EP 19: The Patient I Almost Refused to Operate On | OR DIARIES

Welcome to the Five Codes podcast where we discuss evidence-based methods to elevate yourself to the next level through optimizing the way you look, move, perform, feel, and connect. Welcome to today's OR Diaries. These are always really special episodes for me because I get to just tell you what's on my mind right after stepping out of the operating room after a week of surgeries. This is like the last thing that I do. You get a kind of a raw unfiltered version of what's on my mind after surgery. And this week, they tend to run themes. I think that's just how my brain works a little bit. But this week I was really thinking about the relationships part of these surgeries to me. One of these in a nutshell, somebody that I said no to. And then here I am talking to you after operating on this person. The relationships, it took me as I matured in my career to realize the not how important they were to me, but to really quantify and understand how they affect me and my value system, my long-term happiness with my career and craft really. It was all about results. It is all about results still, honestly. But there's this whole other element that I was so hyper focused on something else that I wasn't probably understanding as well. It was there, but I just didn't understand it. That's the relationship side of this to me. I am very choosy about who I work with. I'm very fortunate to be able to do that. And I only said that to say that it's because of the outcome that I want to provide. I'm not choosy in a mean way or something. I know that what I can do is perfect for this person, basically. I do this idea of this free photo screen where you guys reach out. You can send me your photos. I look at them myself. I give you an idea. About 20% of the time, I give a thumbs up where we're in line. About 80% of the time, we never even get the ball rolling, basically. It's just sort of like, "It's not the right fit. We're not quite there yet." Sort of what you're seeking involves a little bit of a different path than you're willing to take. Something like that. But there's this narrow that's 20% of this group that we will move on and have a consultation with. It's definitely a selection of people that I'm choosing. I would want to work with you forever, basically. In that consultation process, then I really get to know somebody. This is way deeper than just photos and interests. I want to know the key relationships in your life. I want to know what drives you, what types of movement you like. These are all connection points that are really important to me, honestly. Anyway, I know those things, but now we get to a consult. We get to really dive into it. This person today was somebody who I had dove into. I got to know this person very well through the consultation process. I got to understand. I got into their mindset a little bit. I understood what they were after. Interestingly, in that, I knew that what they were after was something that I could definitely provide. It was my wheelhouse, my bread and butter. It was a full facial rejuvenation. No question about it. Slam dunk there, basically. Interestingly, I also understood some aspects of this person from the other end of just what their expectations were about, not the results even, but what their expectations were about the process, the healing, the recovery. I honestly just did not think that they were ready for what it was going to take to get to their end result. It's not the most crazy, ridiculous, intense thing you've ever done, but it's also not nothing to go through the recovery. You have to be ready to spend a week or two and dedicate to this. This is your main focus then. This person had a lot of other areas that they were focused on. They were really important to them. They were thinking that this is going to be a very minor deal, that those were going to take precedent. This was just going to happen in the background. I just knew that it was a setup for disaster, basically, for the wrong thing. My staff had picked that up a little bit too. Of course, they don't influence me. They don't really say anything until afterwards. I just don't think it's the right fit. I had some reinforcement after I made this decision. It's really nice meeting you, not the right fit. What you're wanting is going to take a little bit more investment on your end than where we're at. That was it. That was the end of that thing. It was very interesting. I think this might be the first person ever who then came back and said, "Well, I want to talk one more time. I don't think that we have had a good understanding." I honestly thought over that for a little bit because it's like, "Why don't I waste anybody's time, mine, or this person's time?" If I'm not feeling it because this is what I also told this person is, "You don't want to surge in working with you who's just not, they're not sure either that it's the right fit." Nobody wants that. Nobody wants the guys like, "I don't know if I want to do this." You just don't want that person. I told them that. They persisted through that and said, "That's fine, but I just would love to chat one more time and clarify." I respect what it honestly is, person said, "I respect whatever decision you make." I would love to have another chance. Ultimately, I talked to this person again. It was really eye-opening for me to be honest. This conversation went better than I could have ever imagined. I was prepared for a little defensiveness. I was prepared for a lot of explaining why I was wrong. It was more of just a two-way, both of us seeking to understand. I am truly seeking to understand in my consultations where somebody's at with their after, with their baseline is, "I want to know everything." The way that this was worded to me as a person was just like, "I just want you to help me understand better. I want you to understand me better." I was open to that because of that. That is in line with my goals, basically. We talk again and I got a better understanding. Black-up defensiveness, a lot of just seeking to understand both directions and then just some clarifying. Basically, some clarifying of points that the person thought I had missed. They said, "I respect whatever decision you make, but I want you to know these things, or at least know that we're making it through clear lens." After that, we had a very cordial, very happy conversation, which our original consultation was. It was left with, "Let's think about this a little bit and we'll see if we're comfortable moving forward." That was the first time that I've ever had that type of a conversation probably. Ultimately, I thought about it over the weekend and I chatted with some of my inner circle about the situation and ultimately decided, "Okay, I am comfortable doing this. I had the clarity helped me not that I had zero doubts and reservations anymore because that doesn't exist with anybody, but it was more in line with, "Okay, I'm respecting with where this is and we're on the same page and we were very clear." There was very much of mutual respect and I ultimately decided to do that procedure and now it is done. I feel great about it. It was very happy that I pivoted and definitely not too proud to do that. In that situation, I changed my own initial interpretation. I sought more information. I got it. I felt comfortable and I'm happy with that decision afterwards. That was a first, really. I'll let you know how it goes in the long run. But so far, so good. It's been very great interactions with this particular patient and my staff and it's all good vibes at this point. So, and interestingly, like I said, things run in theme. A patient before that one was a person who had had a previous procedure with a local plastic surgeon and that patient for her, it was an interesting conversation because she was just very much talking about how comfortable she was and how like she thought she'd be more nervous because with her previous procedure, she was very nervous and she kind of digested it and unpacked it. We did it together really before surgery and she was just talking about how the surgeon that she had the first time was didn't particularly make her feel comfortable, but she also wasn't at the time concerned with his bedside manner. He was very cold, very quick and she just said, "I don't kind of don't care about that. I just care how good they are." And I totally see that, right? You don't want to choose somebody because they're nice, but you're not sure they're that good. And on the flip side, she chose somebody because this person had good reputation. Bedside Vaner didn't vibe with her as much, but she sort of wrote that off. The cool news is they don't have to be mutually exclusive. You can find somebody who is really good and who you really vibe with, who you align with, who you feel good around, who makes you feel comfortable. And that's what she was unpacking in front of me a little bit was this idea that like, I didn't think that mattered, but when she really reflects back now and she starts to look back, she's like, she was uncomfortable with the procedure itself, which is not a good place to go into surgery. She was always wondering what was happening in her recovery, never really got answers anything, didn't get much follow-up. It's unclear how, where she's at now is in relation to normal results if these things are normal, et cetera, et cetera. So she found me basically, and it's a very different experience there where she's just saying, I'm so comfortable. It's so different. I feel like I've made the right choice. I'm with the right person. I'm going to see her and follow up. She'll see my staff and follow up. She's staying in my curated retreat homes. It's very homey. It's very in one place. It's very unique. It's a very unique experience to have that and to feel that comfort. It's all part of the relationship and the experience of it. This is the spoiler alert. This is where the rubber really meets the road. Those are important not just to your experience and to the process, but to your results, honestly. If you are more comfortable in your healing, if you have a better mindset, you have more clear expectations as to what's going to happen, you will have better results after surgery. You'll have a better experience. It will be more comfortable on all those things line up. It's very much in this idea of they're not mutually exclusive. You don't have to find somebody who's a great surgeon, but kind of a jerk or really terse or short or that doesn't need to be the way that it is. Because I choose my patients with somebody that I would want to work with forever. Somebody I go to battle with basically because there's challenging periods. Even if everything goes perfect, which there is no such thing as perfect, if everything goes absolutely perfect and as expected with your recovery, recovery is still hard. There's parts of that that are just a challenge and you don't want somebody on the other end who's not open and receptive to that and who's going to either make you feel like that's not normal or just not be there. Or their team is there or something along those lines. It was very interesting and show in the week coming ahead we'll really get to see where things are different in her recovery phase. But very much an example of how important that relationship is even just in your experience and what it's like to kind of come into surgery and be relaxed and be comfortable and then to move into the recovery phases afterwards. My whole infrastructure is built around that. My whole team, one of my team members goes home with you the night of your procedure. I have somebody whose their sole job and role is just to help as people are navigating the fall-up and recovery period, easily available, simple text message phone call, always communicating with me. My fellows are seeing you. I'm seeing you. You're always with somebody from our team and it makes that whole process and that whole relationship much more fortified and forged moving ahead and a much more comfortable experience for you overall. So, both of those different themes but in the same vein, a first for me and somebody that I said no to who was very, I guess, persistent and articulate and eloquent and I'm really glad that that particular person pushed me, quite literally pushed me to grow. So I'm all forever be grateful for that to be honest and I can't wait to see the outcome in the end and this will be somebody that I'm forever in meshed with after this. A big important decision for me. A first, thanks for tuning in and listening and understanding, I hope that whoever you find and whatever types of procedures you do, you get to experience that same type of important relationship that I feel makes it a really wonderful and valuable experience going through it that way. If you have any questions or topics you would like me to explore further, please leave them in the comments. I read them all and they often help shape the future conversations here. If you would like to learn more about my surgical practice, you can visit clinic5c.com where you will find additional information on my approach to surgery, recovery and performance focus care. I also want to be clear that the views shared on this podcast are my own and are not associated with or representative of my clinical teaching affiliation with the University of Washington School of Medicine, nor should this be taken as individual medical advice. Thank you for spending your time with me. I appreciate you being here and I will see you on the next episode.