Dr. Hess Reflects on His Approach to Patient Consultations

The following is Fairfax, Virginia plastic surgeon Dr. Hess’ reflection of his initial consultation with breast reconstruction patient Pamela K., and the importance of effective communication between a surgeon and patient throughout the treatment process. Click here to see all chapters from Pamela’s story.

I’ve Been Through a Lot of Training.

College, medical school, and six grueling years of residency. And I’m very happy with the programs I attended. The Georgetown Plastic Surgery residency is one of the top in the country. I worked with dozens of different surgeons learning the techniques necessary to operate. I learned the decision-making process necessary to know when to operate and when not to operate. I performed over 2500 surgeries and saw thousands of patients. So when I graduated, I was confident in my abilities.

I started my practice and almost immediately realized what I had never been taught—how to talk to patients, especially breast cancer patients. I don’t blame anyone for this oversight; there simply is limited time and a lot to do during residency. Frankly, talking with patients is an incredibly difficult skill to teach.

There’s a Big Difference Between Communicating With Patients and Talking With Patients.

Doctors and patients have to talk, they have to exchange information. The doctor listens to the patient give their medical history, takes down all the information, and in the end gives a diagnosis or presumptive diagnosis. It’s no different than meeting with a banker when getting a loan or the plumber when getting pipes repaired. But really talking with patients requires the physician to be more emotionally connected in the conversation.

When I meet with breast cancer patients for a reconstructive consultation, we talk for as long as is necessary. I listen to what they tell me, what they don’t tell me and how they tell it. I study their body language and evaluate their emotional state. I determine how much they know about breast cancer in general, their own diagnosis and breast reconstruction. I don’t just listen, I hear what they tell me. As we talk, I establish what the patient needs from me, both from a plastic surgery standpoint and an emotional standpoint.

Pamela’s Consultation Was One of the Easiest I’ve Done.

She is a smart, energetic, positive and outgoing woman who loves to talk. Which is good, because I too have the gift of gab. We just “clicked” from the start, like someone you’ve been good friends with your whole life. As I do in all of my consultations we discussed her cancer type, size and breast surgery options—lumpectomy and radiation vs. mastectomy.

I went through all of the breast reconstructive options. Not just the surgeries that I perform but all that are available. I’m not trying to make a sale but rather give the patient all the necessary information so that they can choose the best option for them. I explained that breast reconstruction can be a year-long process. She told me that she had a very busy job/life and really wanted the quickest option.

But Downtime Was a Major Concern for Pamela…

She cried as she told me about her son and how to tell him she had cancer. She said that because of him, she didn’t want the downtime that is associated with reconstructive surgery. As we talked, it really became clear to me that she should have the lumpectomy and radiation.

So I was surprised when she called to schedule reconstructive surgery.

Next: The Agony and the Ecstasy of My Cancer Diagnosis by Pamela K.