S05E83 - The 'Difficult' Patient - Effective Patient Communication in Plastic Surgery

Ever grappled with the dilemma of how to steer through the stormy seas of patient interaction, especially in the intricate world of cosmetic plastic surgery? This is precisely the challenge that hosts Dr. Sam Jejurikar @samjejurikar, Dr. Salvatore Pacella @sandiegoplasticsurgeon, Dr. Lawrence Tong @yorkvilleplasticsurgery, and Dr. Sam Rhee @bergencosmetic unravel as they join us to share their treasure trove of insights on fostering productive, empathetic, and crystal-clear communication with patients.

Their combined expertise sheds light on the essential role of setting realistic expectations and the fine art of balancing professional judgment with the emotional currents that run through each patient care decision.

Navigating the relationship currents between plastic surgeons and their patients is an art form, one that our distinguished guests have mastered over their illustrious careers. They recount the emotional weight that complications carry for surgeons and the evolution of their patient communication strategies.

By probing the depths of patient motivations and wielding the power of trust, they demonstrate how understanding can lead to more satisfactory outcomes. Their experiences serve as a compass to guide fellow professionals towards a harmonious surgeon-patient relationship.

Concluding our voyage, we regard the ethical challenges that emerge when patient requests sail into murky waters. Upholding ethical practice against the winds of patient dissatisfaction, our co-hosts chart the course for declining requests with firmness and without emotional turbulence.

As we anchor our discussion, the shared experiences of our guests inspire a brighter horizon for patient relations, echoing with camaraderie and a collective hope for calmer interactions with patients in the future. Join us for a journey of reflection, connection, and professional growth in the ever-evolving landscape of plastic surgery.

@3plasticsurgerypodcast #podcast #plasticsurgery #cosmeticsurgery #plasticsurgeon #beauty #boardcertified #aesthetic 3plasticsurgeonsandamicrophone ⁠#bergencosmetic ⁠#bestplasticsurgeon #beforeafter #aesthetics #realpatientrealresult #boardcertifiedplasticsurgeon #njplasticsurgeon #njplasticsurgery #nyplasticsurgeon #nyplasticsurgery

S05E83 - The 'Difficult' Patient - Effective Patient Communication in Plastic Surgery

TRANSCRIPT

[00:00:00]

Dr. Sam Rhee: Welcome everyone to another episode of Three Plastic Surgeons in a Fourth. My fellow co hosts, uh, as always, it's, uh, Dr. Lawrence Tong from Toronto, Canada, Dr. Salvatore Pacella from San Diego, California, and Dr. Sam Jejurikar from Dallas, Texas. And today our topic, uh, is a very interesting one.

It's one where, uh, Um, I know that none of us have difficult patients. We never, all of our patients are perfect. They are the best patients that we've ever seen, but if you know someone who might be, you know, a physician or maybe a friend who might qualify as, you know, a difficult patient, um, There are, uh, there was a great article in Doximity where they talked about five pool, uh, foolproof strategies for dealing with difficult patients.

And this is [00:01:00] something that even if a patient isn't necessarily difficult, it's really about communication between, say, a surgeon and a patient. And so let's delve, let's delve into what those things that they suggest might be and whether they can help, uh, patients. whether they can help doctors communicate better, uh, for all of their interactions.

But before we begin, let's, uh, start with this is, sorry, the, the disclaimer, please.

Dr. Lawrence Tong: Alright, uh, this show is not a substitute for professional medical advice, diagnosis, or treatment. This show is for information purposes only. Treatment and results may vary based upon the circumstances, situation, and medical judgment after appropriate discussion. Always seek the advice of your surgeon or other qualified health professional with any questions you may have regarding medical care.

Never disregard professional medical advice or delay seeking advice because of something on this show.

Dr. Sam Rhee: very much. Now, I, I was kind of being facetious when I said none of us have difficult patients. I mean, pe patients [00:02:00] are people and there are all sorts of different people out there. So, um, what would you say? Let's talk a little bit about your own experience with difficult patients, uh, and how you might sort of identify them or manage them, um, over the years that you've been a plastic surgeon.

Uh, Sam, do you want to start?

Dr. Sam Jejurikar: Yeah. Uh, you know, I think, you know, first of all, I think when we use the term, uh, difficult patients, you know, that, that already sort of sounds a little bit prejudicial, right? You know, generally when, as surgeons, we have interactions occasionally with patients that become difficult, but it's been, but usually there's, there's been, you know, an outcome that doesn't match what it was that they wanted, um, or they've had a complication that wasn't foreseen or the recovery was different.

There's usually. Something that didn't go in the way that the patient was expecting, that is usually the impetus for this, um, [00:03:00] breakdown in communication between the surgeon and, you know, and the patient. And patients are human beings, surgeons are human beings, you know, we all have emotions that we bring to this, which can sometimes cause, you know, These things to break apart.

And so, you know, I think, um, when, when I have a patient that's upset, um, I feel like I'm a lot better at listening to what, what it is that they're upset about now than I might've been 10 or 15 years ago. Um, when I try to remind myself that maybe it's not meant to be a personal affront, it's not meant to be a personal, you know, personal, a personal, uh, insult towards me.

They're, they're just trying to. To, um, you know, voice their own, they want to be heard in a way that, that, um, that's productive, that may or may not be productive, but it's my job as a surgeon to try to make sure I hear what the underlying root causes are, let them understand that I understand where they're coming from and what's, you know, what's wrong with them, and then see if we can come up with productive solutions.[00:04:00]

Dr. Salvatore Pacella: know, I kind of, uh, I kind of separate this in my mind into three different categories of patients, I would say. Um, you know, um, the first, the first category are people that I meet that I know at the end of our consultation that it's not a good fit for me to be their surgeon. I, I can't provide them the best expectation that they're looking for.

And in my mind, that's, that's easy because it's just, you know, we just part ways. We, there's no. There's no, uh, there's no animosity. However, I will say that, you know, over the years I've gotten a handful of bad reviews and 90 percent of them were from people that I didn't operate on, that I told no for surgery, right?

So I think it, it tells a lot when you do a bad review on somebody when you haven't even touched them, you know? Um, so it's probably somebody I, I would, you know, in retrospect, still not operate on, right? Um, the second group of patients. are patients that have an, you know, an [00:05:00] unsuccessful or unfortunate outcome or complication.

And to me, I'm always surprised at how well patients are able to take that complication. And I think a lot of that has to do with the fact that, you know, we spend a lot of time in the informed consent process. I have great nurses and great staff that set expectations. And, you know, I, I was always told by my mentors, which was great, which was a great, bit of teaching that if, if somebody has a complication, you see them until they're tired of seeing you.

Okay, and you know, I want them to know that I'm very attentive to their complications. And I would say a good majority of those patients really are understanding. They're sort of, you know, are able to deal with the ramifications of the complication and kind of stick with me through the process. of attempting and fixing the complication, right?

And then there's a group of patients which are completely unpredictable. And, you know, if you look at a graph of grafting [00:06:00] the, the complication versus the perceived reaction, you know, that's, that's sort of, you would think that would be a linear, linear graph, but it's actually all over the place. And, and I always really take, um, I, I'm, I'm on alert when I have a patient that Exceptionally, um, praises me for my surgical skill, okay, because a lot of times patients will come in after their operation six months, a year later, and they'll say, Dr.

Pacella, you are just a godsend. Your hands should be blessed, and it's just amazing. I'm so happy that you came into my life, and I thank them, and I really appreciate it, but I, I, in a good group of those patients, the other foot has dropped very quickly, and, um, Those patients have focused on a small scar, a small untoward outcome, a small asymmetry, a small lid malposition, and they, they can turn very, very quickly.

And the, and the problem is, is I'm not really able to, to tease out who those patients are going to be ahead of time. [00:07:00] So, um,

Dr. Sam Jejurikar: think many of those patients are probably the same people that when they come see you for a consultation, are the people that will spend time bad mouthing another provider. You know, um,

Dr. Salvatore Pacella: right, which is a huge red flag for me, because I, I would, I would, it's very rare that I would operate on somebody that, That actually does that to me, you know, or that mentions that in the consultation. You know, that's a huge, huge red flag for me.

Dr. Lawrence Tong: Yeah, I think that cosmetic surgery is one of the unique situations where, um,

Dr. Sam Rhee: You

Dr. Lawrence Tong: know it's, it's okay to reject the patient. So part of managing the difficult patient is to identify the patient, first of all, and if You as a surgeon don't feel comfortable or don't think that you're going to get a good outcome, no matter how good the surgical result is, then I think it's important, um, you know, to, to tell the patient that

Dr. Sam Rhee: you,

Dr. Lawrence Tong: Like what you both said, um, it's not going to be a good fit, and it's not going to work [00:08:00] out.

And to Sal's point, um, when somebody does have a complication, um, they have to know that it's going to happen, um, at some point. Some, if you operate enough, you're going to get complications. And it's not the issue that you've had a complication, it's how you handle it afterwards. And so.

Dr. Sam Rhee: you don't need it.

Dr. Lawrence Tong: You know, seeing the patient very often, reassuring them, doing the right thing is going to be the best way to manage those situations.

Dr. Salvatore Pacella: Like Samir, what did, what did Bill Kuzan teach you about being board certified in plastic surgery and complications? No,

Dr. Sam Jejurikar: in plastic

Dr. Salvatore Pacella: no, no. Come on. Do the voice. Do the voice.

Dr. Sam Jejurikar: Being board certified in plastic surgery makes you qualified to make mistakes in plastic surgery. Um Bleh. Meeting that we shouldn't dabble outside of what it is that we do, but, but, you know, I think what you guys are saying about how to manage complications are [00:09:00] 100 percent correct. When you have a complication, it is a huge privilege to operate on people.

And we have to, as part of that privilege, it's our responsibility to get them through, through the, you know, through any sort of consequences that were not anticipated or foreseen. It's just that sometimes. Every now and then, maybe once every couple of years, patients take that complication and they make it as though you did something wrong.

And that's when, in my mind, they become a difficult patient. I don't view a complication as something that necessarily makes someone a difficult patient. It's the reaction and the, and when the relationship between the physician and the patient can break down.

Dr. Salvatore Pacella: Right. Um, you know, for the,

Dr. Sam Rhee: you, go ahead. I

Dr. Salvatore Pacella: um, you know, for the patients out there, I think, um, that are listening here, I, I think it's important to articulate something very clearly. Um, Complications are something that we absolutely, 100 [00:10:00] percent dread as surgeons. If you don't care about your complications, you probably shouldn't be operating.

You probably shouldn't be caring for people. So, the last thing we ever approach is a cavalier attitude toward complications. In fact, when I get a complication, It's something that absolutely keeps me up at night and more importantly, wakes me up in the middle of the night that I can't get back to sleep.

So, I mean, this, this, these kinds of things just fester in your mind as a surgeon constantly. And, you know, you, it's like the old, uh, you know, ABC world of sports on Saturday afternoons when I was a kid. It's the surgery is all about the thrill of victory and the agony of defeat. And it goes back and forth every minute, you know?

So it is, it is a, it is something that gnaws away at us. Yep.

Dr. Sam Rhee: a couple things stand out for me. One is, as we get older, we get more experience with both successes and our failures or our [00:11:00] mistakes. And we don't want mistakes anymore. We, we've gone through all that. We, we are very. I think all of us are much more careful in terms of evaluating patients.

And if we don't feel like either we're going to get the right result for the patient or the result that the patient is really looking for, um, as Sam said, we're, we're going to, uh, Sam and Sal said, we're going to pass on that patient because what we're really looking for is to minimize our risk in terms of, as you said, a negative outcome or consequence, regardless of whether it's technical or just not meeting the patient's.

Ideas and goals. I'm so much more selective now than I ever have been. And I think most surgeons, as they become more experienced, do that. The second thing is, is a lot of this is about evaluating a patient. And like you said, being compatible, um, different surgeons have different personalities, as you mentioned, different styles, [00:12:00] and I want patients who.

are compatible with me. And if I feel like they're not, then I might, then the communication will be tough sometimes. And I've seen it where I've had issues in, in certain, uh, cases in the past. And if the patient trusted me, I knew no matter what happened, I could get them. I could get them. No worries. Um, I knew I could get them to our goal.

regardless of what happens, okay? If someone has no trust in me, you know, suspects everything that I'm doing is, is, uh, has, uh, is very suspicious, I know no matter what, even if it is a really great outcome, they're not going to necessarily be happy. So for me, a lot of it is about communication and trust.

And it's, and when we talk about difficult patients, I would say it's about, Communication and developing the right level of trust [00:13:00] and relationship with a patient. And I think all of us care about our patients. We want awesome results and, and we're savvy enough now to get them. We know we need to avoid risks and risks include making sure that the patient is a right fit for us.

And, and I think that's the same for, um, for patients choosing surgeons. So let me go through the first, uh, advice that they give in this article, and I'd like to hear what you guys have to say about it. The first one is, talk, uh, sorry, listen more, talk less, and they say, everyone likes to talk about themselves, but the simple act of active listening with thoughtful follow up questions will help you get off on the right foot with most folks.

How do you feel about that?

Dr. Sam Jejurikar: Makes sense. Every patient wants to feel like they're heard, you know, that their concerns are being heard. I think that makes complete sense.

Dr. Lawrence Tong: And that's especially true if, um, if a patient is unhappy about something. [00:14:00] Sometimes they just want to, you know, say their mind. And a lot of times it just, uh, You know, diffuses a lot of things and if you take the time to listen and not try to, you know, cut in and interject, that makes a big difference. So, I think that's a great suggestion.

Dr. Salvatore Pacella: Yeah. I mean, I, I think, uh, you know, what I try to do is I try to approach the consultation very open ended. You know, what, what can I help you with? Tell me a little bit about what's going on with you, you know? Um, and then I try to avoid for at least several minutes interrupting them and just letting them, you know, say what they're concerned about.

Dr. Sam Rhee: I think sometimes it also means digging into certain things. So, if I have a patient, say, who comes in and says, I want 650 cc implants. Instead of just doing it, it's a lot of it is like digging. Like, why, why do you feel like that's something that you want? And they might say, well, my sister has 650 CC [00:15:00] implants and that's exactly why I want them.

I want exactly what my sister has. And then you sort of dig into, well, and you don't want to be a psychiatrist, but you also have to be like, okay, so what's your sister like? How does she look? What's your relationship with her? Like, what, what's going on here? And sometimes you have to ask those follow up questions and listen carefully in order to sort of dig into what the motivation for a patient is and what do you think will actually make her happy.

Because if you just throw 650 cc implants in there, I bet you, you know, there's a A lot of times they're just, they won't want that result.

Dr. Lawrence Tong: And, and for our listeners,

Dr. Sam Jejurikar: so, uh, I'm so confused by this example because everything is bigger in Texas.

Dr. Lawrence Tong: that's what I was going to say. I was going to say, I was going to

Dr. Sam Jejurikar: like, I would say, you know they go all the way up to 800, don't you?

Dr. Lawrence Tong: yeah, for our listeners, 650 CCs. Is, is a large site. Maybe not in Texas. Actually, [00:16:00] come to think of it, maybe not in New Jersey either.

Dr. Salvatore Pacella: Everything

is bigger in Texas, except your, It's, it's bigger in Canada.

income state tax bill.

Dr. Sam Jejurikar: Yeah, jealous of that, aren't you? Yeah.

Dr. Lawrence Tong: Well, come up to Canada, you'll see.

Dr. Sam Jejurikar: Yeah. But it's no state income tax in Texas, y'all. It's pretty good. Um, yeah, but I know what you're saying, though. What Sam is saying, and it makes complete sense, is you want to understand the motivation behind things. Is, are people motivated? Because that's genuinely something they want, or are there external pressures that are making them do things?

Are there social situations that potentially might make them want to do things that we don't perceive to be in their best interest? And trying to understand that root cause motivation versus I just aesthetically like really big implants. You know, it was important to make sure, um, You give people what they actually want, and then you actually have the ability to make them happy, too.

So that makes sense.[00:17:00]

Dr. Sam Rhee: Um, the next thing they said, I mean, we already covered be curious, which is what we just talked about, is find something you like about the patient. So let me ask you this. If, if you find the patient annoying or you sort of don't really click with them, Are they still someone you choose to be your patient, or is that sort of a red flag and you're like, I don't really like this person, so I'm not going to operate on them?

Dr. Lawrence Tong: It depends, it depends on how annoying. They are because if they're, if they're really not, you know, not jiving with you and rubbing you the wrong way, then there's nothing that's going to work. But what I find is that initially, if somebody puts you off a little bit, if you, if you actually talk to them a little bit more and find something in common or, um, you know, just figure out what their motivation is, a lot of times it turns out.

It turns out to be fine.

Dr. Salvatore Pacella: Yeah. I mean, I, I, I think a couple things. I mean, it depends on the [00:18:00] gravity of the situation. I obviously do a bit of reconstructive surgery, so, you know, I, I oftentimes give patients the benefit of the doubt in that discipline because You know, I'm there to help them, right? It's not an elective or cosmetic procedure.

So the bar for cosmetic surgery is is much higher in my opinion But but I would say, you know, the me not liking the patient or being annoying or whatever Is is not enough for me to not take them on as a patient But that annoyance or dissatisfaction or not gelling of the personality has to significantly in my opinion inhibit the communication And so, you know, for example, I I may not You know, like somebody because, I don't know, maybe you have different political views, okay?

But that's, that's not, that's not involved with the direct communication of me being their doctor, right? But if it's something like, you know, you're, you're explaining a process to a patient and you, you've probably all had these patients that, you know, some, [00:19:00] some people just kind of sit there and say, yeah, yeah, yeah, yeah, yeah.

When you're telling them something, which tells you that they're not listening. Right. And then, you know, I, it's that kind of thing is, is really, that kind of thing is really, really challenging to deal with as a physician, because you know, that they're not, you're explaining to the best of your ability.

And they're just. Completely toning you out, you know? Yeah.

Yeah. answer Sam's original question. I think I think the interactions are a mirror in some sense. You know, if if if I'm finding something in that interaction with the patient to be unpleasant, They're probably finding something in the interaction with me to be unpleasant as well, and, um, unlike, um, unlike Sal, um, the, the, the other three of us do pretty much 100 percent aesthetic surgery, and so there's a selection process happening in both ways.

Dr. Sam Jejurikar: I also recognize that as a human being, sometimes I bring baggage to the interactions, you know, sometimes I have [00:20:00] to say that if I'm finding the patient, something in the patient to not be to my liking, it's always distinctly possible that it's me, that's the problem, but I'm very much open to that possibility, so if the initial interaction seems a little strained or a little awkward, much like what Larry was saying, you know, I really try to make it better and see what I can do to improve that interaction because I want to make sure it's not me that's causing that and many times, you know, almost every time.

In fact, when the interaction doesn't, from my end, doesn't seem to have gone very well. The patient generally doesn't select me to be their surgeon.

Dr. Sam Rhee: Uh, what would you say about, and this has given me pause, this happened, I don't know, maybe last year or the year before, where a patient said to me, you know what, Dr. Rhee, I, uh, I chose you because, you know, I know you Asians are just so meticulous and careful with everything, so that's why I want, I want you as my plastic surgeon.

And I

Dr. Sam Jejurikar: you actually are,

Dr. Lawrence Tong: Well, that's, yeah, that's

Dr. Sam Jejurikar: Yeah, yeah, [00:21:00] yeah,

Dr. Salvatore Pacella: a, that's not a stereotype. That's a fact.

Dr. Sam Jejurikar: yeah, what, what's

Dr. Lawrence Tong: Asians are very meticulous and very exacting and excellent at calculus,

Dr. Sam Rhee: So,

Dr. Sam Jejurikar: like,

Dr. Sam Rhee: so, I mean, I was like, uh, thanks, but like, I don't know if bringing a bunch of stereotypes to your consultation is really that awesome. So, I mean, you know,

Dr. Salvatore Pacella: Right. But is that an insult?

Dr. Sam Jejurikar: making stereotypes about 650cc implants, literally,

Dr. Salvatore Pacella: right. Right. But Sam, is that, is that a prejudice? Is that a prejudice? If it, if it's a compliment to you, like that's a compliment, right? I mean,

Dr. Sam Rhee: what if they're like, alright, you be my surgeon, just don't be my Uber driver, because I know you guys can't drive worth crap. So, like, I mean, where does that go? Like, right? So, I'm not sure if that's a plus, if they give you that kind of backhanded compliment like that, okay? So, [00:22:00] uh, I mean, I've had, I've had my staff say, listen, that, that woman's perfume is horrendous.

Like, it is so bad, I don't know, and And her nails are terrible, and she's just dirty, And so, please, don't, don't, don't do what she wants you to do. Stuff like that. Like, really odd, minor things sometimes. Like, does that, does that effect what you choose?

Dr. Salvatore Pacella: Absolutely. I mean, and you know, not infrequently when we have, sometimes we have patients that are actually, you know, completely super sweet to me in the consultation. They are just like, Cooperative and great. They're ideal patient, right? And then the interaction with the staff is just absolutely horrific and and that you know from on the phone to the front office people to the nursing staff And and you know, that's also a red flag.

It's like, you know, it's just uh, you know, it's duplicitous

Dr. Sam Jejurikar: Big

Dr. Lawrence Tong: I agree.

Dr. Sam Jejurikar: Yeah, but, [00:23:00] but uh, for our listeners, Dr. Rhee really is very meticulous.

Dr. Sam Rhee: An

Dr. Sam Jejurikar: he happens to be Asian, but those two things are not related.

Dr. Sam Rhee: and I'm not a good dri I'm not a great driver either, so all of that, all of that is true. Uh, so, unfortunately I fit the stereotype. Um, uh, some of the stereotype,

Dr. Salvatore Pacella: Just just take public transportation it's so good

Dr. Sam Rhee: Okay, the next thing that they mention is, um, practice proactive self awareness and widen the gap. We can't control the feelings or thoughts that pop into our head, but we can control how we respond. Sometimes the most powerful way, uh, to control our thoughts and feelings about challenging patients is just to be aware of them, um, and Remember, I might get frustrated, but I also know how to control those emotions, uh, by let instead of letting them control me. So, how do you guys feel about that?

Dr. Lawrence Tong: Yeah, that's true. Sometimes, sometimes you get. Patients who, like, [00:24:00] especially when you were, um, early in your career that sort of trigger you, uh, they'll be like, Oh, doctor so and so knows how to do it. Why don't you know how to do it like that? Something like that. And then you just have to take a step back and just say, okay, well, I don't do it this way because this, you know, X, Y, and Z.

And you have to, if you're getting emotional about it, that's generally not a good thing. So you have to be aware that, uh, if you're getting, you know, personally involved in, and, um, feeling like. You know, there's insults going around and you're taking it personally. That's, that's not a good sign. You just, just have to be aware to, you know, lay off.

Dr. Salvatore Pacella: said than done, you know, this is a very You know, part of being a surgeon is our personality, right? So it's, it's uh, I think it's challenging to emotionally divorce yourself from these kind of things. Sometimes you just have to really kind of bite the bullet, nod, and take a step back, you know.

Dr. Sam Jejurikar: you know, it's, it's interesting cause, cause I know all [00:25:00] three of you guys very well, and I think we have very similar personalities. And Pacella, you may have had a similar thing like this when you were in business school, but when I was getting my MBA, we had to take a bunch of personality tests to try to figure out like what our strengths and our weaknesses were.

And one of the things that came out was on a scale of one to 100, uh, looking at patients where like 100 is like Gandhi and one is like Genghis Khan. I got a two.

Dr. Sam Rhee: Ha ha!

Dr. Sam Jejurikar: study said you are exceptionally impatient, like multiple standard deviations beyond, you know, beyond the, uh, from the mean.

And you need to be aware of that. Like, you can't really change the way that you react or you feel about things. But you can change the way that you come across to others in the way that you control your emotions. And that was a huge light bulb moment for me because I realized that almost every time that I get impatient with something that's actually [00:26:00] happening or with an interaction, it's probably me that's bringing the baggage to it and less so the other person that's actually doing it.

And that has changed the way I interact with other human beings considerably. I think I. actively practice breathing methods to try to allow me to be measured in my responses. It's reflexive at this point. You know, I do meditation like J. J. McCarthy all the time now to try to control those things because ultimately, um, I think we bring a lot of baggage to the interactions with the patients because we're surgeons that are used to making split second decisions.

We do big cases and, and ultimately sometimes we have a lot of things we need to do. So I think when we're

Dr. Salvatore Pacella: when, what about when you're rounding and you're,

Dr. Sam Jejurikar: Rheed!

Dr. Salvatore Pacella: your intern is not talking fast enough to give you the [00:27:00] Read!

Dr. Sam Jejurikar: we had like 40 patients on a vascular surgery service and they just wanted to joke around the whole time. Like But, yes, I have now realized that the problem was me, not you guys.

See, isn't that an eye opener? I apologize to you, and to Trussler, all these years later. I am sorry. Like, I hope you accept my apology.

Dr. Sam Rhee: You know, Sam, I would say that that's the biggest change I've seen about you over the years, is you are such an exceptionally quick and smart person, you never suffered fools, gladly, like, anything that was really dumb or stupid earned your contempt, like, right away, but now, and I've traveled with you, I've seen you interact with tons of people, when you interact with me, Like, you have so much more zen, and the things you say are so much nicer.

I'm always like, I'm always like, who is this person? Like, this is not the Sam Jejurikar that I knew 10 or 15 or 20 years ago. Like, you've [00:28:00] really, you've, you've legitimately changed in such a positive way, and it's rare, it's very, very impressive. Let me just

Dr. Salvatore Pacella: What, what is that phrase you used to describe him? You, fools what?

Dr. Sam Rhee: He never suffered, uh, fools, uh, gladly.

Like, he would just, if you were a dumb,

Dr. Salvatore Pacella: know what that means. That's amazing.

Dr. Sam Rhee: yeah,

Dr. Sam Jejurikar: Well, it definitely describes you as well, Dr. Pacella, that's for sure. Yeah,

Dr. Sam Rhee: idiot, you got no patience for them. Let's just put it that way. Like, and I think most of us as surgeons, like we, we find that to be the case. And that's how sort of we were trained, but I will say this, I will have patients who, and, and this speaks to after, right?

So maybe you've operated on somebody. So you're already wedded to them. You're, you're, you're connected to the patient and I've had patients say you suck, or your results were horrible. Or, you know, I never should have gone to you. And you're right. It's very insulting. It's hurtful. But at the end of the day, I just look at it [00:29:00] as, let me, what is it that, why are they saying this?

What is it that I did or what can I do to make it, to, to address the, the point of issue? And so, and most of the time, if I find whatever that issue is and say, listen, let's take a step back. What is it that, like, I. that I can do here in this situation to help this get better. A lot of times the patient will be like, all right, I was really emotional.

I'm really sorry. Um, let's, let's take care of the problem. And, and, and I can get them to generally not always, but Many times to a place where we get out of that emotional situation and they get to a place where they're, where they're happy about it.

Dr. Sam Jejurikar: makes sense.

Dr. Sam Rhee: let's, uh, let's talk about the last one. Plainly state that you disagree.

So, at the end of the day, even if you practice all of these techniques, there will be times where you have to decline a [00:30:00] patient request or demand. That's inevitable. Um, they give an example about, um, I need a six month supply of my Adderall, or I'm not going to complete these drug screens, but I want my Suboxone prescription.

Oh my God, these are horrible examples. Um, so, I thank God we don't have to deal with that, generally speaking. So, so how is

Dr. Salvatore Pacella: want to be off, I want to be on disability for five months,

Dr. Sam Rhee: Yeah, exactly. That's something that's very common. So, so in those situations, how do you talk to patients in terms of disagreeing with them and, and telling them something that they may not want to hear?

Dr. Salvatore Pacella: I try to, I try to blame the California Board of Medicine.

Dr. Lawrence Tong: Ha

Dr. Salvatore Pacella: California Board of Medicine does not allow me to do that, I'm sorry.

Dr. Sam Jejurikar: ha!

Dr. Salvatore Pacella: Which is not, which is not, it's, it's not lying, actually. The, you know, there is, uh, there are several investigations into surgeons and physicians signing. You know, falsified documents for extended disability [00:31:00] time and, you know, extra narcotics, things like that.

So there is some truth to that.

Dr. Lawrence Tong: Well, you know, if somebody wants, wants you to fill out some form or something like that, say, you know, they need a, like a handicap sticker or, you know, something like that, you just tell them it's not appropriate. And then, usually, if you just say it plainly and firmly, don't say it with emotion, because that's, you know, that you don't fall into the category to, um. know, to, to get one of those or to get whatever you want. I think usually they'll be, they'll be fine with it. Sometimes as a cosmetic surgeon, you feel like you're there to, you know, provide service and you try to do the best job you can. Maybe you're worried that, you know, they're going to leave you a bad review if you, if you don't do what they want.

But, you know, if you're right about something, you just have to stay on your ground and not You know, not say, not state it, um, in a way that's too [00:32:00] harsh, but just state it as the thing says plainly, and I, I'm fine that, you know, patients generally will respond to that.

Dr. Salvatore Pacella: I had a, I had a patient one time who wanted me to sign medical certification that his pit bull was a service dog

Dr. Lawrence Tong: Ha ha ha ha!

Dr. Salvatore Pacella: the surgery he had.

Dr. Lawrence Tong: Mm,

Dr. Salvatore Pacella: And I'm like, I, this is completely out of my area of expertise. I'm not a veterinarian. I have no idea what this dog is, you know, and, uh, that came out in a review online.

Dr. Sam Rhee: Oh, wow.

Dr. Salvatore Pacella: yeah,

Dr. Sam Jejurikar: yeah. No, I've, I've had maybe not that specific example, but similar examples of things like that that ultimately come out in a review. But I think the thing is, we have to do what we believe is right. We have to do what we believe is ethical and not live in constant fear of a perpetual bad review.

Because if you're a busy surgeon, which we all are busy surgeons, I think if we have [00:33:00] 99 percent happy patients and 1 percent that are upset with us for some reason, that 1 percent is going to go running to Google and that 99 percent will probably not do it unless they're prompted to. And that's just the reality of the world.

You know, there's some of our favorite establishments that we go to, whether they're restaurants or hotels, they have 4. 8, 4. 9 reviews, you know, and that's just, that's, you know, you, you ultimately have to do what you believe is right and what is ethical. Yeah, you can't make a pit bull a service animal if you don't believe that that's the right thing to do.

Dr. Sam Rhee: Very good. Any other thoughts about, uh, difficult patients? Uh, anything else that you want to sum up with, uh, before we go?

Dr. Sam Jejurikar: I think this is great.

Dr. Sam Rhee: Yeah.

Dr. Lawrence Tong: Good discussion.

Dr. Sam Rhee: yeah. I wish, uh, I wish we had fewer challenging patients, but, um, and I think as cosmetic surgeons, we've really gotten better at, uh, Um, I mean, like you said, when we look at the people we trained with and how we deal with patients, totally, totally different [00:34:00] levels of, uh, communication, understanding, empathy, and, uh, I think all of us have probably become more empathetic, uh, with our patients as we've become more experienced with, with stuff, um, and we're, we're a little better at sort of navigating the pitfalls of fi like, um, Like Sal says, you can't find everyone who might end up becoming a challenging patient, but I think we've gotten a lot better with that. All

Dr. Lawrence Tong: Well said. Let's end this and sing Kumbaya.

Dr. Sam Rhee: I love that. Very good. All right, guys. Thank you so much. And, uh, until next time.