Dr. Joe Niamtu discusses how to avoid and deal with unhappy cosmetic patients.
Joe Niamtu, III, DMD, Niamtu Cosmetic Facial Surgery, Richmond, Virginia
“You can’t have a good surgical outcome if you have an unhappy patient or if you pick the wrong patient. This is some of the stuff that older doctors learned the hard way,” said Joe Niamtu, DMD, who presented “The Unhappy Patient” during the Maximizing Surgical Outcomes session at the Cosmetic Surgery Forum in Nashville, Tennessee.
According to Dr. Niamtu, cosmetic patients tend to be more complicated than general medical or surgical patients. Cosmetic treatments are a luxury, and many cosmetic patients are already unhappy with something about themselves, or they wouldn’t be in your office, he said.
“Anyone that does surgery is very proud and conscientious, and they go to work to do good. Cosmetic surgeons live in a world of precision. The surgical persona… is ‘failure is not an option.’”
Dr. Niamtu described a scenario he said is part of the profession: You go to work on a Monday morning and are in a great mood, and your staff says, “Mrs. Smith is in a room, and she is not happy.”
“This runs chills up my spine [and] makes me want to sneak out of the office, but it is part of our profession. From time to time, we will all have an unhappy patient.”
Some of the first questions he asks himself is whether he should have seen this coming, he said.
“I forget most of my cosmetic victories but remember every single one of my problem cases. And I think that’s a real common thing throughout our profession.”
Just Say ‘No’
There are ways in which to spot difficult patients before treating them, said Dr. Niamtu.
“Saying ‘no’ can be awkward and flies against surgical principles and marketing but learning how to gracefully decline to treat a patient can go a long way towards happiness and job satisfaction.”
Turning down a case can be even more difficult for younger surgeons, he said.
“When new in practice and in debt, it is hard to say no to a patient who is a surgical candidate and has the finances.”
But difficult patients are embezzlers—not meaning they steal money; rather, they steal your energy, said Dr. Niamtu.
“…dealing with unhappy patients can leave us exhausted at the end of the day. This can lead to kind of a hangover that can linger for years and affect our family lives. Most of us really care. Again, it’s that surgical persona. We want to do good and get this perfection, and when we don’t, it can be very stressful.”
Red Flags
There are various red flags for potentially difficult patients, said Dr. Niamtu.
“You just get a bad feeling. Or they come across as manipulative or difficult.”
They’re too busy, too important, or controlling, he said.
“There are ‘the experts’ and [they] are going to tell you how to do this surgery, and others that have consulted with ‘all the leading specialists.’ No names. They’ll berate the previous doctor but compliment you. You know what that means? The next person they go to, they’re going to berate you.”
Some personality types, like doubters, nitpickers, and those who feel regret, are more likely to reveal those aspects after surgery, according to Dr. Niamtu.
“Some people are just scared. Some people have emotional or psychiatric problems. Then there are negative patients that don’t smile and don’t make eye contact.”
Other red flags include people who want surgery for the wrong reasons, like a job promotion or to save a relationship, as well as people who have a resistant spouse or want guarantees about how they’ll look, said Dr. Niamtu.
“It is a two-way street though; sometimes the negativity can be in the surgeon and staff. So, we have to set the example.”
Complications, poor outcomes, or perceived poor outcomes can make patients unhappy, as can high surgical fees or poor office communication. Some patients need more attention than others and if they feel that the surgeon does not have time to listen to them, they can become very unhappy.
Cosmetic surgeons might notice these warning signs, but often it is the staff that warns the surgeon about a potential patient, said Dr. Niamtu.
“Listen to your staff. When they say don’t operate on this person, they’re usually right.”
Dealing With the Disgruntled Patient
Sometimes patients want to vent and will dig into the surgeon or staff.
“Doctors aren’t used to getting criticized and can sometimes get defensive, which sets off a cycle of arguing. This is a huge mistake. Doctors need to learn how to listen and let the patient get it all out. My good friend and surgeon Jon Sykes talks about “reflective listening,” the art of letting a patient ventilate without jumping in with interruptions or solutions. Let them get it off their chest.”
The first thing to do with an unhappy postop patient is to look in the mirror, said Dr. Niamtu.
“Ask yourself: ‘Is it my fault?’ ‘Could I have done better?’”
Schedule follow-up appointments with problem cases at the end of the day when there are no other patients in the office, he said.
“Trying to manage a disgruntled patient in the midst of a busy day is a prescription for disaster. [If you] take a disgruntled patient, then rush them …you have brewed the perfect storm for further unhappiness. See them at the end of the day and always have the same staff person in the room to ensure consistency. You have to let them know you care!”
Walk into the room ready to listen and find common ground, said Dr. Niamtu.
“What I want to do first is for you to let me know what is bothering you. We’ll write a list and go over all the things and address them. I’m not happy until you’re happy. I’m going to take some pictures today and every day that you come in post-op so we can follow this.”
The documentation is paramount for the patient and surgeon, said Dr. Niamtu.
“You want to document meticulously. Although lawsuits are not common, one of the biggest problems of defense is poor documentation. The surgeon and staff need a problem list to enumerate each and every [patient concern] and update the list at each appointment.”
“You have to let the patient know you …have the situation under control and are doing something to address their problem(s). When patients feel they are not heard or nothing is being done, they can seek other opinions and you have lost control.”
If the patient is angry and verbally abusive, sit back and take a breath. Getting into a verbal battle will only escalate the situation, Dr. Niamtu said.
“The whole bottom line is listen to the patient, don’t interrupt … offer solutions.”
Thankfully, unhappy patients are rare, he said.
“But we all will have them and knowing how to react and handle the situation is a key to success in practice. It may be more difficult for younger surgeons, but following these basic tenants goes a long way.”
