INTRODUCTION
Medical practice has changed due to fierce competition, control by third parties
(health plans), and patient expectations1.
Patients increasingly believe that they are well-informed and can be demanding,
frequently resulting in unrealistic expectations from cosmetic surgery1,2.
Preoperative care should take into account patient physiology and language.
The physician who assumes what the patient wants may be wrong.
Any decision by a customer is based on conscious or unconscious value
analysis.
All seek to identify the product or service with greater value2.
Each person has his own set of values and criteria.
Statistical analysis is relative to the individual customer, with his/her unique
problems and needs3.
Disappointments can be subjective and are inherent to human nature, with
continuous vacillation and a feeling of loss3.
What the patient ultimately wants is to have his/her needs met.
Neuro-linguistic programming (NLP) is the study of how both verbal and non-verbal
language affects our nervous system, and its aim is to elicit excellence in
humans4,5.
NLP offers understanding of the structure of language, clues about how people
think, and how these patterns of thought affect behavior6.
Rapport is a concept in a branch of psychology that refers to a
technique used to create a connection of attunement and empathy with another
person. This word derives from the French word rapporter, which
means “bring back.” Establishing a good rapport is essential4.
Customers who complain too much are described as difficult but wish to remain
faithful to their physician3. Complaints
are opportunities to rectify a customer problem, which generation of loyalty in
direct proportion to the degree of commitment to solve the problem1,3.
On the other hand, while dissatisfied customers may not be sufficiently motivated
to complain, the great majority are displeased enough to silently change to
another professional at the first opportunity2,3. Ironically,
the problems of non-claimants are, in general, easiest to resolve2,3.
Facilitation of communication and providing an opportunity for expression is
essential.
In a recent study promoted by the Brazilian Society of Plastic Surgery, the
greatest concern of Brazilians in regard to plastic surgery (42%) is failure to
attain the expected result7.
The analysis of the result is very subjective and the perception of a good result
may differ between the surgeon and the patient.
OBJECTIVE
The objective of this study was to validate the use of a formula based on NLP to
assess patient satisfaction and expectations.
METHODS
Lele and Sheth8, marketing professors in
the USA, published an equation used to determine customer satisfaction:
Satisfaction = Perceived Performance (P) / Expectation (E)1,8.
If the perception of the outcome of surgery is equal to the expectation of the
patient, he/she will normally be satisfied (P=E).
When the perceived result exceeds the expectation, the patient will be delighted
and would not hesitate to refer friends and family to the surgeon (P>E).
On the other hand, if the outcome of surgery does not meet expectations, the
patient will become disenchanted and frustrated, and this is when problems arise
(P<E).
If the expectation is too great, it will be very difficult to satisfy the
patient.
A low expectation only exists in situations of subsistence or total impossibility
of choice1.
To maintain consumer satisfaction, the relationship between performance and
expectation must be carefully observed.
It was found that customers were willing to pay more for products that would make
them happier2.
The great challenge is to diagnose what is the expectation of the patient and
make him/her understand, unequivocally, the limits of the results, generating a
realistic expectation about what surgery can offer.
The preoperative photographs and the terms of informed consent are indispensable,
but despite providing some legal protection, do not guarantee patient
satisfaction.
The patient does not always give proper attention, despite the apparent
understanding of what has been explained.
Using NLP techniques, we can ask questions and observe the reactions that can
ensure that what has been explained was completely understood4,5.
After explanations about the medical procedures, we must say that it is very
important that the patient understood what was explained.
Asking the patient to repeat what was explained is efficient, but can cause
conflict, because it may appear that we’re doubting of his intellectual
capacity.
There are techniques in NLP, including “anticipated experimental results,” which
function well in these cases. We ask the patient to imagine himself after the
surgery and ask for a description of how he sees himself and what the surgery
would accomplish. This is one way to establish beliefs or experiences that one
wants in the future4.
One should also ask if there is any part of him that is against the change, fully
and completely. It helps to check if there are any limiting beliefs, whether
religious or not, as, for example: “God made me like this and I have to accept
this fact”4,5.
The use of metaphors, by telling a story of a patient with similar appearance
that generated a positive but realistic result, can be of great value to create
a non-fantastical outcome4.
You may ask: “What has prevented you from making this change in the
past?”4.
“Bodily Movements Corresponding to Internal Representations” are particularly
useful.
If the patient’s gaze is directed upwards, he is building or remembering; if
looking down, one can assume that he is in internal dialog, where there may be
conflicts. In this case, explain again the important information or reschedule a
visit, to include a family member who can confirm that the explanations were
clearly offered and understood4,5 (Figure 1).
Figure 1 -
A: Constructed visual images; B:
Remembered visual images; C: Constructed sounds;
D: Remembered sounds; E: Kinesthetic:
feelings and bodily sensations; F: Digital Hearing:
internal dialog.
Figure 1 -
A: Constructed visual images; B:
Remembered visual images; C: Constructed sounds;
D: Remembered sounds; E: Kinesthetic:
feelings and bodily sensations; F: Digital Hearing:
internal dialog.
According to the direction of the eyes, one can understand how the representative
systems of the patient are at the moment of consultation, whether more visual,
auditory, or kinesthetic (those that center their experiences in physical
demonstrations, like touch).
Patients with psychiatric disorders, such as body dysmorphophobia, or those with
any change that they do not want to resolve because they generate attention,
affection, and care of relatives, called “secondary emotional gain”, also need
to be diagnosed in the preoperative consultation. These patients require
attention from a professional in the field of psychiatry or psychology, because
they do not respond coherently to normal issues9.
RESULTS
We have used NLP for 5 years and found a favorable evolution in the number of
operated patients, compared to the previous 5 years. The average annual growth
rate in the previous 5 years (November 30, 2007 to November 30, 2012) was 5%,
and the annual average verified after the introduction of NLP methodology
(December 1, 2012 to December 1, 2017) has increased to 10%.
Our index of reappraisal and surgical complementation was reduced from 20% to
10%, respectively, in the periods evaluated.
Many doctors have an efficient approach based on personal experience, intuition,
or what was learned in training services for residents. Analogous to
digital marketing, one can define a conversion rate by the
percentage of patients who underwent surgery after an initial consultation.
The growth of the conversion rate would justify a significant increase in the
number of surgeries performed.
Tsimtsiou et al.10, in 2017, reported a
survey using non-technical knowledge, including NLP, among dermatologists, and
observed a positive response in managing difficult patients, with a more
conscious use of nonverbal communication and an improvement in the assessment of
diseases through the eyes of the patients.
Among psychoanalysts, the use of NLP is not yet consensual, based on the
difficulty of subjective analysis of results.
Witkowski11, in 2010, selected articles on
NLP, and found that 54.5% of scientific articles did not support the concept,
while 18.2% supported NLP and 27.3% showed uncertain results as to its use.
CONCLUSION
The use of NLP helped us to understand patient expectations in a more consistent
manner, significantly increasing the number of operated patients and reducing
the rate of reappraisal and additional surgeries.
Despite the broadly favorable results, an assessment for a longer period of time
and with a greater number of patients is still required.
COLLABORATIONS
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MTRC
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Analysis and/or interpretation of data; statistical analysis; final
approval of the manuscript; data collection; conception and design
of the study; project management; methodology; carrying out the
operations and/or experiments; writing and preparation of the
original; writing; review; and editing.
|
|
DU
|
Analysis and/or interpretation of data; final approval of the
manuscript; supervision.
|
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1. La Clinique Cirurgia Plástica, Universidade
Federal do Triângulo Mineiro, Uberaba, MG, Brazil.
2. Instituto Nacional de Excelência Humana,
Consultoria de desenvolvimento humano, Uberaba, MG, Brazil.
Corresponding author: Marco Tulio Rodrigues da Cunha, Avenida
Santos Dumont, 2312 - Uberaba, MG, Brazil, Zip Code 30850-400. E-mail:
cunhamarco@hotmail.com
Article received: June 11, 2018.
Article accepted: November 11, 2018.
Conflicts of interest: none.
