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A Tale of Two Surgeons

creating the patient-surgeon partnership

Like many doctors, I rarely spend time as a patient. I need frequent reminders about the vast difference between wearing the gown and donning the white coat.

I recently spoke with a friend in her mid 40s who scheduled a breast reduction. She has wanted a reduction for the last 20 years, and finally reached a place in life when it was time. Her breast size causes back and neck pain, limits her clothing choices, and makes her both frustrated and self-conscious.

She asked friends and searched online to find a specialist in her geographic area. She drove ninety minutes for a consultation with a plastic surgeon with a stellar technical reputation.

The appointment crushed her. She felt dismissed and ugly, and her concerns were not heard. The surgeon measured her breasts and concluded that she had a much different size than she believed.

He focused on cup and band size, telling my friend his wife’s band size, and asking the nurse hers. This comparison between his patient and the 20-something year old nurse was both unprofessional and unkind to both women. He said,

“Well, I can tell you why you have back and shoulder pain – you’re wearing the wrong size bra.”

He pessimistically stated he didn’t know what end result he could promise her. He asked what size she wanted to be and stated,

“I don’t know if I can make you happy.”

Immediately following the appointment, she went to Nordstrom, where they measured her at the size she knew she was. Afterward, when she explained, the saleslady said,

“Well, we wouldn’t hire him.”

My friend said,

“I don’t feel comfortable with this surgeon.”

I told her,

“You would never let someone who makes you uncomfortable operate on your family, so you shouldn’t have him operate on you.”

My friend decided to seek a second opinion. The next surgeon gave her a completely different consultation. She came into the room with a warm greeting and began,

“I do things a little differently. I know you’ve waited a long time for this and I understand how important it is to you.”

This surgeon was warm and reassuring. She validated and heard my friend’s concerns, and discussed the need to change the shape as well as size of her breasts to meet her goals. She assured my friend,

“I want to make you the right size for you. I can’t tell you exactly what that size will be, but it will be right for your body. I will work to give you my very best.”

Both surgeons correctly stated that they could not predict the final surgical result. One expressed it with pessimism, placing the blame for future disappointment on his patient. The other empathetically encouraged her patient, stating that she would do her best work to achieve the right result for her patient’s body.

One focused on bra size – which varies among styles and manufacturers – and raised inappropriate comparisons with other women. The other focused on her patient’s body and a harmonious result.

The patient-surgeon partnership involves tremendous vulnerability. As a patient, you need a surgeon you trust. As a surgeon, you must demonstrate compassion and set realistic expectations, but avoid undue pessimism.

The first surgeon made a therapeutic partnership impossible.

“He made me feel like I wasn’t worth his time.”

The second surgeon built the relationship when she sought out and addressed each concern in a realistic but encouraging way.

“She really listened to how I felt about my breasts and how the width affects my appearance almost more than how much they project from my body.”

My friend’s story reminds me: how I communicate with my patients matters just as much as what I say.

She puts it best,

“The surgeon made me feel that I would be beautiful when it was done. She gave me hope.”

Keep up the strong work!

Single With Scalpel

About the Author

Single With Scalpel is a Pediatric Otolaryngology fellow who tweets about life, humor, and medical education. She blogs here when 140 characters simply aren’t enough.

4 Comments

  1. Its not what you say – its how you say it. Personally reserve a lot of time for communicating. BUT – as a human being there are people I just cannot communicate with. Whatever the reason. I have learnt to trust my initial impressions about people. I just encourage them, actively encourage them to find another surgeon opinion whatever. Two-way street. Yes find the person in life with whom you feel comfortable. Forget the reputation

  2. Working in the ER, you barely have time to perform a decent exam and history, let alone address concerns that seem to be deep rooted and complex, affecting every single problem a patient current has.
    I once saw someone who came in with “whole body pain”, subjective fever, extremity paresthesias, palpitations… The list went on and on, and the more we talked, the more complicated it seemed. He’d seen his PCP twice, but otherwise, I was the third person he saw. He only came to the ER because his wife couldn’t take it anymore.
    I noticed he had an accent. I asked him how long now he’d been in the US for. He said “7months”. He’d come from a warm country in the Middle East to Boston at the height of the winter of 2015.
    All I had to do was look beyond the objective complaints and ask him one single question: “does this winter make you feel isolated, feeing like you don’t belong?”
    He burst into tears. Sobbing.
    My next question was to his wife. “Are you adjusting well?” She said she was. She had a job, she was driving for the first time. That’s when I turned to him again: “Does your wife thriving make you feel like you should be achieving more for your life at this point? Do you feel that, as an immigrant, you are falling behind your peers because you can’t leave the house?” And there it was. BINGO. He looks at me through tears. “How do you know???” All I had to do was reply back, simply: “You hear an accent in my voice too, don’t you?” I smiled. He smiled. He took my hand and said “Thank you so much. Thank you for understanding”.
    The encounter went on. What my patient and his wife were experiencing was disconnect amidst incredible excitement and pressure. To him, it manifested somatically. Of course, I did an EKG and basic labs on him, but what that man really needed was someone to look outside the box and to understand the struggle.
    I never saw him again, but I knew that at that moment, that couple needed my empathy. I was glad our paths crossed.

    • I love this! Thank you for sharing your story, Juliana – what a meaningful reminder that our bodies manifest more than physical problems alone.

  3. Just shocked these doctors can stay in business at all, I mean I just cant imagine having any business if you acted like that. Not that it isnt common, I hear similar stories every week. That wont fly in the future, pts will avoid those types.

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