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Analyzing, addressing patient motivation

Cosmetic Surgery Times talked to several surgeons around the United States about when they feel the decision to operate is not a simple medical or aesthetic choice, but presents ethical issues as well. How do they handle those situations?


Dr. McCafferty
We discussed requests for extreme surgery. Most of the doctors say it isn't hard to turn a patient down if the situation warrants it — and they all have criteria they follow when deciding a procedure is inappropriate.

Edward Eades, M.D., of Tucson, Ariz., says it's not usually just one issue.

"If it's a problem I can see and think might be reasonable — but if the patient's motivation is suspect, I would defer. If a patient has had multiple surgeries, has never been happy and badmouths the previous surgery — I will defer on that by saying I'm probably not good enough."

What about someone who wants to look like a famous person — or a patient who wants to acquire the look of a cat or other animal?

Dr. Eades, a surgeon for 16 years, says motivation comes into play here, too.

"I've thought about that — I've had patients request strange things and it comes down to the motivation. For example, a woman wants a facelift and gets kind of teary and it turns out it's because her husband's looking around. She wants a facelift so she can look younger because she wants to keep him. Usually that's not going to make a difference, he's going to go do what he wants to do anyway, and she'll blame me for not doing the surgery well enough to keep her husband.

"But if someone wants to look like a tiger or something like that, there's no reason they can't be just as happy as someone who has traditional plastic surgery done. If they're going to be happy, if they fit in well in society, if it's something they want, I think it's OK. I don't know that I would do something like that, but from an ethical standpoint, in general, I don't see anything wrong with that."

On the other hand, Dr. Eades recounts a case involving a young woman who had a significantly older boyfriend. She wanted her breasts removed because her boyfriend didn't like breasts.

"He seemed very controlling — something like that where an older man is controlling a younger woman who was willing to mutilate her body to please him — I just said no, it wasn't in her best interest."

Patient evaluation

In Greenbrae, Calif., Tancredi D'Amore, M.D., says ethics play a part in every patient evaluation.

"It's interesting how patients, subconsciously, don't want the procedure for themselves as much as for someone else. If that's the case, it's easy for me to let them know that surgery is not a good idea. I tell them to go spend their money a different way."

In practice for 12 years and an assistant clinical professor at the University of California, San Francisco, Dr. D'Amore says sometimes patients do come in desiring to look like a famous person.

"It's important to help them understand that it's very difficult to do because we really cannot change features that much. You realize that in the back of their minds, the patient thinks that if they resemble the famous person, they will also have the same life and we know that's not realistic.

"I tell them I'm sorry — that's not in your best interest, I can't do it. Interestingly enough, many people are actually grateful for that."


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