The day patients became “clients”…

The extradition of plastic surgery has finally reached its tragic absurdity. The circle closed.

Where has the patient-doctor relationship gone?

The level of targeted manipulation in the field of cosmetic plastic surgery in today's media and social networks is impressive. Everyone's right to speak their truth is completely legitimate and justified. And the right to earn just as much. All of us, including those of us in the profession, are partly responsible for this, by doing or not doing. Maybe that's why we need to write a few words about it from the "other side" of the coin.

Competence and expertise for a particular procedure have absolutely nothing to do with populist portals or magazines. THESE ARE PAID ARTICLES, TV SHOWS and WEB PORTALS by doctor-entrepreneurs and their "PR managers" in which patients are called "clients", "the most famous, most beautiful and best cosmetic surgeons in the Republic of Croatia and beyond", "the king of this and that". As a rule, those who know the least about the profession invest the most in advertising!!

A good product advertises itself?

Among colleagues, stories are widely circulated about the existence of a paid IT team that simulates "positive patient opinions" and sends them to such portals from different e-mail addresses for those who pay for it. Likewise, negative opinions and "experiences" about competing polyclinics and colleagues - entrepreneurs.

The pictures "before and after the procedure" show mostly selected (only good), photoshopped pictures that have little to do with real results or complications and thus create unrealistic expectations of the procedure.

For decades, patients in the Republic of Croatia have been going to unlicensed plastic surgeons, or self-proclaimed aesthetic surgeons and doctors, for breast surgery, without checking their license with the Croatian Medical Chamber or the Croatian Medical Association. For filler and botox applications, they often go to an even more obscure group of "experts" who "freshly arrived from neighboring countries, left behind in their bags from a course". And this has never been the topic of any of these TV or radio shows, populist magazines or portals in the Republic of Croatia!

That, as they say, "doesn't sell the goods."

As the first and umbrella Association of Plastic Surgeons in the Republic of Croatia, HDPREK (hdprek.hlz.hr) has been waging an unsuccessful battle for years to ban advertising outside the name of the license, especially self-proclaimed "aesthetic surgeons" and unlicensed work, which has minimal or no support from the media as an "insolvent topic".

The reason for the failure, in addition to the real lack of information among patients, is the proactive projects and interest of pharmaceutical companies to sell the product "regardless of who installs it" and the interest of some media and journalists to earn money through paid systematic "PR branding" of the image and work of the doctor-entrepreneur.

On the other hand, another type of "PR branding", but this time negative, is also widely represented both in the media and in social networks, often with sensationalist titles such as "Butcher from Hell", "Victims of aesthetic procedures and doctors", etc.! Again, without any argumentation and objectification, it is prejudged that someone destroyed someone's life with a "butcher's operation". It is not uncommon for "media experts, "influencers" and dissatisfied patients to make monstrous accusations and prejudices about who and whose life they "ruined" with bad cosmetic surgery and calls for a media lynching, all for the purpose of "helping the victim" and supposedly "solidarity with the victim". Not infrequently, private "aesthetic" and plastic surgeons are extorted by some lawyers and patients, and those who do not want to pay for "ruining someone's life" they expose themselves to public lynching and burning in the populist media. Some patients also have psychiatric consequences before the procedure. They also make a lot of money from "PR managers" on social networks.

Of course, complications and medical errors also happen. Complications and unwanted results can happen only to those who do not do it. But the court is the only place where this can be judged and adequate satisfaction can be awarded. Otherwise, it ends like the recent suicide of a doctor in Varaždin after a media lynching on social networks. Whose interest is that? Or the suicide of a patient like the one that happened at the beginning of the “popularization of plastic surgery” and the famous TV show on the subject two decades ago in the Republic of Croatia. Whose interest is that? Of course, no one. That is a tragedy at the end of a media and PR comedy.

Who can presume to judge that? Well, the court, of course.

So how do you choose an operator and not a "butcher"? How do you choose a patient and not a "client"?

How did the patient-plastic surgeon relationship become a client-entrepreneur relationship, functional in both directions? In the worst sense of the word.

In such a climate of mutual media manipulation of virtual social networks, who can be trusted, which is the key to the success of the intervention, but also responsibility in case of dissatisfaction with the outcome.

How to choose a plastic surgeon, but also a patient, in such a climate. That choice must be two-way, 50/50%.

From a personal perspective.

The whole story of treatment is a story of doctor-patient trust. In private healthcare, there is a big difference compared to “public healthcare”! In private healthcare, everyone can and must choose. Both the doctor and the patient.

From the patient's side, not the client's:

1. Every patient must first find out about the license of the plastic surgeon they plan to see for an examination and consultation. Ignorantia iuris non excusat. Ignorance does not excuse. Remember that a passenger who sits with a driver who is obviously under the influence of alcohol is co-responsible for a traffic accident when trying to collect the consequences through insurance! Co-responsibility also exists when you go to an unlicensed plastic surgeon.
2. Prepare a list of questions for your interview with your plastic surgeon. Otherwise, you may not remember everything you want to know about the procedure. The informed consent that is signed when you go for surgery or another procedure means that you have been informed and have received answers to all your questions.
3. The experience of previous patients of the potential operator, preferably in person, so that they can assess the reliability of their source of information and not from social networks and unverifiable sources where anything can be said without any objectification.
4. The opinion of his colleagues about the planned operator.
5. And finally and decisively, the patient's impression of the expertise and reliability of the operator to whom they will entrust their trust.
6. The patient must be aware of his or her share of responsibility for the choice .

From the perspective of a plastic surgeon, not an entrepreneur:

1. Every patient who pays is not a good patient.
2. A patient who is focused on the GOAL is a potentially dissatisfied patient. Plastic surgery is not performed on a standardized material like “galvanized sheet metal” but on a biological “fabric” that has biological variability. Let me explain. Ten identical surgeries or other procedures with the same technique and material will often yield ten different results on ten patients. But generally none that matches the patient’s “projection” of the target result nor the patient’s aesthetic vision, which is always a fiction.
3. A patient who is focused on the PROBLEM is a potentially satisfied patient when the plastic surgeon solves that specific problem.
4. A plastic surgeon who does not choose his patients risks becoming an entrepreneur over time, with all the risks of such an approach in terms of "cost benefit".

Ultimately, this era of medicine as entrepreneurship has given birth to the client-entrepreneur relationship. The doctor-patient relationship functions for mutual benefit only if there is both mutual choice and a relationship of trust. And no less importantly: then both parties take on their share of responsibility.

Asst. prim. Ph.D. Zlatko Vlajčić, MD.
plastic surgeon