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Preventing Litigation With Assessment Procedures

By: Trish Henrie, PhD
Posted: May 3, 2010, from the May 2010 issue of
Physician speaking with a patient

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Abstract: When people with mental or emotional disorders seek out cosmetic surgery to help remedy their problems, it can spell trouble for a physician and his practice. Knowing what traits to look for in a person unsuitable for surgery, as well as how to deal with patients unhappy with their surgical results, can be done with assessment procedures that aim to help protect physicians from potential legal ordeals.

Recently, a cosmetic surgeon shared this experience that, unfortunately, is not unique. He reported that he performed surgery on a woman who was excessively concerned about her appearance. After the surgery, she was extremely dissatisfied and insisted on a redo. Still unsatisfied, she began harassing the physician and his family. She took out ads in the local papers, created a slanderous blog about him, and threatened his wife and his office staff. This went on for about six months, until tragically the woman committed suicide.

The problematic patient

Research shows that an inordinate amount of people with mental and emotional conditions seek plastic and other elective surgeries. Presumably, individuals who seek cosmetic enhancement want to improve their self-esteem and self-confidence, and a good surgical outcome should improve these domains, as well as result in increased confidence in social situations.

However, as illustrated in the incident cited above, this is not always the case. Some individuals will never be satisfied with a surgical outcome. These insatiable patients return for repeated procedures, seeking relief from extreme body image dissatisfaction. These individuals have a condition known as body dysmorphic disorder (BDD), which is indicated by a preoccupation with an imagined defect and unrealistic expectations about the outcome of surgery.

Patients with BDD perceive imagined physical defects and seek cosmetic procedures to correct them. Because these procedures will not improve the underlying psychological condition, the patient will not be satisfied with even the most successful surgery. In some cases, concern with physical appearance reaches an intensity that causes subjective distress to the individual and leads to the impairment of functioning in social and other domains.1