The Aesthetic Medicine Patient-Centered Consult

All too often the “bean counters” are telling us how we are falling short. They come up with some scheme to get us to see more patients than we can reasonably see or how to “create” more procedures than are called for. This is bottom-line or practice-centered medicine and in my opinion is unethical and immoral. It is also outside of what we are called to do and is unnecessary and counter to a healthy practice. What I believe builds a healthy practice and is simply at the heart of doing what is right for patients, is the patient-centered consult. This type of consult is designed to get to the root of the patient’s issues and do all one can do to help them achieve their health and aesthetic goals.

In this age of population-based medicine we have all been told to do the minimum, but that doesn’t change the fact that our patients are concerned with optimal health and results. Olympic athletes do not win their contests by training to the minimum nor will our patients be served by providing the minimum. Let’s look at an example of how population-based medicine is creeping into the exam room in a way that is not fully understood by physicians and yet has great impact on the individual (many similar examples can be seen in medicine today):

The drug companies tell us that Plavix is about 30% better than aspirin. What they do not tell us is that it is relatively 30% better. In absolute terms it is about 1% better. What does this mean? Well, in one study on CVA the relative risk reduction was quoted as 25% but the absolute reduction was 0.9 for ASA vs 1.2 for Plavix or about 0.3% (1). Now Plavix costs $5.00 per pill and ASA is about $0.05 so to the individual on a fixed income is the absolute difference of 0.3% worth $4.95 per day? Maybe, maybe not depending 提拉機 on many factors. Certainly it may be worth it to society but society is not paying the bill…the individual on a fixed income is. This is the confusion between population based and individual medicine. Some have even advocated taxing or eliminating Aesthetic procedures to reduce overall health costs in the US. This may help some number followed by economists but is it serving the individual who is interested in a specific goal?

So what is the patient-centered consult? Medicine is complex and in particular, Aesthetic Medicine is complex, yet it has been reduced to sound bites on TV. Commercials ask the question “Is it better than Botox?” or “Is it better than a Medical Peel?” yet they do not give the answer or any real helpful information. Patients have, in general, no realistic idea of what can and cannot be done for them. The patient-centered consult is an educational experience for the patient that helps them understand what is realistic and what is not.

It starts with gaining a detailed understanding of what the patient’s concerns are, not what treatments they are interested in. Most aesthetic patients come in thinking they know what they want. As an example many think they need an upper lid blepharoplasty but what they really need is a brow lift. Other come in asking about fillers but really need Botox or vice versa. The understanding of what they are concerned about is found not by asking what they are interested in but rather, what their concerns are. We start in a conversational manner. Most often a patient will start by saying something like “I think I need Botox right here.” My answer is generally something like, “Well, that is certainly something we can do, but what is it that makes you want Botox?” The next several questions are directed at helping the patient target the real issues behind the concerns such as texture, tone, tightness, wrinkles, poor size, volume etc.

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