Surgical Aesthetics Magazine: How To Say No
By Charlotte LoBuono
Surgeons who offer cosmetic procedures spend a large amount of time and money attracting and converting prospective patients. A less-often discussed—yet vitally important—skill is knowing when and how to turn patients away. Individuals with pre-existing health concerns, unrealistic expectations, underlying psychiatric problems, and those who do not truly understand the risks and implications of surgery are poor candidates for aesthetic procedures. While most surgeons understand this, the act of saying no to an unhappy individual who has come to you for help can be challenging and uncomfortable.
Key to handling these cases is learning to recognize potentially problematic patients and preparing a script that will allow you to refuse their requests tactfully. "The whole subject of patient selection is complex," says Grant Stevens, MD, a board-certified plastic surgeon and medical director of Marina Plastic Surgery (marinaplasticsurgery.com). "How I say no has to do with why I say no. Often I am not saying no to the patient, per se, but I am saying not now or not me."
Pre-Existing Medical Conditions
The most important situation in which you must decline surgery involves patients who have medical risk factors that make them poor candidates for invasive procedures. In these cases, the best strategy is to offer safer alternatives or counsel patients to wait until they are healthy enough to undergo the desired procedure. "There is almost always something that we can offer, even if it's not exactly what they were originally looking for," says Lyle Back, MD, a board-certified plastic surgeon in private practice in Cherry Hill, New Jersey (ilovelyleback.com). "If the medical risk precludes an invasive procedure, we can offer a noninvasive procedure. It might not give the patient the result they want, but you may be able to get most of it or part of it. There are really great situations where we have something that is less risky that will actually work better for such patients' concerns."
In the case of an overweight patient who needs to lose weight to reduce the surgery risk, Dr. Stevens refers the patient to a trainer and a dietician. "They can help the patient lose the 60 pounds or so they need to lose before we can do surgery," he says. "So I'm not saying no, I'm saying not now, because they are not currently a physical candidate for this procedure."
In some cases, a prospective patient is a good candidate physically for surgery, but something about their behavior raises a red flag. "For whatever reason, the chemistry is not there, there is something in their attitude," says Dr. Stevens. "I just don't feel I'm the right person. It's not about the skill set, it's about the relationship." In these cases, he tells the patient that he doesn't feel he is the best person to perform their surgery and gives them the names of three skilled aesthetic surgeons in the area.
Dr. Stevens admits that he arrived at this strategy after years of trial and error. "Experience is a great teacher, and bad experiences teach best," he says. "Follow your gut. For the most part, you will know within five minutes whether or not you should be working with a patient."