous.  Let me enlighten you. The fact that cosmetic and plastic surgery is now so commonplace is both good and bad.  It’s a double-edged sword.  The availability of plastic surgery is a good thing; but thinking about plastic surgery in a superficial way is very dangerous.  Unfortunately, most of the time, when something is readily available to the masses it becomes somewhat humdrum and, believe me when I tell you, there is no such thing as humdrum surgery! EVER!

We jump on the internet and get ‘instant results.’  We want what we want when we want it and the concept of ‘waiting’ has become foreign to us.  We get used to obtaining results so quickly that if the results are not what we want or expect, it’s oh so easy to  ‘just do it over and over’ until in our own mind it gets done right. Our expectations get skewed and somewhere during this personal revelation we start equating “surgery” with “easy” and “commonplace.”  Reality TV and extreme makeover shows have pushed this lie in our face over and over so many times it’s not a wonder we think the way we do. I am so over anyone who has this mindset; really, you must come to terms with it and change it.  It raises a big red flag for me and I immediately let the doctor know that this is not a patient they would want to do surgery on.  There is a new phobia out there that stems from this way of thinking called Body Dysmorphic Disorder. I have seen it time and time again.  “I must be perfect.  I must look this particular way.”  “One nostril is a little bit bigger than the other, and it bothers me when I look in the mirror.  I can’t put my mind on anything else!”

A woman just told me over the phone the other day that she is African American but she is consumed about having a “Caucasian nose.” She explained that she has already had 4 surgeries with another plastic surgeon and he cannot give her the nose she envisions. She is only 21 years old! She said, “I can’t stop thinking about it and I knew the minute my doctor took the splint off for the fourth time that there was no change in my nostrils like I wanted.”  “It consumes me.”

In my years as a patient care & surgical coordinator, I have heard it all.  They want it to be tighter, smaller, bigger, flatter, rounder, higher.  One breast is lower than the other.  One breast is bigger than the other.  My knees are fat. My smile is crooked.  One side of my face is droopier than the other, can he fix it? I have this one line in my face that I just cannot stop thinking about.  Every time I smile; here, do you see it?  I want this, in this size, in this shape; I want this area lifted and tightened; if this is just pulled up like this; see….this is exactly how I want it to look?  I want, I need, I must have…It…Now…  I have even had someone ask if the surgeon could lengthen one of their fingers!

When we think this way, we dehumanize ourselves, we de-medicalize the procedure (if that’s really a word…but you get what I mean), and we de-emphasize the importance of listening, understanding and the art of waiting. This is a generation that cannot wait.  We cannot accept the idiosyncrasies of our own bodies.  We are all individual and unique.  But, the fact that we will NEVER achieve perfection in ANYTHING and especially if it has to do with our bodies is not a concept we can wrap our minds around and it is dangerous, dangerous thinking! We become self-absorbed and as we listen to the physician, we are not really hearing them; but wondering, as they talk, how much it’s going to cost us and if the surgeon actually understands what it is that bother’s us and, of course, what we are going to say next. 

Sometimes we might feel intimidated by the whole process, and then we become forgetful of what we really wanted to ask or we may not even know what to ask or even how to start.  Unrealistic expectations; perfection and assumptions are the single most reasons for malpractice cases brought against a surgeon.  I’ll expand on this subject later.

If a surgeon coddles this type of thinking and does not set you straight; if they tell you they can do anything you want; if they don’t ask you any questions about your history; if they are yes-people who talk in generalities; if they say they can only do a certain procedure only one way because that’s the only way it can be done; if they are enamored of themselves; if they don’t touch you or measure you (remember they are doctor’s and they examine people); if they advertize the price of a procedure with exact numbers; if they say you shouldn’t go to another surgeon because they have legal problems; if they guarantee results; BE WARY!! This is NOT the surgeon you want.

They should not:
·        be your buddy
·        be your best friend
·        party with you
·        help you with your personal life
·        care about anything other than doing an excellent job for you
·        treat you differently than they do any other patient
 and if they “do” or “are” some of these things mentioned above - something is wrong!

You should not expect them to:
  • remember your name or anything about you without your chart in hand
  • be your buddy
  • think you are separate from the rest and special in their eyes
  • meet with you socially
  • give the same deal to your friends that they gave to you
  • give the same deal to you that they gave to your friends
  • help you come up with the money
  • make an exception on any medical protocol or policy just for you
  • be your best friend
  • have feelings for you
Just remember, there are as many different types of plastic and cosmetic surgeons out there as there are different types of people who want surgery. We are all human!  Remember that!

Coming to the subject of a surgeon’s history and has he had any suits brought against him…As I said previously, unrealistic expectations; perfection and assumptions are the single most reasons for malpractice cases brought against a surgeon. It stems from the patient alone and has absolutely nothing to do with the surgeon or the work he has done.  It is a shameful thing to do. Shameful.  Disgraceful.   - to try and ruin someone’s life only because in our own heads we envisioned & expected something that could never ever be achieved by anyone.  It is also disgraceful to think that suing a doctor will do nothing to them and that their malpractice insurance will just pay for it and they will go on with their lives.  This is so untrue. I’ve seen a wonderful surgeon’s life and practice in shambles because, although he won in court, just the fact that he had someone bring suit against him affected his practice for many years afterward.  He endured taunts and jeers; having to explain himself over and over to each patient who saw him and unreasonable internet evaluations over which he had no control. His business never recovered, his reputation was destroyed, his family couldn’t take the length of the trial (it went on for four years because of appeals) and they left him; he became spiritually & financially destitute; he fell into a deep depression and eventually took his own life; all because ONE patient had unrealistic expectations.  They were selfish, self-absorbed, unrealistic and mean-spirited. The results he achieved were superb, but the patient just couldn’t see it! And…when that patient heard about what had happened to him; they actually said he ‘deserved it.’ 

It was really terrible to listen to.  Now, I know you’re saying to yourself, ”Well, I’m not that kind of person.” “I would never do something like that to anyone.” But, you’re wrong. I believe anyone is capable of doing anything, given the right circumstances. Here’s an example about YOU.  Yes, YOU.  That shows YOU are capable of doing something like this, therefore you have the capability to ruin someone’s life.

Have you ever had your hair cut or colored by anyone else?  Yes? I’m sure you’ve experienced a bad cut or a color-job that didn’t turn out so wonderful. Maybe your hair got ‘fried’ or you ended up having to cut your hair real short or maybe even wear a wig.  Maybe it wasn’t really bad but YOU felt uncomfortable for a really, really long time because you knew it would take time to grow out and it just wasn’t fair that you trusted someone to do what you expected and even tried to communicate to them, (you may even have brought in some pictures) and the result turned out to be entirely different than you expected and you didn’t like the way it looked or felt, or the way you thought others would see it.

This is really personal, because you can’t hide; you look at your hair every day in the mirror. It is not what you expected at all.  You don’t want to go out in public but you have to; you have social engagements; family is coming over, etc.  You’re sure your hair will never ever be the same -or- god forbid your wedding is tomorrow.  OMG Look what they did?!  You trusted them! - and they did THIS! Tears well up. Why YOU? And as you try to fiddle with it you start to get mad and frustrated. How dare they! Why didn’t they understand what you wanted?!  They are just inept and shouldn’t be in this business. You may not be able to fix it and it will just have to grow out but, by-golly, you shouldn’t have to PAY for this MESS.  You want your money back. They should give it back to you. It really doesn’t matter to you that your hair may have turned green from a chemical reaction to a supplement you had taken to help you lose weight.  That, and in combination with an antibiotic and a change in hair conditioner which did a number on the chemical structure of your hair. Take a deep breath!  People!  This is just your hair.  Your hair will grow out, right?

Now, substitute your body or your face instead of your hair.  So how would you feel if something didn’t turn out like you expected after surgery? Taking the money that you paid out of the equation,   (I’ll get to that in a minute.) How would you react?  How would you feel?  “This is really personal!”  You would be very, very upset - and very, very scared.  You might have your family or friends egging you with sarcasm; after all they might not have wanted you to have surgery in the first place.

Just think if you started scarring uncontrollably after surgery with big thick ugly-looking scars. (Called ‘Keloid’)  This can happen at any time - with anybody - it may be the by-product of something you’ve ingested five months ago or for no reason at all!  You’ll never ever know.  The doctor cannot control how you heal.  Nor is there any test that would predict how you would heal. You may heal great on one surgery and not great on the next. You didn’t get the results that you wanted, or the results didn’t last as long as you wanted, So - how would you feel? Certainly a heck of a lot worse than when your hair was “really messed up”  

THIS is your actual body!  THIS is your actual face! Wouldn’t you immediately think, “This has never happened before so it has to be someone’s fault - and it was the surgeon who did the surgery so it must be their fault?  What else could it be?? It couldn’t possibly be anything you did, right?  and that might be true - or it might not - but there’s really no way for anyone to know. Truly.  So you surmise, ‘Well, the doctor cut me and those cuts healed terribly.  I might look like this forever - so what option do I have but to get money from the doctor’s malpractice insurance - that’s what it’s for, right?” - and there we go!  All from unrealistic expectations and NOT listening or following direction or not being able to accept  the fact that you or the doctor may never ever know why.

I can tell you right now, if you didn’t heal properly, the right doctor, the good doctor, the experienced doctor, the correct doctor, would decide what might help you heal correctly and continue with your treatment until there was nothing more that could be done.  End of story. Surgery is not an exact science; that’s why you need a board certified plastic surgeon who has done thousands of procedures and knows what to do in ANY situation or with ANY outcome.........."

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