Rohrich, R. J. (2000). The who, what, when, and why of cosmetic surgery: Do our patients need a preoperative psychiatric evaluation? Plastic and Reconstructive Surgery,106(7), 1605-1607.
ABSTRACT. Dr. Rohrich's focus in this article is mostly on the psyche of the patient. He refers to an article in the New York Observer: a New York State Appellate Court ruled that a patient had the right to sue her plastic surgeon for malpractice because the surgeon failed to take into account psychological problems rendering her incompetent to give a real consent for surgery (Kaplan, 2000). This patient had undergone numerous cosmetic surgeries over the years by the same plastic surgeon, was pleased with the results, yet now she was blaming him for doing the surgery, indicating that he should have known she had severe "body image" issues. The author discusses body dysmorphic disorder and outlines the definition of the disorder. Several questions are raised, should all patients have a psychological exam? When does one refer a patient to a psychiatrist? If a patient is under the care of a psychiatrist, does one require clearance from the psychiatrist prior to a surgical procedure? Plastic surgeons need to use patient selection criteria, Dr. Rohrich advocates "who, what, when and why".
* Who is our patient, and what are his or her personality traits, likes, and dislikes?
* What are his or her goals for surgery, and can we accomplish these goals safely?
* When is the best time to perform the surgery? Is he or she experiencing problems that might make surgery a bad option at this time?
* Why does the patient want this procedure, and does he or she have realistic expectation and understand the limitations of the surgery?(Rohrich, 2000)
COMMENTS. As clinicians, we need to be attentive to the verbal and nonverbal messages from our patients. What is your "gut" telling you about this patient? Are the "red flags" waving, or does this patient meet your selection criteria? We work as a team with the physicians; if you sense something is not quite right, or a patient shares information with you that warrants a more careful assessment prior to scheduling a procedure, communicate this to the physician.
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