EP 19: The Patient I Almost Refused to Operate On | OR DIARIES

In this episode, I explore one of the most important and often overlooked factors in aesthetic surgery: the relationship between surgeon and patient. Through a personal story about a patient I initially declined to operate on, I break down how expectations, recovery readiness, trust, communication, and long-term alignment can ultimately determine the success of a facial rejuvenation journey.

CONNECT WITH HOST 
Website: https://clinic5c.com/ 
Instagram: https://www.instagram.com/chesnut.md/ 
YouTube: https://www.youtube.com/@chesnutMD 
LinkedIn: https://www.linkedin.com/in/cameron-chesnut-a6910baa/ 

WAYS TO WATCH/LISTEN 
YouTube: https://www.youtube.com/@5CodesPodcast 
Spotify: https://open.spotify.com/show/1FZ7vpmq21iA1noPcFhixb?si=992ef6c8d859463f 
Apple: https://podcasts.apple.com/us/podcast/5-codes-podcast/id1866214238 
Instagram: https://www.instagram.com/5codespodcast/
 
TIMESTAMPS 
00:00 - Intro
 00:34 - The Importance of Relationships
 01:08 - My Consultation Process
 02:50 - What Happens During a Patient's First Consultation
 04:42 - The Patient's Second Consultation
 08:34 - Bedside Manner vs. Reputation
 11:00 - Why They Don't Need to Be Mutually Exclusive
 13:15 - Outro

ABOUT HOST 
Dr. Cameron Chesnut is the host of the Five Codes podcast and the founder of Clinic 5C, where he leads a team dedicated to integrative cosmetic surgery, regenerative medicine, and functional health. An internationally recognized facial plastic surgeon, Dr. Chesnut is known for producing natural, refined results that enhance rather than alter one’s appearance. His approach blends surgical precision with biological optimization and disciplined restraint, drawing patients from around the world who value excellence, longevity, and holistic care. On Five Codes, Dr. Chesnut uncovers the mindsets and evidence-backed strategies he lives by, helping high performers perform better, recover smarter, and feel their best in every area of life. 

DISCLAIMER 
The views shared on this podcast are my own and are not associated with, affiliated with, or representative of my clinical teaching role at the University of Washington School of Medicine. This content is for general educational purposes only and should not be considered individualized medical advice.

Transcript

Intro

SPEAKER_00 0:00

Welcome to the Five Codes Podcast, where we discuss evidence-based methods to elevate yourself to the next level through optimizing the way you look, move, perform, feel, and connect. Welcome to today's OR Diaries. These are always really special episodes for me because I get to just tell you what's on my mind right after stepping out of the operating room after a week of surgery. This is like the last thing that I do. You get a kind of a raw, unfiltered version of what's on my mind after surgery. And this week, you know, they tend to run themes. I think that's just how my brain works

The Importance of Relationships

SPEAKER_00 0:34

a little bit. But this week I was really thinking about the relationships part of these surgeries to me. One of these in a nutshell, somebody that I said no to. And then here I am talking to you after operating on this person. The relationships, it took me as I matured in my career to realize the not how important they were to me, but uh to really quantify and understand how they affect me and my value system, my long-term happiness with my career and craft, really. Uh, you know, it was all about results. It is all about results still,

My Consultation Process

SPEAKER_00 1:08

honestly. Uh, but there's this whole other element that I was so hyper-focused on something else that I wasn't probably understanding as well. It was there, but I just didn't understand it. That's the relationship side of this to me. Uh, I am very choosy about who I work with. I'm very fortunate to be able to do that. And it I only say that to say that like it's because of the outcome that I want to provide, right? I'm not choosy in like a mean way or something. It's just like I know that what I can do is perfect for this person, basically. And so from uh what you know, I I do this idea of like this free photo screen where you guys reach out, you can send me your photos, I look at them myself, I give you an idea. Um, and about 20% of the time I've I give a thumbs up, like we're you know, we're in line. Uh about 80% of the time, it's a it's a kind of we never even get the ball rolling, basically. Um it's just sort of like, yeah, it's not the right fit. It's that, you know, um we're not quite there yet. Um, sort of what you're seeking involves a little bit of a different path than you're willing to take, something like that, right? So, but there's this narrow, this like 20% of this group that we will move on and have a consultation with. So it's like, no, that's a, you know, it's not not none, but it's uh definitely a selection of people that I'm choosing. Like, I would want to work with you forever, basically. Um, and so in that consultation process, then I really get to know somebody better. This is way deeper than just like photos and interests. And, you know, I'll even ask you, like, I want to know the key relationships in your life. I want to know what drives you, what types of movement you like. These are all connection points that are really important to me, honestly. Um, and so anyway, I know those things, but now we get to consult, we get to like really dive into

What Happens During a Patient's First Consultation

SPEAKER_00 2:50

it. And so uh this person today was somebody who I had dove into, and I got to know this person very well through the consultation process. I got to understand, I got into their mindset a little bit, I understood what they were after. And interestingly, in that, I knew that what they were after was something that I could definitely provide. Like that was this, it was my wheelhouse, my bread and butter. It was a full facial rejuvenation, no question about it. Um, slam dunk there, basically. But interestingly, I also understood some aspects of this person from the other end of just sort of what their expectations were about, not the results even, but what their expectations were about the process, the healing, the recovery, the, you know, I I honestly just did not think that they were ready for what it was going to take to get to their end result. Because it's not the most crazy, ridiculous, intense thing you've ever done, but it's also not nothing to go through the recovery. There's you have to be ready to, you know, spend a week or two and and and dedicate to this. And, you know, this this is your main focus then. And this person had a lot of other um areas that they were focused on that were really important to them. And they were thinking that this was gonna be a very minor deal, that those were gonna take precedent, this was just gonna kind of happen in the background. And and so I just knew that it was a setup for uh disaster, basically, for the wrong thing. Um my staff had sort of picked that up a little bit too, and which of course they don't influence me, they don't really say anything until afterwards, and I was just sort of like, you know, I just don't think it's the right fit. And they're like, yeah. So we there was I had some reinforcement after I made this decision. That's like, it's really nice meeting you, not the right fit, you know. I don't think it's yeah, you know, what you're wanting is it's gonna take a little bit more investment on your end than than where we're at. Um

The Patient's Second Consultation

SPEAKER_00 4:43

and so I thought that was it. That was the end of that thing. And it was very interesting. I think this might be the first person ever who then came back and said, Well, you know, I want to talk one more time. Um, I don't think that you we have it had a good understanding. And so I honestly kind of thought over that for a little bit because it's like, well, I don't want to waste anybody's time, mine, or this person's time, um, if I'm not feeling it. Because this is what I also told this person is you don't want a surgeon working with you who's just not they're not sure either that it's the right thing. You don't want that. Nobody wants the guys like, yeah, I don't know if I want to do this. That's not you just don't want that person. So I had told them that, and they persisted through that and said, you know, I that's fine, but I just would love to sort of like chat one more time and clarify. And, you know, I respect what honestly, this person said I respect whatever decision you make, um, but I, you know, would love to have another chance. And so ultimately I talked to this person again, and it was um really eye-opening for me, to be honest. Uh, this conversation went better than I could have ever imagined. I was prepared for a little defensiveness. I was prepared for a lot of explaining um as to why I was wrong. Um, and it was more of just a two-way, both of us seeking to understand. I I am truly seeking to understand in my consultations where somebody's at, what they're after, um, what their baseline is. I want to know everything, right? And um, and so I when he's or the this way that this was worded to me by this person was just like, I just want you to help under help me understand better. I want you to understand me better. So I was open to that because of that sort of that is in line with my goals, basically. We talk again, and um I got a better understanding. Lack of defensiveness, a lot of just seeking to understand both directions, and then just some clarifying, basically, some clarifying of points that this person thought I had missed. Um, and that they, you know, they said, I I respect whatever decision you make, but I want you to know these things, or at least know that we're making it through a clear lens. And and then after that, we had a very cordial, very happy conversation, much like our original consultation was. And it was left with, like, well, let's think about this a little bit and we'll see if we're comfortable moving forward. And so I can say that that was the first time that I've ever had that type of a conversation, probably. Uh, and ultimately I thought about it over the weekend and I chatted with um, you know, some of my inner circle about the situation, and ultimately decided, okay, like I am comfortable doing this. I had the clarity helped me. Um, not that I had zero doubts and reservations anymore because that doesn't exist with anybody, but it was more in line with like, okay, I'm respecting with where this is, and we were on the same page and we were very clear. Uh, there was very much a mutual respect. And I ultimately decided to do that procedure, and now it is done. And I feel great about it. It was uh very happy that you know I sort of pivoted um and definitely not too proud to do that, you know, in that situation. I changed my own um my own initial interpretation. I sought more information, I got it, I felt comfortable, and I'm happy with that decision afterwards. And so that was uh, you know, a first, really. And um, well, let you know how it goes in the long run. But, you know, so far, so good. It's been very great interactions with this particular patient and my staff. Um, and those are all it's all good, good vibes at this point.

Bedside Manner vs. Reputation

SPEAKER_00 8:34

So, and interestingly, like I said, things run in theme. Um, a patient before that one was a person who had had a previous procedure with a local plastic surgeon. Um, and you know, that patient for her, it was, you know, it was an interesting conversation because she was just very much talking about how comfortable she was and how, you know, like she thought she'd be more nervous because with her previous procedure, she was very nervous. And she kind of digested it, unpacked this. We did it together really before a surgery. And she was just talking about how the surgeon that she had the first time was didn't particularly make her feel comfortable. Um, but she also wasn't at the time concerned with his bedside manner. He was very cold, very quick. Um, and she just said, I don't kind of don't care about that. I just care how good they are, right? And I totally see that, right? Um you, you know, you don't want to choose somebody because they're nice, but you're not sure they're that good. Um, and on the flip side, she chose somebody because this person had a good reputation. Um, Bedside Banner didn't vibe with her as much, but she sort of wrote that off. The cool news is they don't have to be mutually exclusive. You can find somebody who is really good and who you really vibe with, who you align with, who you feel good around, who makes you feel comfortable. And that's what she was unpacking in front of me a little bit was this idea that, like, well, I didn't think that mattered. Um, but you know, when she really reflects back now and she starts to look back, she's like, you know, it was she was uncomfortable with the procedure itself, which is not a good place to go into surgery. Um, she was always wondering what was happening in her recovery, never really got answers to anything, didn't get much follow-up. It's unclear how where she's at now is uh in relation to normal results, if these things are normal, et cetera, et cetera. So she found me, basically. Um, and it's it's a very different experience there, where she just is saying, I'm so comfortable, it's just so different. I feel like, you know, I've I've made the right choice, I'm with the right person. Um, you know, I'm gonna see her in follow-up, she'll see my staff in follow-up. She's staying in in sort of in my curated retreat homes. Like it's very homey, it's very in one place, it's very um unique. It's a very unique experience to have that and to feel that comfort. Um, and it's all part of the relationship and the experience of it. Um, and those,

Why They Don't Need to Be Mutually Exclusive

SPEAKER_00 11:00

this is the spoiler alert, this is where the rubber really meets the road, is those are important not just to your experience and to the process, but to your results, honestly. If you are more comfortable in your healing, um, if you have a better mindset, you have more clear expectations as to what's going to happen, you will have better results after surgery. Um, you'll have a better experience, it will be more comfortable. Um, and all those things line up. So it's very much in this idea of like that they're not mutually exclusive. You don't have to find somebody who's a great surgeon, but kind of a jerk or really terse or short, or that doesn't need to be the way that it is. Um, because I choose my patients with somebody that I would want to work with forever, somebody I go to battle with, basically, um, because you know, they're there's challenging periods, even if everything goes perfect, which there is no such thing as perfect. If everything goes absolutely perfect and as expected with your recovery, recovery's still hard. There's parts of that that are just a challenge. And you don't want somebody on the other end who's not open and receptive to that, um, and who's going to either, you know, make you feel like that's not normal or um or just not be there, you know, or their team isn't there or something along those lines, right? So um that it was very interesting, and you know, she'll in the week coming ahead, we'll really get to see uh where things are different in her recovery phase, but you know, very much uh an example of like how important that relationship is, um, even just in in your experience um and what it's like to kind of come into surgery and be relaxed and be comfortable and then to move into the recovery phases afterwards. And uh my whole infrastructure is built around that. You know, I have uh my whole team, you know, my one of my team members goes home with you after the the the night of your procedure. You know, you have I have somebody whose their sole job and role is just to help as people are navigating the follow-up and recovery period, easily available, you know, simple text message, phone call, always communicating with me. Um, you know, my fellows are seeing you, I'm seeing you. You're always with somebody from our team. Um, and it makes that whole process and that whole relationship much more fortified and forged moving ahead and a much more comfortable experience for you

Outro

SPEAKER_00 13:15

overall. So uh both of those different themes, but in the same vein, a first for me, and somebody that I said no to who um was very, I guess, persistent and articulate and eloquent. And um, and you know, I'm really glad that that particular person pushed me, you know, quite literally pushed me um to grow. And so I'm I'll forever be grateful for that, to be honest. And um, you know, I can't wait to see the the you know the outcome in the end, and this will be somebody that I'm forever enmeshed with after this. So uh big important decisions for me. Uh first, thanks for tuning in and listening and um understanding, you know, I hope that whoever you find and whatever types of procedures you do, you get to experience that same type of important relationship that I feel. Um, because it makes it a really wonderful and valuable experience going through it that way. But if you have any questions or topics you would like me to explore further, please leave them in the comments. I read them all and they often help shape the future conversations here. If you would like to learn more about my surgical practice, you can visit clinic5c.com where you will find additional information on my approach to surgery, recovery, and performance focused care. But I also want to be clear that the views shared on this podcast are my own and are not associated with or representative of my clinical teaching affiliation with the University of Washington School of Medicine, nor should this be taken as individual medical advice. Thank you for spending your time with me. I appreciate you being here, and I will see you on the next episode. Bye.