NO to patients.

Yes, I will repeat it again: NO to patients.

Helping out a patient is innate. We are to give them the utmost care, and it is our privilege to treat them. Dr. Feinberg in one of his articles wrote this: "It is a blessing to work in an environment where we have the opportunity every day to touch someone's life so deeply. We must never lose sight of that. It is our responsibility to not just treat our patients, but also to embrace them. Understanding that this experience is knitted into each patient's story, we recognize that we are called to do whatever we can to uplift their day and to make it better. Today, we are honored and proud to say to our patients, 'It is our privilege to treat you.'"¹

Even if we have all the good intentions and giving them the best treatment and service that we can, there are still patients who are not contented and happy with the outcome and this will give you the following results:

1. Verbal attacks, directly to you or indirectly through their friends and family
2. Internet slander like negative review on your social media
3. Legal actions
4. Physical attacks

If we are to treat all patients coming to our practice, how can we prevent these unhappy patients then? How refusing patients more often will protect our aesthetic practice from problems?

Define your target market

Don't target "anyone interested in my services" but instead, target a specific persona. This include a specific gender, age, demographics, social class, and other interests. Targeting a specific market does not mean you're excluding them and kicking them out of your clinic but it allows you to focus on a specific niche, brand message, the way you handle your patients.

If you are catering to 25 to 35-year-old women who are working in the office near your clinic, you may want to limit your messages and update during weekdays; book them during lunchtime and after working hours; don't let them wait for too long during their said appointment time during weekdays; and they want a quick clinic visit.

On the other hand, older patients want you to have a longer time with them, they want to talk about their life, they prefer a warmer environment, and mostly asked for anti-aging procedures such as botulinum toxin jabs rather than hair removal treatment.

And the list goes on and on.

What I am trying to say here is this: You should know your target market to serve them better. You're not going to a battle unprepared. Know them well to serve them well.

Avoid red flags

These are the patients we don't want to have in our clinics or at least, be careful with, since this will destroy our reputation as a provider and as a brand. These red flags are modified from Vuyk and Zijlkerand from Constantian^2,3:

Personalities:

1. Patients who are difficult to get on with or with poor rapport
2. Patients who lack insight into how these expectations can’t be achieved
3. Patients who do not care to listen to or understand what you are trying to explain
4. Patients who do clinic-hopping, who have been from one clinic to the other and do not stay loyal to one establishment
5. Upon history taking, all they talk about is the bad service they encountered from previous clinics and dropping names of the providers.

I had one patient who upon consultation, had previous problems with 2 clinics because his acne was not resolved. He also said that he made a complaint and also convinced his friend to complain on his behalf. He said he posted the incident on his social media. He wanted a full refund of the series of treatment done on him. I asked him a few questions about his treatment and home regimen and if he was compliant with it. I discussed the possibilities of failure of treatment for him to realize that these things happen, and the provider cannot be solely responsible for the results. I advised him to stick with the regimen for a period of time and let him go back to his former provider to resolve the issue.

6. Patient who have unrealistic expectations or vagueness regarding goals

Every treatment is different because every person is slightly different, and there are always potential risks and complications. I make this very clear to each one of my patients upfront, because they need to know that even with a good result, there will always be minor scarring, bruises, or small complications. If a patient does not fully understand this, or if he or she has unrealistic expectations, I may politely tell him or her that the procedure may not be right for them.

7. Patient who do not have a realistic budget for your treatment
8. Patient with demanding personality
9. Patient presenting with perfectionistic attitude
10. Patient with impulsiveness
11. Patient having an emotional crisis at the moment. The reason for the procedure may be only due to the wrong drive or because of the current emotion.
12. Patient who do not have realistic budget for your treatment

History:

1. Patient with history of multiple treatments and overly done.
2. Patient with litigation history.
3. Patient who have Body Dysmorphic Disorder (BDD) (minor or nonexistent defect)

Body dysmorphic disorder (BDD) is one of the most common psychiatric conditions found in patients seeking cosmetic surgery.^4,5,6,7 In aesthetic specialties, rates are noticeably higher, with a reported prevalence of 6.7% among general dermatology patients, 14.0% among cosmetic dermatology patients, 10% in the maxillofacial setting, and 21% in patients seeking rhinoplasty.^10,11,12

These cosmetic procedures do not make them feel any better about themselves even though the procedure was a success. Or, you can make their BDD worse.

4. Patients who have significant medical problems that would impact the performance or outcome of the procedure – for example, a patient with uncontrolled diabetes or significant heart disease or hypertension.

Others:

1. Patient who asked for a treatment that you think won't be beneficial for her or him; or the treatment is beneficial for the patient but want a particular product to be used which you think would be harmful like non-FDA approved products.

Learn to say NO

You just have to say NO. Say "NO" to the wrong patients. This will be very difficult to do when you are just starting out because you want more patients getting through the door and you'll do whatever you can to keep them. But choose your patients. Choose those who can build a long-term relationship with you. Choose those who share your value and understand what you tell them.

Conclusion

We need to protect ourselves and our practice from unhappy patients as this will break our reputation and our cash flow. "NO" is not a bad word, saying "YES" to an unhappy patient is. Learn to say "NO".

References
1. Kern E, Friedman O. Avoiding the Unhappy Patient by Building Rapport in the Internet Age. Facial Plast Surg 2019; 35:210-213
2. Vuyk HD, Zijlker TD. Psychosocial aspects of patient counseling and selection: a surgeon's perspective. Facial Plast Surg 1995; 11 (02) 55-60
3. Constantian MB. Childhood Abuse, Body Shame and Addictive Plastic Surgery: The Face of Trauma. New York, NY: Routledge; 2019
4. Sarwer DB, Spitzer JC. Body image dysmorphic disorder in persons who undergo aesthetic medical treatments. Aesthet Surg J 2012; 32: 999 - 1009
5. Constantian MB, Lin CP. Why some patients are unhappy: part 1. Relationship of preoperative nasal deformity to number of operations and a history of abuse or neglect. Plast Reconstr Surg. 2014; 134;823 - 835.
6. Constantian MB, Lin CP. Why some patients are unhappy: part 2. Relationship of nasal shape and trauma history to surgical success. Plast Reconstr Surg 2014; 134: 836 - 851. 7. Veale D, De Haro L, Lambrou C. Cosmetic rhinoplasty in body dysmorphic disorder. Br J Plast Surg 2003; 56: 546 - 551.
8. Hayashi K, Miyachi H, Nakakita Net al.. Importance of a psychiatric approach in cosmetic surgery. Aesthet Surg J. 2007; 27: 396 - 401.
9. Felix GA, de Brito MJ, Nahas FXet al. Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty. J Plast Reconstr Aesth Surg 2014; 67: 646 - 654.
10. Bouman TK, Mulkens S, van der Lei B. Cosmetic professionals' awareness of body dysmorphic disorder. Plast Reconstr Surg, 139 (2017), pp. 336-342
11. Brito MJ, Nahas FX, Cordas TA, Gama MG, Sucupira ER, Ramos TD, et al. Prevalence of body dysmorphic disorder symptoms and body weight concerns in patients seeking abdominoplasty. Aesthet Surg J, 36 (2016), pp. 324-332
12. Locatelli K, Boccara D, De Runz A, Fournier M, Chaouat M, Villa F, et al. A qualitative study of life events and psychological needs underlying the decision to have cosmetic surgery. Int J Psychiatry Med, 52 (2017), pp. 88-105