The Art of Patient Selection and Knowing When to Walk

About two months ago, I was fortunate to be part of an exclusive closed-door meeting with over one hundred very prominent plastic surgeons from around the world. The issue being discussed was problem patients – specifically, when to say no and refuse to treat or operate on them. One doctor in particular – let’s call him Dr. Ed – was particularly perplexed because less than a mile down the road from his practice was a large cosmetic surgery practice who did significant volume but very mediocre work. Poor Dr. Ed was getting all the patients with complications and very poor results from this practice knocking on his door. He seemed to have become the “fall-back guy” for these patients, who had balked at paying his higher prices to start with, but in the end wound up paying considerably more to get him to fix the other doctor’s mistakes. They were very unhappy with the process. Meanwhile, the results weren’t anywhere as good as if those patients had chosen to come to him in the first place. Judging from the number of heads in the room that were nodding in agreement as Dr. Ed explained his predicament, he wasn’t the only one with these issues.

Another issue is agreeing to operate on a patient who clearly has either unrealistic expectations or shows warning signs that they will be a problem patient. That’s when the room exploded in side conversations. It seemed everyone had their share of patient horror stories, those patients that they should have NEVER accepted into the practice, but for a variety of reasons – they felt sorry for them, they genuinely wanted to help them, or they needed the money – they did. It often came back to bite them, sometimes causing months and months of stress, headaches, and even legal action.

So, in performing your patient consults, do you and your staff member (the one who is responsible for discussing the money and getting them to sign on the dotted line) have a list of patient “red flags” that trigger you to refer them elsewhere?

In case you don’t, here’s my list. I recommend that you keep it handy and look at it often:

1. Someone who is extremely negative and hard to please. Complains about everyone and everything. No matter how talented you might be surgically, you are never going to keep this person happy.

2. Someone who is clearly litigious. They refer to having sued other parties, another doctor even. Steer clear.

3. Someone who is suffering from body dysmorphic disorder.

4. Someone who is addicted to cosmetic surgery.

5. Someone who clearly cannot afford your services. This is more of a moral and ethical issue but, irrespective of which side of this issue you fall, treating people in this category can prove to be disastrous because they often expect the world and are left bitterly disappointed.

6. Any patient who does not have realistic expectations about the anticipated result. We all know cosmetic surgery is not a silver bullet to fix life’s problems. If the patient’s expectations are out of alignment with yours, refer them down the road.

7. Anyone going through divorce. Again, this is an ethical and moral issue. Having gone through this firsthand, I can speak to the fact that for the first year, you’re pretty much a basket case. A patient who comes to you wanting rhinoplasty or a breast augmentation today might bitterly regret that decision in six or twelve months’ time and, unfairly, they will blame you for their decision. Protect yourself and protect your practice and tell them that you care too much about them to allow them to make a rash decision about a procedure. If they still want the procedure in six to twelve months, they can come back to you and you’ll treat them then. They will appreciate your honesty and your care. If they do come back, you will have won a patient for life. If they don’t, that’s fine. Let another surgeon deal with the fallout that will very likely happen.

8. Anyone who is overly price sensitive. If your patients don’t appreciate you for your skill and expertise and keep trying to squeeze every possible dollar and discount out of you, then walk. These are not your ideal patients. They value low price over your artistry and skill. Let them be someone else’s headache!