Balding Blog

This is a publication from the Kaiser Wellness Journal written by my son Sean Rassman, an orthopedic surgeon moved by a motivational speaker

Woe is me vs. Wow is me – what’s your take?
Published July 9, 2015
By Sean O. Rassman, MD
Department of Orthopedic Surgery, Fontana

Of all the physician off-sites and speeches I have attended in the last nine years, the personal life story told by my colleague, Dr. Kent Miyamoto, had the greatest impact on me. I am sure each physician who heard him speak that day took away something different. What touched me most about his story was not what one may think — the precariousness of life — but what he felt as a patient. He said that he had tried to thank his doctor for saving his life and his gratitude was met with, “I was just doing my job.” He indicated that he actually felt a bit dismissed and cheated by the response.

This made me rethink all of my patient interactions. What we do is more than just a job to the people we treat. I may see up to 40 or more patients on a clinic day, each scheduled for 15 minutes. In reality, I may have even less time than this, due to my seemingly always overbooked schedule. Many days I go through clinic stressed. I work straight through every lunch and often stay an hour or more after my clinic to finish up and then respond to patient messages. I will admit that I have felt frustration and even anger towards patients who try to extend their 15-minute appointment into 20, 30, or sometimes 45 to 60 minutes. I have thought too many times, “Don’t they know how busy I am and how many other patients are on my schedule?”

There was something about Kent’s story that made me realize, although we may only spend 15 minutes with a patient, that 15 minutes is amplified in so many ways.
Often, patients wait weeks or months to see me and may drive for an hour or more in each direction. They may give up several hours of a day for a 15-minute appointment with me. It is likely that all of their family, friends, and perhaps even coworkers have heard about that upcoming appointment. Many patients have likely spent hours thinking about it, discussing it, trying to anticipate what the doctor will say, and, after the appointment, may spend additional hours trying to make sense and summarize that 15 minutes with all of those in their lives.

I realized I had the choice to see these appointments as something that I needed to get through or 30 to 40 opportunities to make a tremendous impact in people’s lives and the hundreds of friends and family who are impacted by that illness. This is both an honor and a weighty burden.

I asked myself, what would happen if I tried to use the 15 minutes not just to “satisfy” or placate patients, but what if I could use that time to wow or amaze them with by showing them that I not only understand their problems, but that I care about them?

Switching to this attitude resulted in a mental shift and I began to look forward to my clinics more as opportunities to make daily, meaningful impacts and perhaps even amaze a few people.

This mindset is something to which I must frequently rededicate myself, particularly when dealing with difficult patients. Whether they are abusive or manipulative, they can contribute significant stress and one or two difficult patients can ruin a physician’s entire day.

I will probably remember little of our motivational speaker from that meeting last year, aside from the fact he liked to climb mountains, but I will always remember Kent’s story and the impact it had on me.

In the past, I was often guilty of brushing off the compliments of grateful patients, because I knew I had a chance to reduce their 15-minute appointments and use extra minutes on difficult patients.

I used to focus on trying to get out by 5 p.m., but came to realize, if I focus on providing not only excellent orthopedic care, but also emotional and psychological care, even if it means I finish 30 or 60 minutes later, I would leave happier and more satisfied.


Now, I make it a point to try and own the difficult patient, even though I have to accept that I will not be able to positively affect each one. Coming up with ideas for dealing with the difficult patient are the things I struggle with most. Here are some that work for me:

1. Attempt to empathize. It may change your own perspective and reactions.
2. Make sure the patient knows that you are truly listening. Sometimes that is all you can do.
3. Make sure the patient does not feel brushed off; something the patient believes other providers have done.
4. Accept that you may need more time with that patient; that you may leave late and try to somehow see this as a positive challenge.

Sometimes, the angry, difficult patients can become the most grateful and sometimes the challenge and joy can be flipping them from angry to amazed.

To all of our baldingblog readers, may this season bring you good health and happiness

 

 

 

 

 

 

 

 

 

Courtesy of Dr. Tony Rustin, Brazil

What about dutasteride? Going by that logic and considering its half life, shouldn’t we gap duasteridet dosage to like once a week or once every 4 days or something? Thanks.

I agree that with a 5 week half life for dutasteride, a once a week dose should work.

This questions was actually asked of a patient. Would I Put Hair On My Tattoo Of A Horse So That IT Has a Real Hairy Tail?

This came in through an email as many of our patients do to get access to us. After considerable thought, I thought through the process and I would be happy to meet with this patient and then make that judgment. Doing something like this is easy for me; however, I would not want to do it if the patient was mentally unstable and did not fully comprehend the significance of what they were asking for. This would not be irreversible if he eventually changed his mind as he could have it removed in one or more laser hair removal sessions.

Cosmetic surgery is purely elective surgery. It happens when a patient and a surgeon agree on goals and realistically under the risks that all surgery impose, not matter how simple. People have died from allergic reactions to Xylocaine or have had spontaneous heart attacks having nothing to do with the surgery, but things happen. So an interview is critical to making a decision to go forward from my perspective. I even thought, why not create a hairy mane as well.

If you are interested in reading about a horses mane, click here: https://en.wikipedia.org/wiki/Mane_%28horse%29

If and when Piloscopy becomes a thing, will you adopt it too?

I’m asking this because you are a very skillful surgeon and it would be a great thing if big surgeons such as you adopt it..

First, what is Piloscopy. A presentation of an endoscopic approach to follicular unit extraction was presented at the ISHRS conference last October by Wesley. The idea was to use an endoscope to enter the scalp from a 2 cm incision and extract follicular units from below the scalp near the skull side with a 1.2 mm punch under suction. At this point in time, it would compete against a well established FUE procedure which is well understood and used by surgeons world-wide. There is no evidence that his technique (which is mostly theoretical) can work efficiently used, if in fact, at all. There are clearly wounds that would be made at different parts of the scalp which would have to be sutured and these wounds would scar. Anyone who claims a ‘wound-less’ surgery is wrong. If the grafts were taken out from an approach below the scalp, there would be a small wound at every folliclar unit where the connection to the epidermis must be cut to get the follicular unit free of the epidermis. This write-up is based upon my memory of his talk before the hair society in October.

See the Consumer Alert in ISHRS website.

I don’t know if I am just super conscious but I started to lift again about 6 weeks ago and it seems like there is much more hair in the shower falling out than before, isn’t it true that lifting will release more DHT or something? or am I just panicking

Wight lifting without taking any medications or supplements, will not cause an increase in hair loss. In fact, it may reduce enough of your stress to take the stress off of the hair loss.

If the hair grafts are taken exclusively from the donor area (permanent zone), they will ?have hair that is resistant to males hormones. The wreath of hair around the side and back of the head, is permanent on 99+% of men no matter what they have inherited from the ancestors, these hair will last their lifetime. Although this is the written rule, occasionally we see some patients that may lose their transplanted hair and if they do it may result from: (1) miniaturized hairs in the donor area (often called DUPA or Unpatterned Alopecia), aging of the donor area (seen in men over 50-70 years old a condition that unfortunately bares the name ‘senile’ alopecia, in many women whose hair around the side and back of the head is susceptible to female genetic balding and for other unknown causes we doctors call the ‘X’ face, which means we don’t know.

When strip surgery is performed and it strip incision is placed in the lower border of this permanent zone, these hairs will be lifetime hairs. If however, a doctor pushes the number of harvested grafts and extends outside of the permanent zone to push up revenue as they charge per grafts which are worth more to the doctor, these hairs may not be permanent.