What do patients want? you asked (PSP, July 2007 Editor's message). The gastric bypass patient wants honesty, respect, and a good result. He or she also needs to know, before the surgery, any anticipated limitations in the result. Before removing acne scars from the chin, an examination is required to determine the best procedure or procedures, which determines the cost.

A woman who "feels like a freak" post–breast augmentation probably looks like a freak. Her result needs to be corrected. A woman with thin thighs needs to be examined and properly advised. Are her thighs really too thin? How are her hip and thigh proportions? She may need no more than muscle-building exercises.

The 2,000-mL breast implants requested by a patient's husband may be just a joke. If a woman is serious, as I have seen in the past, I explain the severity of the consequences of doing that to her breasts. If she still insists, I tell her that I could not in good conscience intentionally harm her, and then I could refuse to do the operation.

In short, patients want honesty, respect, and a reasonably anticipated result. We owe our patients honesty, respect, safety, comfort, and the best possible result given their circumstances. Your requests were not really that unusual, and they become "awkward cases" only if treated awkwardly.

Eugene J. Strasser, MD, JD, FACS
Coral Springs, Fla