By Ryu Inhong

 

Pigmentary lesions are the most common type of dermatological condition yet it is also the most problematic. Dr. Sang-dae Shim of Human Dermatology Clinic Uijeongbu treats many cases of pigmentary lesions and says he finds patients with hypopigmentation the most difficult.

“When PIH occurs, I can perform laser toning, although there is no promise that it will be cleared. But there isn’t much to do for hypopigmentation. Patients themselves are unwilling to try treatment. When hypopigmentation occurs, the patient-doctor rapport is usually completely destroyed. Patients often demand full refund and when their demands are not met, they tend to cause a scene at the doctor’s office.”

Plastic surgeons particularly see a high number of disgruntled patients. Dr. Myung-jong Lee of Noblesse Plastic Surgery explains that the degree of satisfaction with surgical outcome is very subjective.

 

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“Sometimes, even very successful double eyelid surgery cannot correct asymetrical eyes. Most people have varying degrees of asymmetry of the shape of the eyes and naturally, the surgical outcome can also be asymetrical. However, some patients complain of asymmetry, even when the overall results are natural and beautiful. Also, capsular contracture often follows breast augmentation. I take the time to fully explain the possibility of such side effects to my patients before the procedure but some of them still sue the hospital over side effects. Some patients who seek plastic surgery, do so because they are frustrated with their unsuccessful business or their marriage is not working out. Patients with such underlying neurotic tendencies can turn confrontational later. Patients receiving rhinoplasty are particularly prone to neurosis. I once performed rhinoplasty on a patient with a short nose bridge and thin skin. Patients with such features are not likely to experience drastic improvement. This patient was initially satisfied with the result but kept comparing with others and finally demanded resurgery. Faced with such impossible demands, the doctor should be able to firmly say ‘No.’ The demands are endless and the doctor should draw the line somewhere.”

Dr. Jang-seok Bang of Meline Skin Clinic says various problems arise from the patients’ unrealistic expectations.

“In a key example of such unrealistic expectations, patients often ask the doctor to make their skin translucent like that of celebrities. Even a very skilled doctor would not bring such drastic improvements. Bigger problems arise when patients expect one or two treatments to bring flawless skin or even expect free procedures. Therefore, it is important to make patients understand that even the most costly and innovative treatments cannot bring flawless skin over long term. Patients who do not understand this and hold onto their impossible expectations are likely to become problem patients later. Another problem is that even the initial outcome is flawless skin, it is rarely maintained long term. The skin changes and ages every day. Even if your skin is smooth and clear now, in two years it will return to the original condition. If patients fail to understand this, they will continue to pester the doctor. Another type of difficult patients do not have unrealistic expectations but present intractable conditions. Atopic dermatitis is one such condition. Patients who have tried different doctors with frustration will not suddenly improve with me. These patients suffer mentally as well. I even had a patient who cried for two hours in the treatment room.

Dr. Yoo-jung Kim of WHITskin Dermatology Clinic says it is easier to resolve problems if patients have clear demands.

“One female patient of mine developed mild pigmentation after fractional laser. Her husband came to the clinic and angrily demanded reparation. We explained that the condition was not severe and could be resolved in time but he insisted that he would get diagnosis from a university hospital. He returned a week later, saying that other doctors agreed with me and that he would not cause any more problems if his wife’s pigmentation was cleared. This case was resolved after 10 treatments of laser toning. If patients have clear demands, it is easier to resolve their problems. It helps to ask the patient exactly what they want.”

 

-To be continued-