Improving Patient-Centered Communication in Aesthetic Surgery: A Patient Survey.

Abstract

Professional communication is fundamental to the practice of medicine. In 1999, the Accreditation Council for Graduate Medical Education identified professionalism and interpersonal and communication skills as two of the six core competencies that all physicians must demonstrate.1,2 Unlike in other fields, the language used in aesthetic surgery is largely influenced by marketing and culture rather than scientific terminology.3 Professional communication requires sensitivity to a diverse patient population and attention to each patient’s language preferences, yet little is known about how patients perceive informal aesthetic terminology. After institutional review board approval, a survey instrument was revised iteratively through prepilot and pilot testing. (See Document, Supplemental Digital Content 1, which shows the 15-item electronic survey instrument, https://links.lww.com/PRS/F325.) Between July and August of 2020, we invited 898 aesthetic surgery patients to participate in the anonymous online survey. All adult patients who were scheduled to undergo aesthetic surgery between January and December of 2019 at our academic medical center were invited by email. (See Document, Supplemental Digital Content 2, which shows procedures that met criteria for inclusion in the aesthetic surgery patient sample, https://links.lww.com/PRS/F326.) Two subsequent email requests were sent to nonrespondents. A total of 347 patients completed the survey (38.6 percent). The median age was 51 years, most were female (95.7 percent), and the majority were White (85.6 percent). The demographic characteristics of respondents and nonrespondents were comparable (nonrespondent median age, 50 years; 92.8 percent female; 76.6 percent White). More than one-third of respondents (37.3 percent) perceived the phrase “mommy makeover” as inappropriate when discussing aesthetic surgery after pregnancy (Table 1). More than one-quarter (25.9 percent) disapproved of the term “nose job.” Nearly half (44.7 percent) perceived the term “turkey neck” as inappropriate when describing neck tissue laxity. Nearly one-third (29.2 percent) disapproved of the phrase “love handles.” A majority (66.0 percent) believed the phrase “boob job” to be inappropriate. Nearly three-quarters (70.9 percent) preferred, or were neutral about, the exclusive use of medical terminology when discussing aesthetic surgery. Table 1. - Patient Perceptions of Informal Aesthetic Surgery Terms Term Which Would Best Describe This Term if Used by My Surgeon when Talking to Me?* Inappropriate Neutral Appropriate Mommy makeover (n = 322) 120 (37.3) 95 (29.5) 107 (33.2) Tummy tuck (n = 331) 22 (6.6) 67 (20.2) 242 (73.1) Boob job (n = 338) 223 (66.0) 59 (17.5) 56 (16.6) Nose job (n = 328) 85 (25.9) 102 (31.1) 141 (43.0) Crow’s feet (n = 334) 45 (13.5) 86 (25.7) 203 (60.8) Turkey neck (n = 331) 148 (44.7) 81 (24.5) 102 (30.8) Bunny lines (n = 327) 78 (23.9) 126 (38.5) 123 (37.6) Love handles (n = 332) 97 (29.2) 87 (26.2) 148 (44.6) *The number of respondents does not total 347 because not all respondents answered all questions. Values are expressed as n (%). As shown, a considerable proportion of patients found informal aesthetic surgery phrases to be inappropriate. In open response comments, patients characterized colloquial phrases as “degrading,” “patronizing,” and “a barrier to clear communication.” Implicit in many informal terms is a message that the patient’s body is socially unacceptable. A patient-centered approach to communication is one that favors uncontroversial language that is suitable for the widest array of patients. A majority of respondents preferred or were neutral about the exclusive use of medical terminology, which represents the most professional approach to communication. By extension, informal phrases should also be avoided in marketing and education. It is true that some patients prefer informal terminology. Medical terms may be inaccessible to those with low health literacy, presenting a barrier to communication. Furthermore, not all informal terms are viewed negatively (Fig. 1). The use of colloquial or informal language should reflect an understanding of a patient’s language preferences. Whereas using informal terms should not be the default communication practice, they may be appropriate to adopt when a patient brings them into the conversation. When informal terms are used, body-positive language is preferable. For example, “extra neck skin” or “neck laxity” are more appropriate descriptions than “turkey neck.” “Mommy makeover” is better described by its component procedures, or by a different phrase, such as “body makeover.”Fig. 1.: Relative perceptions of informal aesthetic surgery terms. “Appropriate,” “neutral,” and “inappropriate” responses were assigned values of +1, 0, and –1, respectively. Values were summed and the net score was divided by the number of respondents.Professional communication is foundational to the provision of high-quality aesthetic care. Additional research is needed to identify language that is patient-centered and promotes professional communication. Moreover, linguistic preferences are constantly evolving4,5 and vary by region, representing an opportunity for continual growth in the delivery of quality aesthetic care. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. No direct funding was provided for this study.