There are few things more awkward than a conversation with a plastic surgery client that is seeking to accomplish their ideal and you know that you cannot help them. In some cases, it might be that someone else is more qualified to do the job. In other cases, it may be managing their expectations. And then there are the cases where nothing can be reasonably done. In those impossible cases there may be health risks involved that outweigh the benefits of the procedure. Or sometimes, the procedure they want may be non-invasive but the desired result is unlikely to be accomplished this way.

Whatever the reason, if you find yourself in a situation where the client’s wants and your ability to deliver are at odds, what you are about to read will prepare you to best handle the situation.

Doctor-Patient Relationships Are Complicated and Communication Centric

“Medicine is an art whose magic and creative ability have long been recognized as residing in the interpersonal aspects of patient-physician relationship” (Source).

Finding a way to communicate effectively with your patients and potential patients is one of the most important things that you can do as a practitioner. Communication skills are rarely taught to medical students – so many doctors never have the opportunity to practice and adopt an effective communication style before they are thrown into active work. For anyone who is not a naturally gifted communicator this can pose a challenge; especially when you find yourself in a situation where effective communication is what will make the difference between a satisfied patient and a disgruntled one. This can have a real impact on your practice and its reputation through word of mouth, and on your bottom line.

In the case of elective procedures, this point is even more sharp. There may be instances when your patient is seeking a treatment that is outside the scope of what you can responsibly perform, or the results they are seeking are outside the scope of the procedure.  This can be a very delicate situation. However, there is one thing that is very important to remember- and one that all of the professional journals and associations agree on. As worded by our colleagues at the Journal of the American Osteopathic Association:

The manner in which a physician communicates information to a patient is as important as the information being communicated. Patients who understand their doctors are more likely to acknowledge health problems, understand their treatment options, modify their behavior accordingly, and follow their medication schedules. In fact, research has shown that effective patient-physician communication can improve a patient’s health as quantifiably as many drugs—perhaps providing a partial explanation for the powerful placebo effect seen in clinical trials… From obtaining the patient’s medical history to conveying a treatment plan, the physician’s relationship with his patient is built on effective communication. In these encounters, both verbal and nonverbal forms of communication constitute this essential feature of medical practice. Although much of the communication in these interactions necessarily involves information-sharing about diagnosis and therapy options, most physicians will recognize that these encounters also involve the patient’s search for a psychosocial healing “connexion,” or therapeutic relationship.

This signals how important it is to effectively communicate with any patient, but communicating with those that are desiring something you are unable to deliver is much more complicated.

Empathetic Communications

“The patient will never care how much you know, until they know how much you care.” – Terry Canale in his American Academy of Orthopaedic Surgeons Vice Presidential Address (Source).

When you are facing a patient who wants results that you can’t provide, one of the most important things that you can do to maintain a good relationship is display empathy. Take a moment and think about what it feels like to be in their shoes. They are unhappy with something about their body and they came to you to solve the problem. They are hopeful, potentially embarrassed, and anticipate that you hold the key to their life becoming better in some way. Your approach can either leave them feeling dismissed or leave them feeling positive and valuing their relationship with you. That relationship, built on communication, will help them trust you to advise them on the best course of action.

True empathy is based on what researchers refer to as “embodied” cognition. It is based on paying attention to and learning as much from clients as we expect them to pay attention to and learn from us. Literature and the conventional wisdom are filled with examples of the relationship between empathy, learning, and role models. Adages that caution us to walk in another’s shoes or beware throwing stones remind us that comments which result from a lack of empathy gain us little respect from others. Other sayings remind us to lead by example, to instill in others the wherewithal to carry on in our absence. (Source).

Saying No And Leaving Them Happy

So, you have the patient in for a consult. They explain what they want and you know that you cannot deliver. You know that effective communication is going to make the difference here, and that you have to show empathy (empathetic communication). But how do you actually pull this conversation off? How do you say no, but leave them happy with you?

Taking a book from the business world, there are a few key components that you can work into your conversation when you have to say no. These include (Source):

• Using positive language, and ending on a positive note.
• Find the closest alternative that is accomplishable and talk about that.
• Provide an individualized explaination – make it about them.
• Don’t let them convince you to do something you know isn’t right.

For more on developing soft skills, attend the sessions at SCALE 2019 Music City where we are focusing on them. We look forward to seeing you in May.