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Gal pals: Multi-patient consultations: When three's a crowd in the exam room, it's a fine line between friends lending moral support and derailing critical communication

Article-Gal pals: Multi-patient consultations: When three's a crowd in the exam room, it's a fine line between friends lending moral support and derailing critical communication

Dr. Watts
Fueled by the media and the variety of surgical procedures, interest in cosmetic surgery over the last decade has continued to grow at an astronomical rate. Television shows such as "Dr. 90210," "Extreme Makeover," and "The Swan," have helped make cosmetic surgery more mainstream than ever before.

In addition, the Internet provides the latest information on practically any cosmetic procedure that exists, although accuracy may be in question at times. Advertising via infomercials, print, radio and seminars are abundant as well.

This massive media impact on American society influenced 1.5 million cosmetic procedures in 2005. It can be safely assumed that the majority of patients initially saw their cosmetic surgeons for an individual consultation; however, a clear trend has developed that brings friends or family members together for joint consultations. While the overall numbers representing this trend are not yet available, anecdotally, more and more cosmetic surgeons are beginning to see this multi-patient trend on a routine basis.

The majority of joint or dual consultations in my practice arise from the desire among friends to provide moral support for each other. Going to a cosmetic surgeon can be stressful for a patient and having a friend there for support offers calm and comfort, thus enhancing one's experience. Dual consultations also provide a second set of ears to hear the main teaching points of the consultation. In the case of a breast augmentation, friends or family can assist each other in sizing the implants so that the best choice is made. In most cases, patients have had endless discussions concerning the size and look they would like to achieve. One patient may not be able to visualize or verbalize this well, and the friend may be able to understand and express the patient's desires more effectively. In these situations, it is truly helpful to the surgeon so that patients receive the results they desire. To take the benefits of dual consultations one step further, I have found that it is also commonplace for the two patients to schedule surgery on the same day, thereby offering even more support in the way of shared experiences.

Despite the benefits, multiple consultations aren't always without their challenges. A specific example I can offer is a time I had three patients come to me together for a consultation, all seeking breast reductions. Before I entered the consultation room, the conversation was so loud that it seemed as though I was at a party. When I entered the room, they all immediately began to bombard me with multiple questions and comments such that it was extremely difficult to discern who was asking what. One wanted to know what breast size she would have following the surgery; another asked why the breast scars shown in the photo album were so long. The third person was asking me to evaluate her for an abdominoplasty along with her breast reduction. As I attempted to answer one question, the next person would request an answer to a different question. All of this occurred prior to me having an opportunity to review their histories and perform an examination. Then they began to argue with each other about the specifics of procedures such as liposuction of the thighs and the pros and cons of an abdominoplasty. The conversation quickly lost its focus and the multi-person consultation deteriorated rapidly. In an attempt to restore order and to be able to conduct a meaningful consultation, I made the decision to place each of these patients in separate examination rooms. Then I was able to proceed in an orderly fashion, reviewing their histories, performing appropriate examinations, answering each of their questions, and explaining the important medical risks associated with each of the anticipated procedures.

This example illustrates the serious drawbacks multiple simultaneous consultations can have. Cosmetic surgeons can easily become distracted and miss important medical caveats that are crucial to a successful outcome. A patient who is shy and less outgoing may easily be overshadowed by a more aggressive friend such that she may not fully understand the procedure and the inherent risks associated with it. A shy patient may be talked into procedures that she doesn't really want, or talked out of a procedure in which she initially had an interest.

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