Communicating with your Surgeon – Managing expectations, with Dr Jayson Oates

Trish Hammond: Hey all you listeners out there. We’re back again and today we’re having a talk with Dr. Jayson Oates, who is from Subiaco, WA and Crows Nest in New South Wales and Dr. Oates is a … an EMT specialist and he also is the medical director of Academy Face and Body and also the Academy Laser Specialist Clinic in Crows Nest. So welcome, Dr. Oates. I hope I said that all correct.

Dr Jayson Oates: Yeah, well done Trish, good to talk to you again.

Trish Hammond: Awesome. Today we’re gonna talk about something really different. Like normally we’re talking about a procedure or something like this. Today we’re gonna actually talk about client communication and the discussion that we had with our practitioners. So I … we’ve had a little bit of a brief about what we’re gonna talk about but tell us … so what is client communication? Like how does that come into anything?

Dr Jayson Oates: It’s really very important and I was speaking at a facelift meeting … facelifting meeting just recently and talking about the unhappy facelift patient and how to manage it, and a lot of it really came back to how we communicate right at the start when we meet a patient, and the consent process that we go through. And I think there’s been a lot of changes in the thought about how we should consent a patient surgery. And it’s changed a lot for me over the last few years, and for the first 15, 20 years of my medical practise I thought I was doing it right and doing the right thing by the patient but I think I’ve come to believe that what I was doing then wasn’t the best way to help patients with the communication.

Trish Hammond: So, so what you mean by that I like I come to you and I know I want a facelift, but I ask you what I need and you kind of say to me, well, you know, what do you want? Is that what you mean?

Dr Jayson Oates: Yeah, that’s where it used to … came from, and so in fact very frequently the patients will come to me and say what do I need. And I will almost always say, well you don’t need anything, it is all about what do you want. When you’re working in cosmetic medicine, it’s just something that you feel that will help you feel more comfortable, confident in your body. It’s gonna improve something in how you feel about yourself. Now sometimes a patient will come in and have a very specific idea, and say I wanna have a facelift, and sometimes that’s what I think is the right option, sometimes it’s not.

And often I’ll talk to people and say, well there’s a whole range of reasons why you look different today than what you looked when you where 21 and I say a first thing is Ultraviolet light and I’ll grab their arm and show them the back of their arm and say, all this pigmentation and the lines and creases, and roll the arm over and look at the under-surface of the forearm and say, see this beautiful skin here? Well that’s what it’s meant to be like. Ultraviolet light has done this and if you want to improve quality of the skin, then we need to use creams or microdermabrasions or radiofrequency or IPL, maybe lasers, but we need to treat the skin and we’ll improve the skin quality.

So, that’s one. The second is folding the skin. If you fold skin, like you smile or you frown, you’ll eventually wear the collagen away and get a crease, and that’s what we call a dynamic line and there’s a specific treatment for that. You’ve gotta treat the muscle to stop from folding and that’s Botox and the similar neurotoxins. And then the third thing is gravity. Gravity drags everything down and that’s where surgery comes in and that’s why all the surgeries are lifts. So there’s brow-lifts and facelifts and neck-lifts and eye-lifts and boob-lifts and butt-lifts and it’s lifting everything against gravity, and everybody can understand that.

And then the fourth thing is volume. Specially you get to the age of 40 and you start accumulating volume where you don’t want it and you’re losing volume in your face where you need it. And so that’s why we’re manipulating volume and we’re sucking it out from areas, we’re pumping it into other areas. And for each of these things there’s a specific treatment for a specific problem, and there’s only a modest amount of overlap between the two, so if somebody’s feeling concerned about their ageing, sagging face, well maybe injecting fillers is an option, and you can plump that skin up and tighten it up and … you know there are limits though to how much you can put in before it’s not looking better, it’s just looking odd and overdone.

So, if it needs lifting, well then it needs to have surgery, but that’s when I’d start discussing the various options that a person has. So when somebody comes in and maybe they’re 60 and have a face of ageing changes, I’ll say, well you’ve got skin changes there and you’ve got a lot of, what we call photoaging damage. You need laser resurfacing. And you’ve also got a lot of gravitational changes in the skin and in the tissues that planes that they’re … they’re sagging down, and you need to have a facelift. And you’ve got areas where you’re lacking volume. You need volume injected back in, and you need volume replaced into these areas. And then sort of say … I used to always just say to the patient, well what do you want? And they used to say to me, well tell me what I should have.

And I used to say no, no, no, I’m not here to tell you what to have. You tell me what you want, then I’ll do it for you. And an argument, and they couldn’t understand why I wouldn’t tell them what to have. And that’s where I think I was doing it wrong and then that was, sort of the way we were trained, is not to be paternalistic, not to be telling people, choosing for people. Now I do it more around the other way, and I’m asking people, where do you want to get to? What changes would you like to see? Where do you want to be? And then what are you willing to do to get there?

In fact then, I had an interesting woman to come and see me today referred to me by her GP, and she had been a bit ill over the last year or was wanting to do something, she said like her whole face has changed just in the last 12 months. And she had a lot of sagging sort of changes and so I started to say, well then surgery and a facelift. She, oh no, no, no. No, no. No surgery, no anaesthetics something like that. Well okay, well scratch that all. We’re gonna now change where we’re gonna get to because you can’t get to how you looked 20 years ago with your sagging changes without having a facelift. But she had a lot of photo damage and skin change, and so I said, okay what we’ll do is Laser resurfacing.

Here’s a picture of somebody who’s had Laser resurfacing. Do you like that after picture? And I said, and here’s what they look like at one week when … after they’ve had that laser. Faces aren’t burnt off and she said no. No, no lasers for me, we won’t do that, so I said all right, we’re gonna reassess where we’re gonna get to and we’ll talk about fillers then because you’ve got areas where you’ve got hollows, you can have fillers put in, and we’ll do the fillers and that will get you to this point, at least we can make that much change. And she said no, no I don’t want any fillers injected. No needles and no Botox. Then I sort of say, well that sort of leaves me without any treatment anymore. We’ll go speak to the therapist and see if they’ve got anything for you. I knew I had to, like prepare her and say, well this big change that you are hoping for, you’re not going to get if you’re not willing to have the treatment.

So we … it’s very much where you want to get to? And what are you willing to do to get there? And so if you’re not willing to do that, then I can say okay no, facelift is not for you. You’re not willing to have the surgery and the anaesthetic, but okay, let’s cross that off. Let’s talk about something else, I think that you’re willing to do. ‘Cause you’ve gotta end up with something that you’re willing to do.

Trish Hammond: Yeah. Of course, of course. So, say for example … ‘Cause I have actually had a consultation for a facelift and I didn’t actually know what was possible, and I was relying on the doctor to say … I was saying, okay well I don’t like my jowls, I just wanna look a bit rejuvenated, so he made a lot of suggestions and the suggestions that he made, I thought was a little bit too much. For me, I didn’t want so much … I got frightened thinking that I was gonna have that really, really swollen face for a bit. So, so … it’s a fine line as to, sort of how much you could … you know, you can tell me what I should have but how much I wanna have done. So I guess the option is where, I suppose you gonna … you can probably compare with showing some before and afters of someone who might be similar, maybe.

Dr Jayson Oates: Yeah, so that’s, sort of really important because my patients have the same problems, because I have several different facelifting alternatives, and I’ll often say to patients, that big treatments get big results and little treatments get little results. And you’re just not gonna get the big results from a little treatment. And so for a facelift my preferred way, for a person who requires it is a deep plane facelift, where we come in at a deeper level. We divide the retaining ligaments that are preventing the face from being lifted up, then the whole face sort of comes back in sort of one unit as it securely attached, and in fact the recovery usually is really good with that because you don’t dissect immediately under the skin.

It’s done deep down so you don’t get as much scrubbing and bruising that you can see. But it’s a bit more involved. It’s a longer procedure, it’s more expensive and it gets closer to the nerve … to the facial nerve that controls all the movement of the face. So the risk is perhaps slightly more. Some people don’t like that so much so we’ve got less invasive option, which is what I always used to do. Like the max lift, where you can do a lift without going so deep. It’s not as strong a lift, as big a lift, perhaps doesn’t last as long as the deep plane facelift, but it’s less invasive, less risk and it’s cheaper. And for some people that then becomes where they’re comfortable. And so it’s important to … for the surgeon to really find out from the patient what it is that they want, and in fact part of it is even how much they’re willing to spend.

Yeah, is no point in saying from what you’ve … what you have to have is this $20,000 procedure if they’ve got $5000 to spend. Sometimes it’s better to say, look what you’re trying to achieve you can’t achieve for $5000, and do nothing or say, look here are options that at price point but they’re not really going to achieve you’re initial aim, but is a secondary aim that’s a smaller aim still gonna be enough to make you happy?

Trish Hammond: And I guess it’s … once again it’s that fine line of telling people what they need without offending them as well, I guess.

Dr Jayson Oates: Yeah, and so … and then, and then … that is part of the understanding your own bias as a surgeon because you’re doing a service, providing a service for people and charging them a fee, and in general cosmetic surgery is not cheap. It’s a significant expense for people. And you need to be aware of your own motivations as well, and not get caught up in pushing the most expensive procedure.

Now sometimes I’ll have patients. They say oh well, which of these should I have? Which of these do you think I should have? And I say you should have the expensive one because our mortgage … I want you to help me pay that off, but hopefully they get the joke. But it’s … I think it is important that, for surgeons to be self-aware enough to know that they do have this bias and they’ve gotta be cognitive about themselves.

Trish Hammond: Yeah, well I was re=sharing a story to you before, like what happens in the case where I had a consultation with a nurse injector, actually. And this was about ten years ago. Yeah, I was about 44, I haven’t had anything done ever and I had a consultation for some cosmetic tattoo and I asked her what she thought, you know … what else? … should I have anything else done. Thinking that she would say to me no, you don’t need anything done she started saying, okay well, frown … oh, we gotta get rid of that, and I was like oh my god, it actually made me look at things that I hadn’t looked at before. Like the Marionette lines and stuff like that. So you don’t wanna kind of put … you don’t wanna kind of make someone feel bad about themselves I suppose as well.

Dr Jayson Oates: It’s an interesting balance and that is, sort of the art of a good communicator because some people don’t, sort of have the insight into what they need if they want to achieve the best aesthetic outcome that they can, and the … you need to be able to explain to them, perhaps what they do have as an aesthetic problem and what the potential correction for it is. But at the same time you don’t want to be pointing out every single flaw in somebody, and giving them this huge shopping list of things that they need to spend a fortune on to correct.

And I think it’s very much based on the feedback that the patient wants and the doctor or the nurse asking the right questions, and seeing how the patient, sort of reacts, because, yeah that’s always the worry. When somebody comes in front of you and you say, what would you like to talk about, they say, well isn’t it obvious and you sort of look and you’re thinking. Well, it’s your big nose. Do you say the big nose and then they say what’s wrong with my nose? I better be worried … should I be worried about my nose? I didn’t realise. Now I’ve made them worry about something else.

Trish Hammond: That’s exactly happened to me. It’s true. It’s a slippery slide isn’t it.

Dr Jayson Oates: It is and … but at the same time some people do want that and they … and that’s what they there … and they’re paying you, the surgeon a professional fee and coming and asking for your advice, and in that case you do wanna be giving them your advice. So it’s all about balancing out what you understand that patient is really wanting, and then trying to give it to them.

Trish Hammond: Yeah, and you know what? On the other side of the coin, if the patient asks the question correctly, like what … I’m not happy … I feel like I look a lot older, sorry … I feel like I look a lot older than I feel and what are the things that are available for people that may wanna rejuvenate their skin and … give me all the options and I can pick as far as I wanna go or whatever.

Dr Jayson Oates: And that’s great when somebody’s like that, although sometimes you’re sort of thinking, jeez, there are a lot of options to discuss, this is gonna take a long time, but yeah it’s in fact, it’s a worrying sign for a surgeon if somebody just can’t come out and tell you what it is that they’re worried about. It’s very useful if they come out and say it’s my eyelids, it’s my nose, it’s my jowls, it’s my ears, it … and if they can pinpoint it, then you … and you’re looking at it and say, yup I can see why you have a concern and I have a technique that can improve that, and the chances of everybody being happy at the end of this relationship, is good. But if somebody can’t express what it is that they’re concerned about, then it’s … I think it’s gonna be much harder for them to then feel happy with the end result. When they didn’t know what it was that they were worried about in the first place.

Trish Hammond: That’s so true. That’s so true. And, I mean the good thing is about coming … going to a surgeon, at least you can get all options, you can get the non-surgical and the surgical op … well, providing you do non-surgical. You can get both options.

Dr Jayson Oates: Yes, well some clinics, like our clinics, we tend to be able to offer a really broad range of things. And there are some surgeons who just like purely surgical, and they don’t cover any of the other options. And I can see the benefits of running both kinds of clinics and there are times when I wish I had a really simple, small practise, and I didn’t have all the lasers and the toys that we have, but yeah, just try to work- [crosstalk 00:18:45]

Trish Hammond: Yeah, ‘Cause how do you decide … how do you decide what to tell some … ‘Cause they could do … you could do, just do everything.

Dr Jayson Oates: Well that’s … the golden key is you can’t do everything, and that’s the hard bit.

Trish Hammond: Yeah, yeah. Now that’s true. So all to … what it comes down to is if you … as a patient you need to be really clear in your communication. Before you, kind of go somewhere, know exactly what you want, or at least what you want to achieve, and have some sort of a background and have … and hopefully the doctor will give you something to compare yourself with something similar with the … someone your own age who’s got similar features or if you wanna get your nose fixed, someone who’s got a similar background with a similar shape nose and the results that you’re gonna achieve. So it’s … it kind of onuses back on the patient as well to give the sum indication of what you want.

Dr Jayson Oates: Yeah, I think it’s a really good idea to write a list and I’m amazed, in fact how few patients actually do, because it’s so easy to forget the things that you where planning to say. So I think it’s useful. I think it is useful if you … if it’s a rejuvenation-type surgery. You wanna look a bit like how you looked 10, 15 years ago, then definitely bring a photo of yourself from 10, 15, 20 years ago so you can say well, used to look like this. I wanna look more how I used to. That’s really, really helpful. Yeah, we can’t, as a doctor we can’t expect you to have the medical knowledge and the understanding of the techniques, the surgery, potential [inaudible 00:20:31]. That’s our job, you know that and to try and impart some of that knowledge back to the patient, so they can feel comfortable in deciding to actually go ahead with this [inaudible 00:20:43].

Trish Hammond: And the possibility of what’s actually achievable as well, I think. ‘Cause sometimes we just don’t know what’s achievable.

Dr Jayson Oates: And I think if you also have a clear idea of what you’re not willing to do. So if you say, look I just don’t wanna have surgery, then at least the surgeon knows how to guide the rest of [inaudible 00:21:07]. Or they might be that they can say, well you obviously have some good reasons that … do you mind if I ask what they are? And … ‘Cause they might then say, I had this bad experience and the surgery might be able to reassure you, okay well that’s unlikely to happen again or … or say okay no, that’s, that’s totally fair enough. Let’s not explore that pathway and that can then guide your time with them. Following where you want to go.

Trish Hammond: Yeah, yeah. That’s true, and I guess that’s … that comes back to, I guess the person answering your phone as well when they book someone in, hey?

Dr Jayson Oates: Yeah.

Trish Hammond: Making sure they know exactly what they’re booking in for.

Dr Jayson Oates: Yeah, and that’s important. That’s all part of the training everybody. That’s why I’m so blessed with the staff that I have. Many of them have been with me for more than 10 years. And yeah, they know what I do, they know what patients are going to go through and the recovery, so they can give them lots of information and insight into what I’m gonna be talking about.

Trish Hammond: Yeah, well it’s been so interesting. Yeah, I’ve really enjoyed that because it’s right up my alley. So I know, oh what do I need? Well thank you for that.

Dr Jayson Oates: You’re welcome Trish, always a pleasure to speak with you.

Trish Hammond: Awesome. So, if your listeners out there wanna go and see Dr. Oates, as I said, he’s available in Subiaco at Academy Face and Body or you can also get in contact with him at Crows Nest and so you can look him up online or you can drop me an email to Trish@platsicsurgeryhelp.com.au. So, until next time Dr. Oates. I’ll speak to you then.

Dr Jayson Oates: Great.

Trish Hammond: Thanks so much, bye.

Dr Jayson Oates: Bye.

Trish