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How to recognize and avoid nightmare patients

Article-How to recognize and avoid nightmare patients

Difficult cosmetic surgery patients are usually one of four types, according to Brenton Koch, M.D., a facial plastic and reconstructive surgeon in West Des Moines, Iowa. Dr. Koch, who wrote the book "Raving Patients!,” presented on the topic of nightmare patients yesterday during the Vegas Cosmetic Surgery and Aesthetic Dermatology 2016 meeting in Las Vegas.

When it comes to defining those difficult patients, “Some are angry,” Dr. Koch says. And, usually, that has nothing to do with you, but is projected at you because you are something they think they can control when they can't control what's truly hurting them, Dr. Koch tells Cosmetic Surgery Times.

There are also uninformed patients. Their questions seem never-ending, and sometimes they realize they don’t know why they’re consulting with a cosmetic surgeon. Or they have gotten all their "information" from the Internet or a chat site.

“People should be reminded of the obvious selection bias going on with internet discussions and information,” Dr. Koch says.

Unrealistic patients wonder why their eyes are swollen one week after surgery. These patients, according to Dr. Koch, need education and are often most helped most by illustration, demonstration and information.

Finally, there are those patients with underlying psychological disorders, including body dysmorphic disorder, borderline personality disorder, codependency issues and depression.

Dr. Koch offered these tips for dealing with difficult patients:

  1. Identify the type of patient and what's going on early in your interaction. Be specific with questions about why they’re consulting with you. Separate yourself from the interaction and evaluate that patient from a third-party perspective to identify underlying issues. It can be difficult for practitioners not to take comments and reactions from these patients personally, according to Dr. Koch. It's important to remember that their problems have nothing to do with you, and oftentimes an attempt to understand their pain will help you to keep perspective and even help.
  2. Always, always, always remain positive in your discussions and resist the urge to argue — at all times.
  3. Often, there comes a time to let go of problem patients. That time might even be at the first consultation. One luxury cosmetic practitioners have is the option of saying, "You look great just the way you are, and I don't recommend any intervention or treatment at all." Even not charging for a consultation that may include this interaction, frees you of prolonged attachment with regards to accepting money for making a patient unhappy, so to speak.

“To recap: identify, remain objective and positive, and don't be afraid to separate [yourself] from patients like this. No one procedure with a nightmare patient is worth the long-term frustration and damage to one's reputation that can result,” Dr. Koch says. 

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