Portal de Periódicos da CAPES

“Mrs. —, How Can I Help Myself?”

2004; Lippincott Williams & Wilkins; Volume: 114; Issue: Supplement Linguagem: Inglês

10.1097/00006534-200410001-00027

1529-4242

Robert M. Goldwyn,

Dental Education, Practice, Research

At a recent meeting, an enthusiastic office manager was extolling the miracles that marketing could bring to a plastic surgeon. To illustrate the benefits, she described the following ploy that she had learned and used. When a new patient enters your office, she said, your secretary should pretend that she does not know why the patient is there. Suppose she has scheduled her appointment for a face lift. Your wily secretary, previously tutored, says, “Oh, Mrs. —, you’re here for your nose, aren’t you?”, thereby embedding the dart of doubt into the patient, who will soon writhe with the thought that her nose also needs surgical improvement. Her anxiety will shift from her indecision about her aging face and you as her surgeon to how quickly you can operate on both her face and nose. Marketing in plastic surgery has progressed from assault to infiltration. Leaving a show-book of preoperative and postoperative results on the table in the waiting room is passe. Far better to have a discreet sign stating: “Anyone wishing to see Dr. Trickum’s informational photo album of aesthetic procedures he commonly performs should apply to the secretary.” Gone are the days when the plastic surgeon gave patients what they wanted. Now we give them what they didn’t know they wanted. To think that I have spent most of my professional life in the Pleistocene era of one patient, one operation is astonishing. It demonstrates how persistent ignorance and naïveté can be! Dolt that I am, I realized only recently that a single patient has the potential to be the recipient of multiple surgical efforts—that is, if he or she qualifies, not medically or surgically, of course, but financially. As someone who has educated or miseducated almost a generation of students and residents under the old rule, I belatedly offer the following instruction so that your patients will be the beneficiaries of the total range of your surgical prowess. Mrs. Munn E. Finder, your secretary, leads the next new patient into your consulting room. “Doctor, this is Mrs. Nye Eve.” With a charming smile and a wicked laugh, she says breezily, “Don’t make the mistake I did. She’s not here for her nose as I thought, but for her face. Please accept again my apology,” she says to the patient as she scoots out, her head bowed, signifying shame and repentance for her error. “Mrs. Eve, I apologize for my secretary,” you say. “She means well, but she is too frank with patients. She’s like an umpire: she calls it the way she sees it. While I admire her honesty, I admit that her insensitivity can be annoying.” Mrs. Nye Eve is by now up to her mandible in your quicksand. “But how can I help you?” you ask, as solicitous as your Machiavellian mind will allow. “Frankly, doctor, I have come for my face, but now I am confused. Should I be here for my face or my nose or both?” she inquires pleadingly. Pushing your chair backward and looking upward, you laugh while saying, “Oh, dear me, we have confused you. Let’s forget about your face and your nose and choose another area where I know you need nothing done—your abdomen or your breasts.” “My Lord,” Mrs. Nye Eve gasps, “although you’ve never seen me before, you know me too well. You must have x-ray eyes, doctor.” You shrug your shoulders, accepting silently the curse of being superhuman. After a deliberately long minute, you reply: “Mrs. Eve, I am here to help you in any way I can. Whatever meager skills I possess are yours.” The earnestness in your voice as you lean forward would guarantee the nomination to any presidential candidate. The patient, immersed in your intensity, realizes that she is in the presence of a martyr, a holy crusader against ugliness, a knight in search of the “Holy Grail” of beauty that lies hidden within every woman. At this point of the scenario, eliciting the history, doing the physical examination, and obtaining informed consent are mere superfluities meant for terrestrial beings. You and your patient have embarked on a cosmic quest, hand in hand (more accurately, your hand in her handbag). She leaves your office with her eyes fixed to yours. For Mrs. Nye Eve, her time with you has been more of a religious experience than a surgical consultation. As you guide her to your secretary so that she can schedule at least four procedures, you sigh, betraying the fatigue that has come from years of exhausting labor in the service of the plain looking and the aging among us. After you close your door, a small smile is on your face. You think of your harried colleagues straining to attract and treat five times as many patients as you do. You wonder how long it will take them to realize that multiple operations on one patient are far easier and more lucrative than a single procedure on many patients. Well, you conclude, most human beings neglect the obvious. Let the others rush around attending meetings and symposia. They would do much better with a course in acting. “If I had the time,” you think to yourself, “I would present a paper at the next national meeting on “Strategies for the Initial Consultation.” The title pleases you because it connotes a military campaign. Why not? A successful plastic surgeon must possess also the qualities of a Napoleon as well as those of a Laurence Olivier. On second thought, you decide that you will write the article but have it appear posthumously. Why jeopardize a smash hit now?