Patient stress is the number one enemy of both you and your clients. Overcoming patient anxiety is a key to your success—a task that should be incorporated into every phase of patient treatment and every aspect of your practice, from the front desk to the billing staff and everything in between.

Investing the time to listen to patients and alleviate their fears can produce major dividends in patient trust and rapport—as well as improved patient outcomes both medically and psychologically.


A 1999 study by Rutgers University found that plastic surgery is a “high-stakes stressor” for many patients and that the most disturbing complications are psychological rather than physical.

According to the study’s authors, “Ineffective management of psychological complications of surgery can have profound consequences, resulting in delayed recuperative times, delayed return to work, poor patient compliance, dissatisfaction with the surgical outcome, hostility toward surgeons, and anxiety.”

The study also found that psychological complications are much more prevalent among plastic surgery patients than physical problems (such as infection), and that anxiety reactions were encountered by more than 95% of plastic surgeons. A 2005 study from the Annals of Plastic Surgery revealed that preoperative anxiety levels in cosmetic surgery patients are significantly higher than for reconstructive surgery patients. So, what’s worrying your patients?

Every patient is different, and each one will come to you harboring a different combination of worries or concerns about their plastic surgery or procedure. Some have fears about pain, others fear scarring. Some are concerned about the effects of anesthesia, the length of recovery, or unexpected problems during surgery (that something will “go wrong”).

In many cases, patients are worried about the results—how they will look after the procedure and whether they will be pleased with the results. Knowing that these fears exist—and taking the time to listen, acknowledge, and discuss them—can make a huge difference in your patients’ overall experience, including medical outcomes.

More often than not—particularly in these economic times—patients have fears about money and the cost of surgical procedures. This is the number two problem with most patients. It is important not to gloss over this aspect of patient anxiety, but to meet it head-on with a candid discussion as well as an offer of practical solutions, such as a payment plan or financing.

Because of the elective nature of plastic surgery, many patients feel guilty or that they are being “selfish” when they consider spending money to undergo a cosmetic surgery procedure such as a facelift or liposuction. This should be addressed, too. Including the patient’s spouse or financial partner in your discussions will help to overcome these fears and concerns.


These types of fears actually present great opportunities for you and your staff to enhance your rapport with patients, which in turn will help you to retain satisfied, happy patients and obtain referrals.

The time you spend listening to, educating, counseling, and “pampering” your patients is well worth the investment. It builds word of mouth and enhances the reputation of your practice as a place of caring and concern. The following are a few ways to incorporate an “anxiety-aware” approach into all the phases of treatment:

  • Initial screening—Developing a rapport and easing patient anxiety begins with the very first phone call. Your reception staff should spend time on the phone with new patients to get to know them and to learn about their specific goals, desires, worries, and concerns. Be sure to record in patient files the source of any fears and have the coordinator or nurse follow up with a friendly discussion.
  • Consultation—Your initial and ongoing consultation process with patients should be highly personalized and characterized by three important words: listen, listen, and listen. Both you and your coordinator/nursing staff should be highly attuned to hidden messages from the patient about worries and fears so that each one can be individually “unpacked” and addressed.
  • Patient education—Fear of the unknown is at the root of almost all patient anxiety. The best way to combat this is to make sure patients are fully informed and know exactly what to expect preop, postop, and during their surgical procedure.

Provide adequate educational materials. The use of realistic visuals is extremely helpful for most patients. Professional computer imaging systems, instructional DVDs, and complete illustrated guides to specific procedures are available and should be used to provide detailed information about what will be done and what the patient can expect at every phase of her treatment.

  • Staff training and skill building—Easing patient anxiety is arguably the most important skill that your staff can acquire. Don’t overlook this aspect of staff training—to develop good listening skills, the ability to “normalize” their fears and concerns, and to act as coach and counselor. These talents are part of the job description for everyone on your staff, from the reception desk to the billing office. As with other certifications and technical training, your staff should receive ongoing training and periodic refreshers on how to overcome patient anxiety and how to provide a caring, nurturing experience.
  • Presurgical briefing—Patient anxiety can be most acute just before the scheduled surgery date. In order to combat last-minute jitters or cold feet, the nurse or coordinator should meet with the patient and review the entire surgical process, including postoperative recovery instructions. Explain what will happen on the day of surgery, step by step; who will monitor their progress; and what level of pain they will experience before, during, and after the procedure.

Patients who know exactly what to expect and feel properly prepared are much better able to manage anxiety—and discussion of their fears is scientifically proven to help dispel them. The presurgical briefing is your best opportunity to invite honest discussion of fears and anxieties, answer questions, and offer reassurance.

  • Surgery day pampering—On the day of surgery, be sure that your coordinator or nurse understands her role in reassuring and guiding the patient through the process.

Greet the patient warmly, and revisit her questions and concerns to be sure that you have addressed all of her worries. Before she leaves the office following surgery, be sure to reiterate postsurgical care instructions and answer any new questions she may have.

Don’t underestimate the value of a friendly and concerned follow-up phone call from you on the evening or day after a procedure. It extends your caring beyond the office into your patient’s home and helps to build her confidence in you.

Incorporating an “Anxiety-Aware” Approach Into Your Practice

  • Train your staff. Understanding how to overcome patient fears is just as important as any technical component of their job—maybe more so.
  • Build sufficient consultation and listening time into patient treatment plans.
  • Develop patient-friendly educational materials, which may include statistical information about procedures and comments on your own experience and success.
  • Understand that patient anxiety fear is often related to the “elective” nature of many cosmetic surgery procedures. A sense of guilt is part of the panic.
  • Acknowledge that financial concerns are real. Take them seriously and offer practical solutions, such as credit financing or payment plans.


“I always make a point to call surgery patients on the evening after their procedure to check on their progress and make sure their pain levels are under control,” says Wesley W. Hall, MD, who practices in Reno, Nev. “This is a great time to touch base about any worries they may be having and reassure them. The reaction I receive is always one of gratitude, and I sleep better knowing they are recovering well. And they sleep better knowing that I really do care.”

  • Postsurgical and ongoing consultations—Use your periodic office follow-up visits with patients to not only ensure physical healing and recovery are progressing successfully, but also to address any remaining worries or concerns. It is during the follow-up phase that patients will receive compliments on their new look and will talk to friends and family about their experience.

Patients who start out with fear and anxiety, and ultimately have highly successful experiences, can be your best sources of word-of-mouth promotion. You might consider asking this type of patient to speak with another new patient who has similar worries and fears, in order to provide helpful pointers and reassurance. This firsthand patient perspective is worth more to your business success than your whole advertising budget.

  • Billing and administrative procedures—It is important to remember that administrative and billing staffs who interact with your patients have the power to reinforce—or undo—all your work in overcoming patient anxiety. One rude phone call about a missed appointment or late payment can start the cycle of worry all over again, especially if the patient’s concerns were related to finances or scheduling. Be sure that everyone on your staff understands the complex nature of patient anxiety in plastic surgery settings, and lead by example in your own interactions with patients.


According to a study by the Nursing Clinics of North America, “There is no nursing specialty in which the marriage between physical and psychosocial care of the individual is so evident as in plastic surgery nursing.” Author K.W. Spencer explains that a patient’s surgical outcome and adjustment to a new body image depend largely on the quality of care and information provided by a knowledgeable and empathetic nurse.

Be sure to reward those members of your staff—nursing or patient coordinator or aestheticians—who are especially gifted in helping patients overcome fear and anxiety. These individuals are helping you to build a reputation and retain happy patients, and their talent is the lynchpin of your success.

Cheryl Whitman is internationally recognized as a consultant to aesthetic, medical spa, wellness, and anti-aging practices. She can be reached at (201) 541-5405 or