Mirivel: The physical Exam (cosmetic) Flashcards
What is the title of this piece?
The Physical Exam in Cosmetic Surgery: Communication Strategies to Promote the Desirability of Surgery
What is the background?
This piece represents the intersection of consumerism and entrepreneurial medicine
In 2004, there were 9.2 million cosmetic surgery procedures, a 700% increase since 1992
What are the functions of the initial surgical consultation?
Initial surgical consultation (45-90 minutes total)
– Assess patients’ aesthetic needs and goals
– Talk about procedures
– conduct a physical examination
– Show “before and after:” photo of surgical results
— Education vs. persuasion
see quotes
What were the methods in this case?
Setting: a privately owned cosmetic surgery clinic in the western US with 2 surgeons and various support staff
– exclusively elective surgery not covered by insurance
Participants: 15 women and 2 men (patient)
Data:
- 30 hours of vieo recordings
200 hours of on-site field work
2 indepth interviews with surgeon
2 90 minute stimulated recall sessions
What are the 4 ways that surgeons “Close the Deal” during Physical examination?
- Moving undesirable features of the body
- Medicalizing the body
- Disclosing and embodyinig the diagnostic
- Enacting surgery and its aesthetic value
What is involved in the first way the surgeons close the deal?
Surgeon treats the body as an object of analysis
- notice spatial positioning of surgeon & patient
- Limited eye contact
- limited talk
Surgeon physically reduces waistline and squeezes excess tissues, demonstarting aesthetic “problems”
Surgeon lifts and releases breast to activate “sag” or ‘droop”
What is involved in medicalizing the body?
“Medicalizing” means to view a person/condition/situation througha medical lens (as something that is diagnosable and treatable)
Some things that used to be viewed as behavioral or moral problems are now medicalized:
- addiction
- depression
- ADHD
This is often accomplished through medical terminology (jargon)
What else is invovled in medicalizing the body
Surgeon uses a tape measurer on the patient’s body, announcing measurements to the medical assistanct
Surgeon uses medical terminolog
- grad 3 ptosis bilaterally
What is ptosis?
It is the distance between the fold of the breast and nipple
There are 3 grades; 3 is most severe but all grades require surgery
No gradefor the “perfect breast” meaning that htere is no such thing as “normal” sag or droop
Ptosis is a natural event
What is involved in disclosing and embodying the diagnostic
Surgeon explains the diagnosis and directs the patient’s gaze to his/her body
- invites patient to see ehr body through a diagnostic lens
- uses a pen an institutional instrument to point out problematic aspects of body
- uses hands to exaggerate contours
Creates ambiguity between educational and persuasive agendas
What is involved in enacting surgery and its aesthetic value?
Surgeon moves body aparts to a post-surgical position
Surgeon uses descriptions such as “youthful” in reference to post-surgical breast
Surgeon uses pen as “scalpel”
== pen represents a “pain-free, conseqence-free, complication-free re-enactment of surgery”
What are the ethical considerations?
Mirivel sees the physical exam as most persuasive part of the inital consultation precisely because there is no obvious “sales talk”
Mirivel noted that there were no supportive comments about patients’ bodies
What are more ethical consdierstaions?
Surgeons only examine body parts that patients bring up themselves
Surgeons don’t always recommend surgery
- Concerns about psychological suitability
- – Concerns about litigation
