How do surgeons align patient expectations with realistic surgical outcomes? Dr. Lee Sharma speaks with facial plastic and reconstructive surgeon Dr. Michael Brandt about understanding patient motivations, communicating limitations, managing dissatisfaction, and building trust through honest conversations.
What happens when a technically successful surgery still leaves a patient unhappy?
In this episode of The Scalpel and Sword, Dr. Lee Sharma welcomes Dr. Michael Brandt, to explore the complex relationship between patient expectations and surgical outcomes. They discuss how family, culture, social media, personal experiences, and self-image influence what patients hope to achieve through cosmetic procedures.
Dr. Brandt explains why curiosity, careful questioning, and clear communication are essential to understanding the story behind a patient's request. The conversation also examines how unrealistic expectations can lead to dissatisfaction, conflict, and medical-legal challenges. Dr. Brandt shares practical lessons on aligning treatment goals, explaining risks and limitations, responding to unhappy patients without becoming defensive, and knowing when to decline a procedure.
Ultimately, successful patient care requires more than technical skill. It depends on listening, building trust, setting realistic expectations, and prioritizing the patient's well-being over the desire to please.
Three Actionable Takeaways:
About the Show:
Behind every procedure, every patient encounter, lies an untold story of conflict and negotiation. Scalpel and Sword, hosted by Dr. Lee Sharma—physician, mediator, and guide—invites listeners into the unseen battles and breakthroughs of modern medicine. With real conversations, human stories, and practical tools, this podcast empowers physicians to reclaim their voices, sharpen their skills, and wield their healing power with both precision and purpose.
About the Guest:
Dr. Michael Brandt is a facial plastic and reconstructive surgeon at Form Face and Body in Toronto. He trained at the University of Michigan under renowned facial plastic surgeon Dr. Shan Baker and teaches at the University of Toronto. His work includes peer-reviewed research on facial scar assessment and medical-legal expert consulting. His clinical perspective emphasizes realistic expectations, thoughtful communication, and aligning surgical outcomes with patients' goals.
Connect with Dr. Michael Brandt
About the Host:
Dr. Lee Sharma is a gynecologist based in Auburn, AL, with over 30 years of clinical experience. She holds a Master’s in Conflict Resolution and is passionate about helping colleagues navigate workplace challenges and thrive through open conversations and practical tools.
[00:00:00] Hello, my peaceful warriors, and welcome to the Scalpel and Sword podcast. I am your host, Dr. Lee Sharma, physician and conflict analyst. So a lot of you already know that kind of my day job is that I'm a gynecologist and a gynecologic surgeon. I've been doing this for about 28, 29 years now, and one of the things that I think is always really important to address anytime you're doing any kind of surgical management is trying to assess and accurately be able to meet a patient's expectations.
And that's a big word, expectations, and even just that word can mean different things to different people But when you're talking about surgery, and we'll take that one step further, if you're
talking about plastic surgery ,
then we're talking about more than just an expectation. We're talking about what we see in the [00:01:00] mirror.
We're talking about an ideal or an image, and is that something that's harder to measure, the difference between the face a patient sees in the mirror and the face they expected to see? And my guest today lives inside that question. Dr. Michael Brant is a facial plastic surgeon and reconstructive surgeon at Form Face and Body in Toronto.
He trained at the University of Michigan under Dr. Shan Baker, teaches at the University of Toronto, and conducts peer-reviewed research, including work in facial scar assessment, and serves as a medical legal expert consultant. I can't think of anybody who's more suited to help us address this question today.
Michael, welcome to the show. Thank you so much for having me on. So one of the things I kind of want to get into before we start talking about this idea of managing expectations, we kind of have to talk about where expectations comes from. So [00:02:00] when a patient comes down and sits in front of you, their first time they're meeting you as their plastic surgeon, and they tell you, "This is what I want," they're not starting from ground zero.
They're starting from the face in the mirror. They're looking at photographs. they saw a famous celebrity and saw something that they saw there. So when you're listening to somebody describe this expectation, what are you actually listening for? Yeah, it's a great question.
I'm listening typically for the reason behind the request. You know, a patient might come in and say, "I want a sharper jawline," but I need to understand why that matters right now. Is, facial aging creating a disconnect between how they feel and how they look? Is this a long-standing concern, or did it appear after, some rude comment at some point, a relationship change, a job loss, or they looked at some weird filtered image?
you know, the physical feature is often only the surface of the conversation. [00:03:00] My job is to really understand the story that the patient's really attaching to that issue. That's brilliant, and I'm so glad you said that because this is one of the challenges in expectation setting, is the idea that we think that expectation might be face value.
But what you're really doing when you're getting this from the patient is you're having to dig deeper. You're really having to... And I love how you talk about this as being a story that you're trying to really get to. So do you have, in terms of getting that sort of level of relationship with the patient, how do you start that process?
So it's really about curiosity and asking questions to find where they're coming from. Why are they here today? What's brought them in? Is this, you know, something that they've been thinking about forever or has something happened in their life that's really prompted today's visit? And that's really sort of where we start the conversation from.
I'm so glad you said that because I think that's one of the things we talk about on the podcast [00:04:00] so much, is this concept of curiosity. The idea that you're having to ask the whys to actually get the reasons, and if you don't ask, you're never gonna know. And unfortunately, sometimes we get into a really dangerous area, which is assuming that the reason why a patient wants something specific, that we assign, maybe assign our own values or our own thought process or even our own stories to why a patient may want something.
And instead, it's so much more powerful to exercise that process of curiosity. So as you're starting this conversation, are there certain things that you intentionally do? Are there things that, do you actually bring the patient into what your process is? Like, "I really wanna give you what you're looking for, but to do that, I really wanna understand your reasons for asking."
Yeah, I mean, it's mostly based on just asking questions, is really the main thing. Trying to understand where their expectations, where their rationale for coming in [00:05:00] has come from, right? Like, are they coming from family, culture, past experiences, photographs, social media? Did somebody just make some random hurtful comment and that, that's been with them since childhood, right?
Each one of these things impacts on why they're here today, and then, you know, we really wanna explore that. Of course, social media has really intensified a lot of these things 'cause people are being exposed to, curated images and filtered faces and all these other things, and now they're coming in with this sort of distorted sense of, you know, what's possible.
And sometimes they don't even come in with sort of an exploration of identifying a physical problem. They're coming in with a treatment goal. Like, they're coming in saying, "I want X treatment because I saw that online and it's gonna fix this problem that I have," as opposed to, "Well, let's take a step back and talk about the problem.
What is the problem that we're trying to correct today?" So very often as you're talking to patients about these kind of things, [00:06:00] you're really having to reframe this With understanding what their whys are, but you're actually having to put this in a context for them as well. Mm-hmm. It's like, "I hear you.
I completely understand why you're asking for this, but let's go ahead and reframe this in such a way that I actually can give you what you want." Yeah, yeah, and it's determining exactly what they want is sometimes the challenge, right? Because sometimes what they want and what I can deliver are two different things.
and that, you know, gets at sort of the entire impetus for this discussion. But really that's- the reality of seeing somebody for a cosmetic change, is trying to align what you want with what a surgeon can deliver, and There's sort of, an ability to sort of meet there, between those two things.
So I'm really glad you said that because I think the concept of alignment, of course, is something we talk about a lot on Scalpel and Sword. But as you are being curious about the patient and as you are sort of framing based on this [00:07:00] curiosity what you feel like the patient really wants, sometimes you really are having to say, especially with what you do in facial plastics, "We're gonna have to find a place in the middle."
Mm-hmm. I may not be able to give you exactly what you're looking for." How do you build that alignment? Because you're already sort of starting at a place that maybe you're having to tell a patient, "I can't give you exactly what you're looking for, but let me see if we can get on at least close to the same idea of what you want."
Yeah. and to sort of get there, we need to really agree on three things. the first thing is what are we trying to improve? what are the risks and limitations that we're willing to accept to get there? And then the third issue is what a realistic result would look like. And that can help us, arrive at a shared understanding.
But sometimes, figuring out what is that realistic result really requires us to dig deep on a patient. And quite frequently, I have to [00:08:00] have them repeat back to me, some of the limitations and things. And it's not a test, it's just really trying to see if they really understand that we're talking about an improvement as opposed to a complete life change.
Because, a surgery, for example, can remove a barrier to confidence, but I can't manufacture an entirely new identity for them. and we really have to be able to make sure that what we're trying to achieve is an anatomic problem that has an anatomic solution, and we're both looking to correct that with no secondary gains really with that is really what primarily drives a successful outcome Every surgeon needs to remember those three things.
What you just said, that's so important, that every surgeon needs to understand is like what are, what problem are we trying to solve? What's anatomically possible? And is our expectation going to be aligned with these two things? And I think if every surgeon did that, every surgeon took the time to do that, [00:09:00] there would be a lot of happier post-op patients.
Mm-hmm. And especially the fact that you take the time, because I think this is a big thing in medicine, and especially when we're talking about surgical procedures, is that we are speaking a language that is intuitive to us. We get it. this is the sea we swim in. We understand it.
But talking to somebody, even if you're talking to maybe somebody who's medical but doesn't do what you do for a living- Mm-hmm ... because what you do is so specialized, that you're still having to make sure that that patient has clarity about
what it is you explained to them, because this is
a pivotal part of the decision-making process.
Yeah. you're absolutely right. And, the thing that really drove this home for me was actually when I was working, at the University of Michigan with my fellowship director who, he is an international authority on facial reconstruction. He's literally written the textbooks on this issue.
His name is, Baker. Where is it? Right there, behind me. Yep. I mean, the man's written everything. And we [00:10:00] came across a patient who came in, and they were asking questions about, like, outcomes and everything else, and a patient doesn't know this doctor from anybody else. They don't understand.
They don't really care about the accolades and experience and all this other stuff to some extent. Mm. They're just hoping for a particular outcome. And, you know, they're coming in and all this stuff doesn't matter relative to what this surgeon has done and what they've achieved and all of their results, their book of a million results, within this book.
They're coming in because they have a particular problem, and we need to align on correcting that problem, and they need to understand what, is possible, and, really align on those factors. Yeah. I think it's really cool because when training with somebody like Dr.
Baker, sat at the feet of the master who really does- Mm-hmm ... all of this. But then I also think that gave you a great laboratory to really understand how to align expectations because I am sure there are people who walked [00:11:00] into U of Michigan thinking, "Oh, I'm getting Dr. Baker.
This is the best facial plastic surgeon on the
Planet. I'm gonna come out of here and I'm gonna look like a supermodel." It's like- Right ... okay. Yeah. So it's even more important sometimes I think if patients have the perception of seeing you as an expert. Mm-hmm. They see you as somebody who's at the top of your field.
I almost get concerned at that point that expectations are even more likely to get out of whack with reality or what's achievable because- Yeah ... they see you as someone who's so competent. Absolutely and we see that frequently. I mean, no surgeon is infallible. We all have patients that look for secondary opinions from other people.
We all have complications as surgeons. I mean, the only surgeon that doesn't have complications is the one that doesn't operate, right? There you go. I mean- Yep ... and the reality is that- All of our patients get around, so to speak, and talk to other surgeons and ... Each one of our results is not just being looked at by the patient, it's being looked at [00:12:00] by our colleagues, and everyone else.
and the reality is that when they're seeing an expert, even though that person is an expert in their field, for the patient, yes, they might have an extra level of expectation because of that expertise, but that person isn't infallible as well. and we see that all the time where, expert surgeons go out and they do a great surgery and then the patient comes in to see me for a second opinion afterwards where they're not totally pleased about a particular area.
And then it's a long discussion about what is it in fact, that made them unsatisfied with that particular procedure, and is it, a surgical issue? Was it an expectations issue? What exactly sort of drove, drives them to come into my office today to talk about this concern, right? I'm so glad you brought this up because this is where this traditional definition of an outcome, when we talk about a surgical outcome, [00:13:00] this is where we really have to start confronting this idea of expectations.
Because what we look at as a successful procedure, this is a good surgery, patient did well, no complications, fantastic. Patient comes back for follow-up and you're thinking, "Oh, this is great. Patient did well. Awesome." And you go in the room and it's like, patient's not happy. It's like, "Oh, what? The surgery did great.
You did great." And the patient has this list of things that they really thought were going to be part of the successful procedure that was not part of what happened. So this is something, like you said, ... And for louder for the back of the room, the only way to avoid a complication if you're a surgeon is to never operate.
The only way. this is the norm. This is gonna happen to all of us. This is, you know, unfortunately what we do. But when this happens, where we think a success and the patient doesn't see it that way, how can we as surgeons work with this in such a way that we're still maintaining a relationship that's hopefully positive with the patient?[00:14:00]
Yeah, that's a great question. I mean, this happens. I've had ... every surgeon can tell you stories about a technically successful operation where
everything went amazing ,
but the patient was unhappy. and this happens to me like it does to everybody else. I guess the real question when we see this patient, even though they may have had an objectively great result, is to try to understand why.
Why are they unhappy? is there a correctable concern that just wasn't addressed? Was there a misunderstanding in what we were trying to do? Is the patient still adapting to their changed appearance is part of it? do they have a different goal, or a different sort of image in their mind?
or were they expecting surgery to solve something that it could never solve is really something that comes up too. And, I've learned is that the worst response is to become defensive and just tell the patient, "But you look great," they don't care about that. they're coming in- Right
because they have a concern, and addressing that concern and asking questions [00:15:00] about it is not necessarily acknowledging that you've created a problem or that you're admitting to doing anything badly. You're just basically being curious about why they're there and what's going on, and trying to get to the bottom of it, and seeing if you can find common ground.
I think that's wisdom, and I'm so glad you said that because I do think there's sort of a I wanna say a natural response, but a very common response that when the patient comes back, we think the patient had a great outcome. ... We think they're doing fantastic, and the patient comes back in and they're not happy, that we do have that tendency to become defensive about the work that we've done because we feel like we've done good work.
And the second we become defensive is when this starts to break down. So first and foremost, you had to continue to exercise that curiosity, and then to actually really try to get the story of what's going on, what's behind it. Because especially I think for facial plastics, the mirror's not [00:16:00] objective.
when the patients are looking in the mirror, They're bringing their biases, everything that they thought was going to happen as a result of the surgery. And I think it's also really important, what else was gonna be corrected? What else were you expecting to improve by having this happen?
So as you're becoming more curious about it, we can start to understand some of these biases that patients have, but that's not a process that's easy. We have to really work on that. So what are some things... So you've had this situation happen- ... where the patients come back and it's like, "Oh, okay, Dr.
Brant, I'm not exactly thrilled with this." How do you go through that process? Yeah. And then, it's again, getting back to sort of curiosity, asking questions. What is it about it? what were you expecting to be different? What part of this is not something that you had expected and what do you want to be different?
And in some circumstances, we can find a shared understanding that you know what? The scar isn't the [00:17:00] greatest. We have to work to make that better, and there are options available and we'll try to deliver on that. but in some circumstances- we've all experienced this where patients just don't have realistic expectations of what happened, and somehow, in spite of all of our questioning before and everything else, they've managed to sort of filter through the cracks and still have surgery and still be unhappy.
And sometimes that gets back to, a secondary gain issue. Sometimes it gets back to a weird anchor that they had relative to their appearance, They could be anchored to a feature or anchored to a way that they look that, is just distorted from the start, and now any sort of effort to modify that anchor is not going to make them happy.
give you an example. I had a patient who came in for a lower blepharoplasty, a lower eyelid surgery to correct the fat bags under their eyes, and part of the [00:18:00] problem was that they had been overfilled multiple times with filler, and they had- ... retained filler in their cheek.
They had lymphedema in their lower eyelids. It looked objectively very bad. To anybody looking at this person, they looked bad, but their anchor, their identity and sense of self was this overfilled face. And in spite of my best efforts surgically to dissolve the filler to start with, do the procedure, get them a great result, they weren't happy with the result because their anchor is an overfilled face.
So what did we have to do at the end with this patient? I had to use some filler back in their face after their surgery to give them back that overfilled appearance because that was their anchor and that was the only way that we were gonna be able to achieve common ground and, have them feel happy about the overall outcome.
and even though it wasn't my aesthetic and what I had hoped to do, and not something I was proud of relative to the fact that, this [00:19:00] isn't objectively a great result from my perspective, this was a great result from their perspective. And at the end of the day, we're trying to sort of achieve common ground and make patients happy I love so much though that when you were going through this process with this patient, a big part of what you did to achieve alignment, and I think, and I would suspect probably had a happy patient by the end of it, is that you really had to step back and say, this isn't necessarily what I would say was gonna be a good aesthetic, but I'm going to meet the patient where he or she is, and this is how I'm going to help with that.
I'm going to actually refocus my lens and see this way my patient sees it." And I think there's a tremendous amount of humility that's involved in doing that, and that's always gonna be beneficial anytime you're in a conflict situation. So I think that's amazing that you did that for that patient.
Yeah. at the end, I don't know how overall pleased they were, to be frank with you, [00:20:00] because ... some of these patients are difficult to please, you know? and you know, surgery as, in general can never make anybody happy. and the real challenge is we meet patients so briefly that it's very difficult for us to discern, is this person coming in from a good mental health state or is there other stuff going on?
And, an unhappy person will be unhappy whether or not they had a facelift or not. They're not going to be made- Yeah ... happy by a procedure. and that's the real challenge in what we do is that even though all of our staff is super well-trained and they spend so much time with patients, I mean, our patient care coordinators are outstanding.
They literally spend 45 minutes to an hour with a patient on the phone talking about all these things before I even meet them for the first time. I'm getting great- Wow ... insight from them, and then I sit down and I have a conversation with patients. In spite of all of that, people still filter through and people put on a face to sort of get a [00:21:00] procedure done, and at the end of the day, some of them are still, not happy.
Thankfully, the vast majority of my patients are happy. and that's why I keep doing what I'm doing, but some of them will filter through, and happiness can't be brought about through surgery unfortunately. Absolutely. And it kind of brings an interesting point that if as we're talking about expectations, we can do everything we can to try to get on the front end what those expectations can be, but there's not a way to objectively measure expectation.
And this is part of the challenge in terms of working in this space, is that we are very much having to collect as much data as we can collect, and of course, that is dependent on the patient. How much are we willing to get from the patient? And as you said, especially I think for patients that are very motivated to get a particular thing, that the true motivations may not necessarily be as forthcoming.
And as a result, it makes it hard for us to measure [00:22:00] expectation. And if it's hard for us to measure something, sometimes it's hard to meet it. as you are doing all of these things and you're trying to reconcile this gap between what's expected and what's experienced, is that the space that we start to see that conflict arise?
Without question. That's always the space where conflict arises is, there is the objective evaluation of something, ... And the way in which the patient experiences it. And that, I... That was part of the research that I did on surgical scarring, in that, you know, you can objectively evaluate a scar.
You can look at a scar's width and thickness and vascularity and contour, and all these other fun objective features. But at the end of the day, the amount of impact that scar has on that person is very different from one person to another. A small scar in the middle of somebody's face might create an [00:23:00] incredible amount of anxiety in somebody who's 20 and a model or what have you, and a massive scar on somebody's face in, later stages of life or what have you, where they really don't care about these things, has no impact on them whatsoever.
and then there's everything in between. So you're exactly right in hitting it on the head in that there is an objective evaluation, and then there's how somebody might experience that So one of the things, 'cause, uh, especially because you've done this research, this is a big part of what you've done in terms of scar research, which I think is so cool.
But as we talk about this mismatch, this idea that there's this gap, and this gap is where conflict can arise, of course if we start taking this conflict to, a little more unfortunate area, we start talking about medical-legal implications with this. And this is something you also work in terms of the space.
So how often do you see this mismatch between what's expected in terms of an outcome and the actual outcome play [00:24:00] into how this occurs in legal
issues as you're reviewing cases and
testifying? Yeah. We see this all the time. this is the basis, right, of most medical-legal issues, is that, even when there's a legitimate complication or a technical concern, patients can frequently accept an imperfect outcome when they're felt heard and properly prepared and supported afterwards.
You know, one of my mentors, as a resident basically gave me some amazing advice, is you know, when you have a complication, your instinct is to run away from that complication. You don't wanna see the patient, you don't wanna be reminded of all these issues and everything that you did wrong. But the reality is, is that you need to kill them with kindness.
You need to see them way more than you would anybody else, because they're living with that complication every single day. Yep. And they need to feel like they're being heard and properly taken care of. And conflict always becomes more likely when somebody [00:25:00] believes a risk was minimized or an outcome was implied or their concerns were dismissed, and that's where a lot of the medical-legal problems stem from.
the medical-legal stuff usually begins long before the complication. it occurred at the outset where somebody just didn't feel like they were being heard. and sometimes when we leave a conversation in a consultation, we believe that we're actually agreeing, and we're actually imagining two different outcomes sometimes- Yeah
when we do that as the consultant and as the patient. and we really need to make sure that we are in alignment, as we've discussed. Yeah. I wanna drill down on this for a second 'cause what you just said was really powerful, that when we talk about these kind of medical legal things that may have happened because of an unexpected or an unwanted outcome, that lawsuit didn't start with a bad outcome.
It started way before that. It started way before in the consultation with that relationship, [00:26:00] with the patient feeling
like they were not heard, with a doctor feeling
like the clinician was not engaged. it started way before that, and the outcome was just the trigger that basically made that manifest.
And I think that's such an important thing to talk about because when we're talking about the space and it's like, "Oh, well, there's a bad outcome," there's... But it's not a not, it started way before that. And so I think it's really important that you recognize that, and especially with what you do, so much of what you're doing is built on this idea of understanding exactly what somebody wants to the best of your ability.
Even more so than maybe somebody like
what I do, 'cause if I'm counseling a person for a
hysterectomy, they're a little bit different in terms of what expectation. But still, the expectation is there, and being able to invest in that process long before the pre-op visit, during the procedure, in the post-op window, anything that's happening,
And I'm glad you also had people who taught you not to run. I think that's so important. It's like, if you've got something going [00:27:00] on, I wanna see you twice as often. I'm gonna have you call the office. Mm-hmm. I'm gonna call and check on you every day. How are you doing? You doing okay? Can I do anything for you?
That is a level of engagement that we want, and I think unless you have that modeled for you,
it's really hard to learn to do .
Yeah, you're absolutely right. I agree with you completely. thankfully we all stand on the shoulders of giants, after, we get out from our training and- Yeah
thankfully I had a lot of great mentors along the way who instilled a lot of this stuff in me. and it's critical to be able to, take ownership of problems, to some extent. and that doesn't necessarily admitting that you did something bad or any of this sort of stuff. It's just acknowledging that something's occurred, and hearing the impact that it's had on that patient, Yeah
and getting them through this process. And like we all do, I had an experience with this where I had a patient who had a complication, and we saw her all the time, and we sat down and we scheduled an extra half an hour just to sit and listen. [00:28:00] And I did, of course, you know, the one thing I would recommend is bringing in somebody else into the room.
so my patient care coordinator was there as well, just to make sure that we had another person there who could reflect back what was being said,and hear and acknowledge things so that there was no false interpretations of what was occurring. And we just had long conversations about things and eventually got them through, and this patient is one of, our practice's biggest champions at this point, That's awesome
in navigating some of those issues. So it is really important to make sure that everybody is heard, in spite of the fact that your gut is, "I gotta be out of here. I don't want to deal with this. I mean, this isn't a big deal. Why are you making this a bigger deal than it is?" but it's a big deal for them and we have- Yes
to acknowledge that's really what's driving them to sit in the chair with us. Absolutely. So I'm betting that there are probably times or have been times in your career where a patient has come to you, [00:29:00] say, "Dr. Brant, I want X, and I have this expectation, I have this picture. This is what I'm really wanting and I really wanna have this, and I've saved up for it.
I'm so excited to see you." And you're looking at the story, you're looking at the
why. You've been
very, very diligent in exercising your curiosity, and your staff has been doing this work with you. And you all have the feeling that you're not gonna be able to meet this patient's expectations.
Mm-hmm. You're probably not gonna be able to give this person what they want, and now you are confronted with the possibility of having to say no to doing a procedure. Have you had that happen? Absolutely. Have it happen every day. Yeah. And, I say no to a lot of people. and in my mind, saying no is not a failure to provide them with care.
It's sometimes the most important care that I can provide them, in telling them that this isn't the right thing for them, especially if, I believe that the patient's central problem can't be solved by changing [00:30:00] their anatomy, right? Sometimes that's just not the thing. And frequently we'll see some warning signs about shifting goals or inabilities to accept imperfections, repeated procedures in the past without satisfaction-
or fixating on something that's barely perceptible or believing that a surgery will, automatically repair a relationship or transform their life. each one of these things, and I really try and look at and watch the patient as I describe some of the limitations and risks, and seeing if they are internalizing these things versus-
just brushing them off. ... because if they're actually internalizing them, and they're understanding things, and they're accepting of the procedure in spite of these limitations and risks, then I know that there's a bit more alignment there. But if they're sort of just brushing things off and accepting it, "Oh, yes, yes, yes, it's not gonna be an issue.
All will be well," then that really sort of starts to raise red flags for [00:31:00] me and I think it's really important, especially as physicians and surgeons, that the understanding that if you're already having suspicion that you may not meet expectations, if you're already thinking... and I agree with you that it's like, "Oh, no, it's gonna be fine.
Oh, no, it'll be okay." It's like, okay, so we really haven't thought about why." And I always wanna make sure, and this is the biggest thing I teach medical students, you know, when they're on rotation with me, it's like, "What's the biggest thing you need before you go to the operating room?" And they say, "Uh, I don't know."
It's like, "You need a why. Why are you here? Is this-" ... trip to the operating room actually going to correct the problem that you are addressing with the patient? Because if the answer-" ... to the question is no, then you have no business being there. And if that's not a clear point, and you already know that the patient is expecting something different than what you can give them.
My dad was a general surgeon. He had a great saying, and I've used it forever: "The good surgeon knows when to operate, and the great one knows when not to." And sometimes you really do have to be the [00:32:00] person that says, "I don't think this is the right way to go." And that's really hard to do because, again, I think being in medicine, we love our patients, we have compassion, we want them to be well, and sometimes that leads to a people-pleasing space that we want to please them, and sometimes want to please them so much that we may be tempted to do something that we're already thinking may not be the right thing to do.
Yeah. and it's especially true within the aesthetic space and any, private sort of surgical procedure theoretical, and people paying out of pocket. And, you know- Mm-hmm ... you're running a business and, every patient that sits in your seat is a potential client that, you've got your bills to pay and all these other things, and secondary gains that occur after we see our patients.
and that's- ... the reality of aesthetic medicine. and, at the end of the day, we still have to be able to look ourselves in the mirror and know that we're doing right by our patients, and saying no to a patient might be the best thing for them, and that [00:33:00] is critical in the long term.
I've worked in a few different practices with different colleagues, and this has always been a thing for me where, I'm not building a one-time procedure. you're not buying a car from me. We are going to be friends for a long time because I'm gonna do an intervention on you that has risks and issues and other things, and I wanna make sure that our friendship can last, you know, can stand the test of time.
And to that extent, I will tell patients yes or no that we can do things and we can achieve things, and if I'm telling you no, it's for good reason. And the best patients I have in my practice recognize that and come back to me even years later after I've said no upfront, they come back and see me and is like, "Is now the time?
Do you think now is good? Because I went to somebody else and they were willing to operate on me right away, and that sort of irked me." Right? And I'm like, "And it should irk you."
when I'm creating a relationship with a patient, we're creating a long-standing [00:34:00] relationship where we're friends. I want you to come in when you have a question, when you have a concern. And some of the best patients I've ever had have been patients who I've said no up front, and then they come back years later and they're like, is now the time?"
And now might be the time to consider something. whereas before you just weren't a great candidate, and now you are. and they're grateful for that, and they're grateful for me saying no to them because they've gone to a lot of other practices. and we don't live in a bubble.
Toronto's a big city. There's a lot of surgeons around, a lot of cosmetic providers. They'll go to somebody else and they will tell them they'll treat them. And quite frequently, some of my patients will go in for that consultation and they'll just say, "Oh yeah, we could do that procedure." And then they'll come back and tell me about this sort of interaction, and then they really had their back up and guard up because somebody was just so flippant about just jumping into wanting to do something, as opposed to really having the conversation and saying no up front.
And [00:35:00] then they come back and they talk to me about it, like, you know, "Why did you say no? What was the issue? When do you think is the right time?" And then we could sort of proceed accordingly. I'm so glad you're talking about this. I am so glad you verbalized this because I think this is something that so many doctors, and myself included, are afraid of, is that if we say no to the patient, that the patient will get mad at us, they'll hate us, and they'll stomp and they'll walk away and they'll say nasty things about us, right?
But when we are grounding that in what we know and feel to be medically correct, I'm not saying no to be the bad guy. I'm saying no because I really want you to have what you want, and I don't think this is the pathway to get there. And whether that is refusing patients antibiotics if they've got a viral infection, whether that's saying, "Yes, I think you need X procedure," whether it's the patient asking for a particular imaging test and you going, "What are we hoping to get from that?
I don't think it's gonna give us any new data. We've already got these other two imaging tests that tell us what we need. This [00:36:00] one's not gonna give us anything more." Any time we're doing that but we have a very clear explanation that we're sharing with the patient, this is why, I think it actually has the reverse effect on the physician-patient relationship.
I think it makes it stronger- ... because that patient understands that you love them enough to say no. and you've definitely seen that. Absolutely. And, like good fences make good neighbors, good boundaries strengthen trust, right? and I think that's part of it, is what you're doing is you're telling them what you can deliver, what you cannot deliver, and where those things align and where you will not compromise on their care and your own internal sort of values, right?
And I think patients- Yeah ... respect that. and, I can go to bed with a clear conscience knowing that I am not a snake oil salesman. I am providing great quality care to my patients, and they're happy with the care that
I'm providing them.
100%.
you know, you've been well-trained.
You are training other [00:37:00] physicians. You are helping other people learn how to do what you're doing well. You're k- you're teaching somebody how to align and set appropriate expectations, and you're gonna give them maybe one or two pieces of advice before they're walking in and talking with this patient.
What would you encourage them to do? the best advice I would probably give, other doctors is to ask the patient really what do they think the treatment will change, or what is really gonna be changing if you had to ask one question.
Yeah. You know, "What is this facelift actually going to change for you? And then listen to what they have to say. don't jump to interrupting them. Listen to what they have to say. some of them will tell you, "Well, it's not gonna change anything," and that's great. That's what I wanna hear. I wanna hear that
the only thing it's gonna change, "I'm gonna feel better about myself. I'm gonna be sitting around, I'm gonna feel better. I'm gonna, you know, be able to put my makeup on easier. my life will feel better when I'm [00:38:00] sitting around with my friends. I'm not gonna feel like the oldest one sitting there."
these sort of things are good reasons to consider surgery versus- Yeah ... "Yeah, I wanna go... I just broke up, in a relationship. I wanna look really hot and, shame my ex or whatever," right? Yeah. "Or make him jealous." Right. these are all weird things that patients sort of bring in to their consultation as far as reasons.
"I've been out of the workplace forever, and I really wanna get a job." maybe that hair transplant might be able to help you, but is it really gonna give you the qualifications that you need? Is it really gonna, set you apart to get you that job? I don't know. Yeah. Maybe it'll add to the overall resume, but I don't necessarily know if it's gonna deliver on that job and make you happy.
So when we ask the question, is, relative to what they believe the treatment will change, it really gets at the crux of that. That's beautiful. I love that. And I think that's getting to the essence of what an expectation is. When you're [00:39:00] actually getting to the essence of what the patient's expecting, it's not just what happens at that first or second post-op visit.
It is the narrative they are telling themselves in relation to that entire journey. And the more that we understand that narrative, the more likely we are to be aligned in that expectation. So , I love that that's great advice, Michael. Yeah. No, thank you. So if people wanted to reach out to you, if they have questions-
about the work that you're doing, how best would they find you? Yeah. Best way is to look at our website formfacebody.ca. you can find us on social media, Instagram, also Form Face Body. and, my own Instagram, drmbrandt, on Instagram. Fantastic. Michael, thank you so much for being here. This has been a fantastic conversation.
Thank you so much, Leah. It was, great, and, hopefully, people have, take something away from this. I'm sure they will. For all of our peaceful warriors who have joined us today on The Scalpel and Sword, if [00:40:00] this conversation resonated with you, share it with a friend, share it with a colleague.
And until next time, be at peace.