The moment when patient and doctor meet for the first time in aesthetic surgery significantly differs from the same occasion in other surgical branches. They, above all, talk most of the time.

The purpose of this conversation is multiple and could be, conditionally, divided into several segments:

1. Basic mutual introduction and establishment of positive contact, one realistic and healthy relationship.

2. Building mutual trust, for both sides to express themselves in a sincere and open manner and maintain this trust throughout the whole period of surgical treatments. Some patients already have confidence in us considering that someone they trust have recommended the clinic or they have seen results of some surgery that they liked; on the contrary, there are distrustful patients. They often visit a large number of clinics and usually, during the conversation, they first mentioned all those bad and tragic examples they have heard of or read about: bad results, ugly scarves, severe complications, etc.

3. Taking over mutual responsibility for planned procedure, that is, by both physician and patient (Note: despite the fact that the physician might be impressed by the situation, which often occurs, when the patient fully relies on his/her decision saying: “Do whatever you consider the best”, one should be careful, since it indicates patient’s problems to decide or he/she simply does not want his/her share of responsibility).

During the medical exam, the physician is obliged to provide privacy, discretion, calm and relaxed atmosphere, no rush, interruption, telephoning or such. Patient must feel that the time is solely and exclusively dedicated to him/her and his/her problem, that he/she is fully and seriously understood. Kindness, patience and positive attitude must be evident.

There are no standardized approaches or patterns for this first medical exam and it may be said that the approach is individual for each patient and different and depends on patient’s personality and his/her requests and attitude. Somewhat usual standard order is as follows:

  • Patients presents his/her wishes and ideas
  • Surgeon performs objective examination of patient’s condition
  • Surgeon presents his/her opinion on what could be performed and what is, in his/her opinion, the best solution
  • Provided both parties agree, the goals and plan for surgery are defined (“It is necessary for both parties to clearly understand the goals of planned surgery, what the wishes are and what may be achieved.”).

The patient almost always comes to the exam with a certain idea, idea about the outcome. However, that idea is often unclear, unformed and undefined. His/her goal is, above all, subjective. Some patients feel uncomfortable and are ashamed of their wishes, there are some patients saying they feel stupid, that they should not have come. Some of them are scared since they want the surgery at any costs, but fear bad results, pain and fatal complications. A famous American surgeon Mark Gorney, in a slightly humorous tone, wrote: Patient comes with more or less clear idea of his/her wishes; surgeon, on the other hand, more or less knows what could be done! In other words, surgeon must find out and understand what are patient’s wishes and expectations from the surgery and to estimate whether those wishes and expectations are realistic and can be fulfilled. On the other hand, the patient must be informed, must understand and realise the realistic possibilities and limitations to the achievement of wanted result or fulfilment of his/her expectations, in this procedure specifically.

It is usually stated that aesthetic surgeon is not expected to be just a surgeon in technical sense of the capability to perform certain surgery. He/she is expected to be creative, with the good eye for beauty and coherence, with a general sense of aesthetics and above all it is necessary for him to be capable of solid psychological evaluation of the patient. Namely, the psychological factor is not so significant nor has such a great, sometimes, crucial overall effect on the surgical procedure and its end result in any of the other surgical branches as it has in cosmetic surgery. That is why, apart from so called physical diagnosis, the psychological diagnosis is equally important, since all researches so far proved that patient’s physical problem is always, more or less, connected to psychological one, which he/she does not have to be always aware of, but surgeon has to. Therefore, it is necessary to approach each patient as a person with a delicate personal problem and to follow-up the satisfaction of patient’s psychological needs in the same manner and equally seriously as the solution to physical problem.

The fact that should be taken seriously is that during this exam the patient evaluates the physician in the same manner in which the physician evaluates patient. Regardless of the fact to which extent the surgeon might consider himself a good expert (which he/she really is), the patient might not find this to be enough to trust him. It might often happen that patients examined by the physician with a reputation of a good expert, stated that they have not been satisfied with the contact, some of them were bothered by the fact that he/she did not dedicate them enough time, the physician was in a hurry or was on the phone, or used the terms they could not understand or he/she kept his/her distance or some of them simply did not like his/her appearance or even the way he/she dressed. This again proves that subjective and not objective factors are always present and sometimes even decisive.

Yours sincerely, Dr Vladislav Ribnikarr