Who’s Looking After Your Patient

In aesthetic medicine, we obsess about details: patient selection, choice of surgical or nonsurgical procedure, material management (best sutures, implants, garments, post-scar therapy). As trainees, we were exposed to the full range of Plastic Surgery – General, Craniofacial, Hand and Cosmetic, with a heavy emphasis in Reconstruction. My business model of solo private practice is probably unsustainable, for new graduates, however it was one, which was accessible when I finished residency and returned to Newport Beach. The focus has “morphed”, as the practice matured and opportunities presented. I started as an E.R. consultant, taking maxillofacial trauma & hand workman’s comp cases, which were second nature to a recent graduate. My schedule became more predictable when I became an HMO specialist – skin cancer, breast reduction, breast cancer reconstruction. I had always “done my best work, under pressure”, however I had a change of heart about 6 years ago and decided to emphasize quality over quantity.

I must admit that I’m not completely comfortable when patients exclaim “you’re an artist or a perfectionist”. What I have cultivated is a neurotic attention to detail and an insatiable curiosity about my craft and patients. No case is exactly the same but the process is similar in all regards: understanding the patient’s goals, agreeing on expectations, using skilled techniques, and close follow-up. Occasionally patient care takes me back to the hospital where I can “benchmark” my practice and this provides opportunities to improve as well as to be grateful to spend the majority of my time, chez moi. Armed with the knowledge of my strengths and weaknesses, I am empowered and motivated to problem solve and evolve. Once, someone told me that “change is inevitable and requires the investment of energy and the abandonment of security”. This observation has lingered and has become my prime directive.

The “leap of faith” is reciprocal for patient and surgeon; we both enter into a plan, hoping that the outcome will be satisfactory for both. Once briefed, I commit to the plan. Flanked with a highly motivated and trained staff (including our fabulous Anesthesia providers) I expect great results but have one significant variable to manage, the patient’s post-op support system. Concurrent with the trend of transferring recovery from medical procedures to the outpatient arena, the role of caretaker has mostly been assumed by family and occasionally friends; this isn’t always a formula for success. Despite the typical layman’s deficits: knowledge, ability and trust (that their loved one will progress to independence), it’s preferable to the scenario where a patient denies having any support. For our part, we provide comprehensive post-op teaching, schedule frequent visits and encourage dialogue but the “magic” occurs when a significant other rises to the challenge and becomes an agent of change in facilitating all aspects of the patient’s recovery (meds, drains, activity, bathing, resumption of Activities of Daily Living). I salute these “surrogates” and thank you for assisting the transformations.