Hard Lesson on Surgeon Communication

[Jamie_Finndust]

I flew half way around the world only to have my surgery aborted at the 11th hour. Understandably, Im very disappointed right now.

 

I’m writing this as a lesson to others of the importance of choosing a surgeon who can clearly communicate to their patient, what the likely outcome of surgery will be; and have the tools and capabilities to accurately determine patient requirements.

 

My story:

Ive been following this forum and others for years. This year I had the funds to go ahead with surgery. I had online consultations with two respected clinics and decided to go with the second; as the surgeon there does most of the work. This story only relates to the second clinic.

After sending an email with my current photos, I had an initial video call consultation with the surgeon regarding having a hair transplant procedure undertaken with them. We discussed my expectations and what would be possible. I was told I was a Norwood 6 and that we could have a good outcome with 6000-6500 grafts over two procedures. I was happy and excited with the way things were sounding, so booked the appointment. 

 

Over the next couple of months, I emailed the surgeon a few times with other questions that had come up with me. I received slow; short responses, or none at all. It was apparent that as people on the hair transplant forums had said previously; this was ‘a person of few words’.

 

The time came for my surgery so I took two weeks off work and spent 17 hours in transit to fly to the surgeons country/city.

 

I had my pre-surgery appointment which I thought went ok. We determined that I was still receding and that I would need medication to save the remaining DHT receptive hair. It was decided that we’d achieve an even density of 40-45/cm across my whole head (slightly higher across the hairline), now using 7000 grafts over 2 procedures spaced 12 months apart; the first 4000 grafts being performed the following day. Up until this point, I thought we were both on the same page regarding the expected outcome.

 

That night a couple of questions came up for me concerning possible hair styles and density/ ‘illusion of density’. I was able to talk with the surgeon about these topics the next morning while being prepared for surgery. This ultimately turned into a one hour (approx) conversation (with both of us dressed in surgical scrubs), where we seemed to go in circles trying to respectfully understand each other’s expectations.

 

I trust and respect that this surgeon aimed to achieve the best possible outcome and that their expectations are the closest (but still only an estimation) one could get to understanding the reality of the final outcome. 

 

Therefore the way I see it, the challenge to the surgeon is to ascertain patient requirements; communicate what outcomes are possible; and understand / communicate if patient requirements can be met. 

 

Once the patient understands what is possible with that surgeon and knows if this meets their personal requirements, surgery can commence. Simple right?

 

My main requirement was that I was able to grow my hair out and style it in a way that created an illusion of density without looking like an obvious 70’s comb over. I didn’t want to go through this entire process only to still end up looking bald/ very badly thining and then having to just continue to shave my head (albeit with scars). There needed to be at least an illusion of density. From what I had read online and heard from the surgeon previously, 40-45 /cm seemed to achieve this. 

 

Throughout the course of our conversation during surgery preparation I was now told that I was a Norwood 7; and based on the surgeon’s understanding of my requirements; that I would now need 3000 - 6000 additional grafts (10-12k in total) to achieve my desired look; but, that unfortunately I did not have that amount of donor hair available. I was quickly shown examples of very dense results that I said I would be very happy with; to only then be told that these weren’t available to me. I was not shown examples of results that looked similar to what the surgeon was suggesting. It was actually very unclear what visual outcome the surgeon was proposing.

 

Again; actual surgery and logistics aside, I see the hardest challenge as communicating surgeon and patient’s expectations to one another. 

 

I feel this is where my HT experience flopped. The surgeon was unable to communicate what outcome I might expect; I do not feel confident that the surgeon understood the outcome that I would have been satisfied with; and I believe they more than likely assumed my expectations were higher than what they actually were.

 

Furthermore; it took until the actual time of surgery for the surgeon to make a decision for themselves regarding their patient’s expectations; only to then state that a significant amount of unavailable grafts would be required to achieve this.

 

The surgeons advice now was that they felt I would be unsatisfied with the outcome and as such, they were uncomfortable performing the surgery. After hearing this, I felt that my power to make my own decision had been taken away from me and that I had no choice but to respect their advice. At this point, the surgery was canceled, along with my hopes and dreams of hair restoration.

 

Although the surgeon in question appears to be highly regarded for their technical abilities, I do not believe they have the skills to accurately understand and relay back patient expectations, be able to communicate to the patient what possible outcomes can be achieved, or do this within a time appropriate manner. While the responsibility of this is shared between both parties, I believe that the surgeon, given that this is their trade; should have available to them tools and capabilities to aid this process to a satisfactory end. The importance of a surgeon to be able to do these things is the lesson I want to pass on today. 

 

I’m happy to answer any questions or reply to comments.

 

Edited October 27, 2023 by Jamie_Finndust
typo’s

[jjalay]

Who was your surgeon if you dont mind telling?

[Jamie_Finndust]

42 minutes ago, jjalay said:

Who was your surgeon if you dont mind telling?

Im not totally comfortable posting his name publicly right now. If people on the forum think it’s important that I share; I’ll reconsider.

[donpizmeov]

Hi Jamie,

Sorry for your bad experience. The “man of few words” have been used many times on dr laorwong so I take you went there… This could probably be avoided had an in person consultation been done and not just over web, food for thought for your next booking - maybe with a doctor like Eugenix or Zarev who are experts in High NW cases?

 

all the best mate

[Chrisno]

I understand OP is let down.

However, although some communication errors have been made, this sounds like an ethical doctor to me in that the surgery is cancelled when he understands that patient expectations cannot be met. If there had been more surgeons like that, many 'disaster cases' where patients are highly dissatisfied could have been avoided.

[mister_25]

From my experience, observations and personal anecdote, I will say that communication is a extremely important part of the surgery. I was once a person on here that believed “at the end of the day, the result is what matters and I’ll choose based on that, who delivers the most consistent results, what are they like at their worst and what are they like at their best in terms of ability and portfolio”

Only after consulting with other doctors for my second procedure did I realise how much clearer, honest, straight forward communication adds to the surgeons ability as a whole. 
 

I think your frustrations are under represented in this industry. At the end of the day, the surgeon did right by you by stopping the surgery if they had no confidence in restoring your hair. But the heartbreak, the struggle, the ruined anticipation for taking the first step towards fixing your life. That’s on them.

Edited October 27, 2023 by mister_25

[Hairwolf]

Sorry to hear about this-no doubt, uncomfortable situation. I think there is definitely a lesson to be learned for all parties. Your concerns were perfectly legitimate and all parties should definitely be on the same page with expectations. As already mentioned, it was ethical to call of the surgery. Bad luck

[Berba11]

9 hours ago, Jamie_Finndust said:

Im not totally comfortable posting his name publicly right now. If people on the forum think it’s important that I share; I’ll reconsider.

I think it would be useful.

It's not clear to me that this surgeon did anything wrong or that you did anything wrong. I think it shows the limitations of not getting an in-person consultation prior to the booking of a surgery, and it shows how communication can breakdown a bit when travelling abroad. These are important realities that you've shared, which is a useful contribution for others looking to go abroad.

As for the Dr's name - if you did share it might at least help others considering the same surgeon to know that a) that surgeon would be willing to pull the plug last minute (which isn't a bad thing by any means), and b) to have an understanding in advance that communication might be tricky and to plan accordingly.

[Jamie_Finndust]

8 hours ago, Chrisno said:

I understand OP is let down.

However, although some communication errors have been made, this sounds like an ethical doctor to me in that the surgery is cancelled when he understands that patient expectations cannot be met. If there had been more surgeons like that, many 'disaster cases' where patients are highly dissatisfied could have been avoided.

This is not so much about ethics. They acted ethically by providing advice which aligned with their understanding of the situation.

 

In saying that, I did ask in advance for a copy of any contracts/ liability release forms to review; and was told there weren’t any. Then, the day before surgery I was asked to sign something… 
 

Anyway, this topic is more about the surgeon’s abilities to communicate with their patient whats possible and have the tools and competencies to extract the patient requirements and understand what they’d be happy with.

[Jamie_Finndust]

58 minutes ago, Berba11 said:

I think it would be useful.

It's not clear to me that this surgeon did anything wrong or that you did anything wrong. I think it shows the limitations of not getting an in-person consultation prior to the booking of a surgery, and it shows how communication can breakdown a bit when travelling abroad. These are important realities that you've shared, which is a useful contribution for others looking to go abroad.

As for the Dr's name - if you did share it might at least help others considering the same surgeon to know that a) that surgeon would be willing to pull the plug last minute (which isn't a bad thing by any means), and b) to have an understanding in advance that communication might be tricky and to plan accordingly.

I did have an in person consultation the day before surgery. Unfortunately there was inadequate communication during that session. Otherwise we wouldn’t have had changing advice the day of surgery, with regards to how many grafts I would need.

I tried. They tried as well Im sure; but ultimately, it missed the mark.

My point really is, do you want to choose a surgeon who can’t effectively communicate with their patients? For straight forward cases, it may (arguably) be less important. For high Norwood/ complicated cases, it is very important.

[Berba11]

2 hours ago, Jamie_Finndust said:

I did have an in person consultation the day before surgery. Unfortunately there was inadequate communication during that session. Otherwise we wouldn’t have had changing advice the day of surgery, with regards to how many grafts I would need.

I tried. They tried as well Im sure; but ultimately, it missed the mark.

My point really is, do you want to choose a surgeon who can’t effectively communicate with their patients? For straight forward cases, it may (arguably) be less important. For high Norwood/ complicated cases, it is very important.

I understand you had a consultation the day before. My point was that, nevertheless, you'd travelled a long way only to not end up getting the surgery. It's a limitation of going abroad (or rather, going abroad to somewhere very far away).

We could argue the surgeon acted ethically based on their own perception of the situation, or we could argue their inability to effectively communicate with a patient has cost that patient time and money travelling for a surgery that was wrongly cancelled. Either way I'm not seeing any reason to withhold the name of the surgeon. Ultimately that's what this forum is for.

[Eli_Avdikian]

Would you mind sharing your pics ?

[Jamie_Finndust]

I think it’s worth remembering that between the first face to face meeting; and the time of surgery; which was the very next day; the advice changed from; you need 7k of grafts to achieve your goals, to; you need 10-12k, but thats not available to you due to insufficient donor

Edited October 28, 2023 by Jamie_Finndust

[Gatsby]

Yes I would have to say that communication is key with surgery. 

[Berba11]

4 hours ago, Jamie_Finndust said:

I think it’s worth remembering that between the first face to face meeting; and the time of surgery; which was the very next day; the advice changed from; you need 7k of grafts to achieve your goals, to; you need 10-12k, but thats not available to you due to insufficient donor

Do you have some pictures that you can share? 10-12K seems like a lot unless you're a very advanced NW7 (or, of course, the surgeon's understanding of your expectations was way off base - which seems to be the case ultimately).

[TorontoMan]

Just curious, they told you you were nw7 at the clinic, what was your estimation for your Norwood before getting there ?

[Fabio]

Without you saying the name of the doctor, I can tell who it is. While I agree the communication could be better, it’s difficult to provide an accurate analysis based on photos when consulting over email. When it comes to the pre-consultation in-person, I agree, it happens very quickly and more questions should be asked by the doctor. While this doctor is extremely talented, if he/she wants to truly manage expectations with their clients, there needs to be more asked during that process. With that said, no doctor will be perfect and sometimes the clients have to engage the conversation to truly convey what it is exactly what they want. Without any pictures, it’s tough to say how much better of a job the doctor could have estimated this ahead of time. 
 

On another note, do you still expect to get a HT? Even with an estimate of 7k, that’s a lot of grafts. Since I trust the doctor in questions estimations, I don’t think any other doctor will be able to achieve the density you want with the grafts you have available. 

[BackFromTheBrink]

Reading between the lines, I would guess that the surgeon believes you will only be satisfied with extremely high density. 

Presumably, that’s the reason he showed you pictures of high density transplants. Did he also show you lower density results, or ask specific questions about your expectations?

Would you be able to share the questions you asked of them the day of surgery?

It’d be great to see pictures, but I’d be shocked if 7k grafts wouldn’t have given a significant and worthwhile improvement. Were they all scalp grafts? Perhaps you may also want to consider whether body hair would be useful too? 

Since he’s decided he can’t give you what you want (which is no doubt very frustrating), and therefore will not risk a dissatisfied patient, your only move is to consult with other surgeons, and use this as an opportunity to think about what you’re actually be satisfied with, then find a doctor who can deliver it.

I also wonder whether you can use the delay as an advantage to check you can tolerate finasteride given you now know more about your pattern of loss and have miniaturised hair. You may also recover ground and reduce the amount of grafts needed.

Edited October 29, 2023 by BackFromTheBrink

[wprevil]

On 10/27/2023 at 11:02 AM, Jamie_Finndust said:

I did ask in advance for a copy of any contracts/ liability release forms to review; and was told there weren’t any. Then, the day before surgery I was asked to sign something… 

Huge red flag. Or, its possible that since there were more grafts estimated than initially assessed the doc figured it could turn out to be too much of a risky surgery.

 

Quote

 between the first face to face meeting; and the time of surgery; which was the very next day; the advice changed from; you need 7k of grafts to achieve your goals, to; you need 10-12k, but thats not available to you due to insufficient donor

That sounds sus. Its good no surgery occurred since all this sounds more than strange.

Chalk this up to experience which you have already, so good for you. One has to feel out a doc or situation which comes from proper communication as implied.

Dont worry... in the near future you'll be able to find the right doc you feel confident and comfortable with given good communication.

All the best

Edited November 3, 2023 by wprevil

[Jamie_Finndust]

On 10/28/2023 at 8:02 PM, TorontoMan said:

Just curious, they told you you were nw7 at the clinic, what was your estimation for your Norwood before getting there ?

During the video call consultation/ review of photos I was told NW6. Another clinic also gave me the same advice. The day of the surgery at the clinic, was told NW7. 

Im not quite at NW7 but you can clearly tell that I am heading that way due to my thinning patterns.

[Jamie_Finndust]

On 10/29/2023 at 11:40 AM, Fabio said:

Without you saying the name of the doctor, I can tell who it is. While I agree the communication could be better, it’s difficult to provide an accurate analysis based on photos when consulting over email. When it comes to the pre-consultation in-person, I agree, it happens very quickly and more questions should be asked by the doctor. While this doctor is extremely talented, if he/she wants to truly manage expectations with their clients, there needs to be more asked during that process. With that said, no doctor will be perfect and sometimes the clients have to engage the conversation to truly convey what it is exactly what they want. Without any pictures, it’s tough to say how much better of a job the doctor could have estimated this ahead of time. 
 

On another note, do you still expect to get a HT? Even with an estimate of 7k, that’s a lot of grafts. Since I trust the doctor in questions estimations, I don’t think any other doctor will be able to achieve the density you want with the grafts you have available. 

I’m also left not knowing what to believe. Would I have been happy with the surgery; or as the surgeon said; would I be dissatisfied?

I did my best to research HT and communicate with the surgeon.

I dont think I could put myself through that process again.

[Jamie_Finndust]

As most people have guessed. My planned surgery was with Dr Kongkiat Laorwong. 

Probably best using him for low Norwoods. For high NW or complicated procedures; if you use him; do so only if you are confident you can brake through the communication barrier.

Edited November 3, 2023 by Jamie_Finndust

[mr_peanutbutter]

as a norwood 7 you should mostly go with

dr.pitella

eugenix

 

bodyhair will be needed.

be glad the dr. didnt go through with surgery, no you can reconsider and get surgery with another doctor

 

i personally think the behavior of the doctor was ethical

[Jamie_Finndust]

1 hour ago, mr_peanutbutter said:

as a norwood 7 you should mostly go with

dr.pitella

eugenix

 

bodyhair will be needed.

be glad the dr. didnt go through with surgery, no you can reconsider and get surgery with another doctor

 

i personally think the behavior of the doctor was ethical

Why exactly should I be glad the Dr didn’t proceed with surgery?

Also, the point of this thread is to stress the importance of communication; not one about ethics. If you want to discuss ethics; feel feee to start another thread and I’ll happily contribute to that. Although one thing I will say on that is, its clearly unethical to flat out lie about the requirement for a liability waiver, which Dr Laorwong did, in writing.

Edited November 3, 2023 by Jamie_Finndust

[mr_peanutbutter]

1 minute ago, Jamie_Finndust said:

Why exactly should I be glad the Dr didn’t proceed with surgery?

 

Also, the point of this thread is to stress the importance of communication; not one about ethics. If you want to discuss ethics; feel feee to start another thread and I’ll happily contribute to that. Although one thing I will say on that is, its clearly unethical to flat out lie about the requirement for a liability waiver, which Dr Laorwong did, in writing. 

 

The focus of this thread is about communication.

sometimes thinning and miniaturizing isnt that visible in pictures. to get a full picture  need a clear eye and sometimes even a microscope.

another example would be signs of lichen planopilaris which basically rule out any form of hairtransplant but not necessarily can be seen in pictures 

 

pictures can never replace a in person consultation - so yes, if the clinic hasnt said that, it was miscommunication