Recommendations
Recommendations
The physician’s recommendations should be based on the patient’s physical, social, and economic concerns. Sometimes the answer is straightforward, such as treating facial
telangiectasias with a series of vascular laser or intense pulsed-light treatments. More often, achieving the requested results noninvasively will require a combination of procedures to volumize, relax, resurface, tighten, or lift. If you think referral for surgery is appropriate, find out if it is a consideration, and if not, why not. Be clear that nonsurgical procedures can provide excellent, but still not surgical, results. The public generally does not understand that surgery may be less expensive than the combination of nonsurgical procedures necessary to produce results. Patient expectations must be set by the physician with both clinical and financial boundaries. A patient who expects to pay for one syringe of a filler but requires at least six syringes to get to the desired result will not be satisfied.
Today, most patients arrive for consultation after having already researched procedures on individual physician, specialty, academy, industry, informational, and community websites. While educational, these sites also provide opinion boards for dissatisfied patients. The physician bears the burden not only of explaining their own recommendations, but of dispelling common myths. Be prepared to explain what you expect the procedure will achieve for that particular patient, how it is performed, the number of times it must be performed and at what interval, the expected degree of discomfort, downtime and posttreatment care expected, and risks involved. If multiple procedures are being considered, explain why one is recommended or why the patient might prefer one over the other. If there are multiple procedures, design a reasonable plan that balances the patient’s priorities with what you as the expert think will make the most significant improvement in appearance within the patients health, time, and budget constraints. And be prepared if asked to let the patient know how many of each of those procedure you have done—is it your bread and butter everyday type, or is it something new that you have just started but in which you feel quite comfortable—and why?16 Finally, be clear that every procedure has benefits and risks and that there are no guarantees of outcome.
The time require for adequate explanation may be more than the physician has available during a busy schedule. Engaging assistants who regularly work with you and know your thought process begin the consultation during their preliminary patient interview provides a frame of reference for understanding. When in the room with the patient, be present, face the patient, and show that you are actively listening and remembering.14 The physician and staff should use similar language that is easily understandable to a layperson and provides a consistent message. Use of visual paper or digital educational resources developed by the doctor, specialty association, and/or industry, may be helpful. After the physician provides specific recommendations, they can leave the room (without appearing to rush out) in order for the staff to review the details.