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.


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