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4/24/2010
Avoiding Dissatisfied Clients
The best strategy for dealing with difficult patients is to avoid them in the first place
Patient dissatisfaction with cosmetic surgery avoided by building positive relationships

Expert encourages strong support of staff, as they are the ones who play large role in caring for patients
Surgeons must pay attention to their verbal, nonverbal language when communicating with patients
The best strategy for dealing with difficult patients is to avoid them in the first place, and success in that regard involves careful patient selection and multipronged efforts to provide the patient with a positive experience from beginning to end, says Howard A. Tobin, M.D.


Dr. Tobin

Under influence from his mentor, Richard Webster, M.D., Dr. Tobin says he decided in 1982 to limit his practice scope to cosmetic surgery. Among the many pearls he learned from Dr. Webster was that the way surgeons deal with their patients is just as important as their clinical acumen and surgical skill.

"There are many things that make patients dissatisfied," says Dr. Tobin, a private practitioner in Abilene, Texas, and clinical associate professor of surgery, University of Texas Southwestern Medical Center, Dallas. "It could be something you did, something you didn't do, or something they think you didn't do right, and the fact is, we don't always accomplish what we hope to in the OR."


"However, treating the patient well from the initial consultation until the end of the postoperative care will build a positive doctor-patient relationship that helps in preventing patient dissatisfaction, or dealing with it successfully if it occurs," he adds.

Treating patients well is a responsibility of the surgeon, but it also requires a supportive staff. Assuring the latter element is in place means making certain office personnel know they are appreciated and allowing them to develop to their full potential.

"Remember, your staff is your most important asset. They really run the practice and play a large role in taking good care of patients. This, in turn, will help to keep patients coming back," Dr. Tobin says.

LISTEN, LISTEN, LISTEN In their interactions with patients, surgeons must be cognizant of their communication skills, paying attention to their verbal and nonverbal language. Letting the patient talk without interrupting and listening with genuine interest are critical. It is also important not to talk patients into procedures they are not seeking in the first place.

"If you push for more, the patient agrees, and something goes wrong, you will be considered completely at fault," Dr. Tobin says, "whereas the patient is likely to be far more understanding if there is a problem with something the patient asked you to do."

In the initial consultation, surgeons should be watching for red flags that suggest a patient may not be a good match to the practice. As described by Vic Narurkar, M.D. (Cosmetic Surgery Times, March 2006), some signs of a "problem" patient include obsessive-compulsive behavior, a history of "doctor shopping," excessive rudeness or flattery, litigiousness and sudden whims. To this list, Dr. Tobin adds patients who bargain.

"You want to avoid patients who send bad vibes, but be diplomatic in declining their request for surgery, perhaps stating you don't think you would be the best surgeon to do what they need," Dr. Tobin says. "Don't flatly refuse to operate, because if you treat them with kindness and respect, they still may appreciate your thoughtful consultation and refer other patients."

ENSURE EDUCATION Ensuring the patient is properly educated about the procedure and its possible outcomes are also essential in preventing dissatisfaction, but this seems to be a weak area for some cosmetic surgeons. Dr. Tobin emphasizes that the information must be presented in terms the patient understands and be reinforced with additional resources (for example, online information or written literature), keeping in mind that patients will retain only a small percentage of the verbal information they receive in the office.

In his practice, Dr. Tobin uses materials developed in-office rather than stock literature, and presents slide shows highlighting outcomes of past patients. However, he limits the content of the latter to cases achieving average results. He is also careful that patients understand the risks and limitations of the proposed procedures.

"Promise less and deliver more, and you will come out ahead of the game," Dr. Tobin says.

In Dr. Tobin's practice, a follow-up letter is sent after each consultation, thanking the patient for coming in and reviewing the recommendations. It also asks the patient to read the literature they were given, and encourages them to come back or call with any questions.

"We rarely schedule surgery at the time of the consultation. Instead, it is better to allow patients time to go home and think," Dr. Tobin says.

Patients who have decided on surgery are also given the consent form in advance, not on the day of the procedure, so they have time to read it and develop questions. And on the day of the procedure, Dr. Tobin and other OR staff visit patients before surgery.

"Getting patients into a relaxed state when they go into the operation means they will be more relaxed when they come out," he says, noting that it may also be helpful to "bring your dog to work."

"My patients love to see my dog, and having my dog around helps my mood as well," he adds.

OPERATE OPPORTUNISTICALLY In the OR, Dr. Tobin says his motto is "operate opportunistically," which means modifying the surgical plan as necessary to avoid unnecessary risk. With that in mind, he also advises surgeons not to be among the first to try every new procedure.

"Surgeons are most likely to experience major complications after they've returned from a major meeting. Don't be in a rush to go back and try what you've just heard about. Wait for the procedure to stand a test of time and realize that if anything goes wrong, you may not have the experience to know how to rectify the situation," he says.

If complications occur, or if the patient is dissatisfied with the outcome for another reason, Dr. Tobin advises acknowledging the complaints and dealing with them, expressing one's personal regret rather than arguing with the patient.


"Patients can be forgiving if they think you really care and are trying to satisfy them," he says.

"Saying 'I'm sorry' does not generate a lawsuit or admit liability, but rather bonds you with your patients, especially if you reassure them you will help to correct a problem," he says. "Still, be careful about what is written in the chart."

Patients who are still unhappy can be encouraged to seek a second opinion, but the surgeon should be proactive in recommending a colleague expected to be supportive and circumvent the patient from picking someone who may be one's adversary. Dr. Tobin notes that except for the OR expense, he waives any charges for correcting a complication and will also refund the entire fee if a patient remains unhappy despite all of his best efforts.

"Giving dissatisfied patients their money back is not a settlement or admission of negligence, but says you didn't achieve what the patient hoped you would. Remember, as a bottom line, keeping your patients happy is the most certain way to keep yourself happy. Achieving self-satisfaction along with satisfied patients are the surest ways to build and maintain a long and successful practice," Dr. Tobin says.

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