Dr. Michael Litrel, Longtime OB/GYN, Talks Candidly About Becoming a Pelvic Reconstructive and Cosmetic GYN Surgeon – Part 3
My philosophy as a doctor is the mother principle—in that you treat all your patients the same, and always keep in mind how you would want your mother, wife or other loved one to be treated. If your mother is on that operating table, you’d want the surgeon operating on her to bring his A game. For me, an A game is not just about being in one place and doing well, it’s about availability, continuous improvement, compassion, learning the latest technology and methods, follow- up, etc. so I’m giving my patients the best possible care and aftercare.
The Doctor/Patient Relationship
Apart from the mother principle, the patient’s attitude tends to guide me. My principle is that I do my very best and I’m as honest as I can be. I try to do it in a way where people can be receptive. Sometimes it works very well and other times, well, not so much. Physician-patient compatibility is very important.
For example, I recently had a patient with life-threatening blood pressure issues, and she really didn’t want to hear anything I had to say. She was being completely non-compliant by not taking her prescribed medication to combat dangerously high blood pressure readings. She became impatient, even angry with me, changing the subject to something else each time I tried to discuss the severity of her situation and the importance of following my recommendations.
On the other hand, another patient reached out to me in desperation. She described how her son was heavily into drugs and how her father was seriously ill. The situation was causing devastation to her, both mentally and physically. Apart from understandable emotional turmoil, she was compensating for the difficulty in her life by overeating and was rapidly gaining weight.
I listened to her because I truly sympathize and care about the struggles she’s going through. I gave her the best advice I possibly could. It was clear that she was receptive to everything I was telling her and would follow my advice.
The non-compliant patient made me realize that our doctor/patient relationship was a mismatch and was going nowhere. I knew I would probably decide not to see her again, and I’m okay with that. My heart is telling me that she would be-or should be-better off with another doctor, and I’m okay with that too.
However, the troubled mother was appreciative of the help I was trying to give her. I knew that, unlike my other patients, or those that I see over the years for just an annual exam, she would remain in the forefront of my thoughts. I would remember her son’s name, follow up with her regularly, stay in touch, and even pray for her because I’m genuinely concerned. I don’t doubt she truly wants my help. I can only help those people who want to accept my advice and, in turn, help themselves.
Talking with Inhibited Patients
With shyer patients who are more reluctant to discuss their problems, I simply confront the issue. I basically just tell my patients, “Look, I completely understand that it’s very embarrassing sometimes to talk about sexual or genital issues. It’s humiliating if you ‘poop’ or ‘pee’ on yourself, don’t know what an orgasm is, or if you’re ashamed of the way you look. Whatever it is, I know some of these things can be difficult to talk about. That said, I’ve heard and seen it all, so now I’m going to get the information I need from you. Sooner or later, I’m going to find everything out anyway, and we’re eventually going to have a trusting relationship so the more you tell me now, the more comfortable you’re going to be, and the more I can help you.”
If I just acknowledge the fact that it’s an awkward or socially embarrassing subject, people tend to relax a little and speak more freely. Then, once I do an exam, my knowledge and experience guides me to ask more direct, delicate questions based on my visual findings—questions like, “Do you need to touch your vagina to defecate? Do you leak stool? Are you sexually active? Do you urinate when you cough, sneeze or jump? Do you have a sensation like your bottom is coming out? Does your back hurt a lot?”
Because I’ve been practicing for so long, I can duplicate the anatomical findings with the physical symptoms. This makes them think, ‘Oh, he knows that, so maybe this is a normal thing!’ When that connection is made, we can discuss and build a trusting relationship.
My philosophy is that, unless surgery is absolutely necessary, I discourage it. If you must have surgery, do it for the right reasons. I feel that patients seeking operations to improve their sexuality or the appearance of their genitals can be extremely vulnerable, impressionable and overly trusting of people who might want to take advantage of that vulnerability for their own profit.
Since the internet has come into our lives, we’re often led to believe that there’s only one solution to all our problems. A place that sells widgets will try to convince you that widgets will solve everything that’s wrong with your life. Desperation causes people to believe that so they buy that widget only to find out it’s not a cure-all. It’s the same thing with surgery. It’s not always the answer to everything simply because it’s radical and is made to sound like the perfect answer to everything.
I don’t subscribe to that way of thinking. Again, I rely on the ‘mother principle’, going on the premise that if this was my mother, wife, sister or daughter seeking help, I would recommend surgery only when surgery is indicated. I wouldn’t want my mother or my wife going somewhere and being talked into surgery simply because that’s how the provider makes money. There’s a higher degree of ethics that’s required, and that’s to do your very best and treat people with as much love as possible. If you honor that, your patients will thrive and you’ll have a very happy career.
I feel that a lot of plastic surgeries promise unrealistic results, but because I deal solely with women’s problems, I understand that quite often, these desired results will not happen. In my opinion, altering genital appearance for visual enhancement only is much like the case of Michael Jackson, who pursued surgery after surgery, turning his original attractiveness into an almost garish version of his former self. Plastic surgery did not solve his underlying problems of low self-esteem. Unnecessary cosmetic gynecology is no different.
For me, cosmetic gynecology is all about making women more comfortable with their bodies. A lot of women come to me devastated because they don’t feel like they’re good enough. Some have given an important part of themselves to a husband or father of their children for years and have been made to feel substandard. And suddenly they’re faced with separation or divorce. These women seek cosmetic help so they’ll feel attractive, desirable and confident enough again to have a good sex life with someone else in future. I see these things all the time.
Prayer, Spirituality and Health
It’s already been documented that I pray with my patients when they ask or need me to, usually before a surgery when they’re frightened and more vulnerable. I’m happy to do it. I pray all the time. It’s part of my life, much like breathing to me.
As a doctor I can alleviate a lot of the physical suffering, especially in my areas of expertise, but much of the pain we have is not of the body, it’s of the soul.
Prayer is very basic and healthy. If you’re not praying, then you’re not really listening. I’m not saying prayer as in asking for something. I’m saying prayer as in listening to what God wants from you and if you listen, I think things will go pretty well. You need to have good relationships with people around you, have loving relationships with family and God, and for me, prayer is a very important part of that – to be faithful and to strive to listen to what God wants me to do. I think that’s a really important factor in maintaining good health.