Plastic doctor-patient relationship

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With the rise of "beauty economy", people are more and more aware of the importance of beautiful appearance, so the number of patients receiving minimally invasive and non-invasive cosmetic surgery has increased all the way.

At present, Realself is a popular platform for patients in the United States. It not only helps patients, but also enables doctors to understand patients' experience and how to improve. Researchers from Boston University * recently analyzed RealSelf.com, a website that gave negative comments to patients, and recorded the reasons why patients were dissatisfied with the following medical beauty projects:

Cellfina

Cooling

Embumpt

Injection lipolysis (Kybella)

MiraDry

Thermage

Buried wire wrinkle removal and hot stretching (Ultherapy)

research method

From June 2019 to July 2019, researchers extracted data that RealSelf patients can evaluate their surgery on the website as "worthwhile, uncertain" or "unworthy". There were 1512 comments on all the data extracted from the category "unworthy". Record the reasons for the patient's dissatisfaction. If the patient lists two reasons for dissatisfaction (such as complications and no treatment), record the two reasons. If the patient is unhappy due to complications, record the specific complications listed.

If the patient shows no treatment in the expected postoperative recovery period (improvement of orange peel tissue), 3 months after Cellfina and frozen lipolysis, 6 weeks after Embump, 1 month after injection of lipolysis, catgut embedding and wrinkle removal, 1 month after MiraDry operation with hyperhidrosis, and 6 months after Remagi and Relati), the analysis excludes reexamination. If the patient's dissatisfaction is due to the medical staff's poor attitude towards the patient, dissatisfaction with the treatment process or other management or non medical issues, it is also excluded.

Research results

1204 negative comments were included in the analysis. Among all the items analyzed, the common reasons for patients' dissatisfaction were none: cellulfina (n=18,58.1%) cryolipolysis Coolsculping (n=427,82.9%), fat burning and muscle strengthening EmpSULPT (n=5, * *), fat dissolving Kybella injection (n=55,69.6%), sweating inhibition MiraDry (n=40,64.5%), and ReMagee Thermal (n=81,54.7%), embedding and wrinkle removal (n=36,45.6%) And pyrotti (n=120,59.1%). Complications and pain refer to the second and third common reasons that patients rate surgery as "not worth it" (see the table below).

New "mass" (n=6,50. The improvement of orange peel tissue surgery was 0% (Cellfina). Common patients reported complications.

Fertilization in the treatment area is a common complication of frozen lipolysis (n=23,22.1%).

The common complications of swelling and numbness were caused by injection of Kybella (n=9,47.4%) and MiraDry (n=6,35.3%) respectively.

Incision is a common complication of catgut embedding for wrinkle removal (n=10,30.3%). Fat loss is a common side effect of Remagi (n=26,53.1%) and Relati (n=32,48.5%).

discuss

Among all minimally invasive medical beauty items analyzed in this study, none, complications and pain are the common reasons for patients' dissatisfaction, and most patients feel unhappy because of none. There were also previous studies on the satisfaction of laser patients. Interestingly, most patients who received laser and intense pulsed light treatment were unhappy.

In addition, some patient evaluations listed some surgical complications not reported in the literature, such as fat reduction after ultrasound treatment. Interestingly, 16.3% of non obese patients who received cryolysis reported abnormal fat hypertrophy (PAH), which is much higher than the PAH rate mentioned in the literature (0.025% to 1%). We suspect that there are two reasons:

Qualitative PAH that patients may mistake for postoperative swelling or weight gain;

Confirm that the components of the deviation may exist. A given patient may read PAH on the Internet and feel that they are suffering from the same complications as other complications.

In an era when patients can immediately post comments to social media and online patient interaction platforms, patient experience becomes more and more important, especially in plastic surgery. Understanding and discussing the results reported by patients will help adjust the expectations of doctors and patients, * and ultimately help improve the patient's experience.

- Photoelectricity

In the United States, the frequency of laser and intense pulsed light (IPL) treatment for beauty seekers is increasing; However, it was reported that patients reported subjective evaluation results of these photoelectric items. Clinical trials provide a method for scientific investigation of objective results and patient reporting of subjective satisfaction. Social media and other online comment communities provide doctors with another tool to gain insight into the patient experience. Online portals Yelp and Zocdoc were used to study patients' satisfaction with skin disease treatment.

Researchers from Boston and Yale University collected data from RealSelf.com, the larger doctor-patient interaction community in the United States, to determine the common reasons for patients' dissatisfaction with photoelectric therapy.

Friendly Tips

This study is not applicable to China. The reason is simple. In China, poor reviews are a profession

research method

From September 2018 to November 2018, researchers selected researchers. RealSelfcom extracted the data of patients' poor evaluation results: laser Tattoo Removal, intense pulsed light (IPL), fractional laser resurfacing, laser hair removal CO2 dot matrix laser therapy (CO2).

At RealSelf, patients can evaluate their project experience on the website as "worthwhile", "uncertain" or "unworthy"; The researchers used the data extracted from the comments of this study from the "unworthy".

There were 583 adverse comments in total, with a median of 117 for each treatment. It does not include adverse comments from outside the United States. If the patient lists two reasons for dissatisfaction (such as complications and no treatment), record the two reasons. At the same time, collect the specific complications listed by the patients.

Research results

Laser Tattoo Removal, intense pulsed light (IPL), fractional laser resurfacing CO2 dot matrix laser therapy (CO2) complications are the common reasons for patients' dissatisfaction (n=312, 63.2%). Treatment was not the second cause of dissatisfaction (n=184, 37.3%).

However, the common reason for patients' dissatisfaction with laser hair removal is that no complications (n=55, 61.8%) is the second common reason (n=42, 47.2%) (see the table below).

Fractional Laser Resurfacing (n=47,40.5%), intense pulsed light (IPL) (n=51,39.5%), carbon dioxide lattice laser therapy (CO2) (n=side effects are common in 24,50%).

Scar is a common side effect of laser hair removal (n=10,52.6%). Skin burn is a common complication of laser hair removal (n=18,42.86%). The side effects of CO2 laser treatment are usually unrelated to these treatments, such as facial volume reduction (n=39,8.5%) and static wrinkles aggravation (n=35,7.6%).

discuss

Research shows that complications and treatment are not the common reasons for patients' dissatisfaction. The previous literature shows that the important factor affecting the results of plastic surgery is not the objective technical success of the surgery, but the patient's opinion of the surgical results.

Patients' understanding of "none" and treatment can be improved through basic patient education and preoperative communication before treatment, and reach the expected agreement with patients. In many adverse comments, patients commented that they did not get suggestions on the expected number of courses of treatment, and there was no single or limited number of treatments.

In addition, a consultation that openly discusses potential complications before the expected postoperative recovery and treatment may alleviate the initial postoperative concerns and alleviate patients' dissatisfaction when complications occur. The patient listed some adverse comments "complications", such as temporary changes in skin wrinkles, heavy skin color, bruises, etc., Because of their dissatisfaction. Well educated patients hope to avoid or reduce adverse experience after surgery through some treatment, but unknowing patients may think this is a complication, leading to negative patient experience.

In the era of modern social media and online comments, from a subjective perspective, aesthetic treatment of patients seems to be increasingly important. Patients' dissatisfaction can not completely prevent real complications and no treatment; However, doctors can improve the patient's experience by studying the negative results reported by patients as detailed in this study.