Your Math Does not Add Up
As some of you know, I submitted my book manuscript a couple of weeks ago but today I am doing a final edit on the fat grafting chapter and thought of a good blog idea. Many patients ask me, “How long is the recovery?” “What percentage of improvement can you think to achieve with this (fill in the blank)?” I have become increasingly wary answering these questions because I do not know what my patient really expects or how their expectations are in alignment with mine.
Oftentimes what happens is that when it comes to a percentage improvement or how long will my filler last, it is a natural tendency for almost every patient to remember the bigger number. For example, “I think your acne scarring will be improved between 30 to 70%.” In that individual’s mind, he/she hears “up to 70%”. That is troublesome. That is the problem with items on sale that read “up to 50% off”. Most likely, most things are 5 to 10% off with 1 or 2 items you don’t even want listed at 50% off. But what we hear is “everything is 50% off.” That is human nature. If I say, “Your filler should last between 6 months to a year.” People hear, “Oh good, it will last 1 year.” That is a problem. What if the filler lasts only 3 months? Then I have lied to the patient.
All of this is really hard. We all want general parameters, but after I give some parameters people tend to have their brain stick to a number. It is much easier to remember something concrete like a number and not my long discourse on why it may or may not fall within those parameters.
The converse is true. Let’s say I say “Your recovery should be between 7 to 10 days.” Well, what the heck does that mean? Discomfort, bruising, swelling, what? Patients tend to remember the lower number in this case. Oh, he said I could go back to work at 7 days. That is difficult too because I NEVER know when you will be happy. I had one lady after fat grafting say, “Doc, you lied to me. I do not look acceptable at 2 weeks.” I had another lady say at a month, “I can’t believe I look this way at a month. This is terrible.” I thought both looked great when I saw them but it really does not matter what I think. It matters what my patient thinks. These are very rare cases but at the same time I have now angered two patients (who actually were very happy only 2 weeks later for both of them.)
Finally, what the heck does “50 to 70% improvement” even mean? Acne scarring is one of the most difficult things I do because I know I will NEVER get it perfect. I can only improve on the situation. This lady at a year following silicone injections told me, “I thought I would get at least 50% improvement.” She looks so good, she is actually on my website so I was befuddled. Now, I am very frightened to give percentages.
I still give numbers out to help people think of rough parameters but I am careful to state with absolute clarity the absolute non-absoluteness of my comments absolutely!
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