I really hope they feel guilty about what they did to you. Not that I am holding my breath or anything.

Good to you for standing your ground and mustering up your confidence in yourself to counter their cosmetic bullshit. They should be ashamed of themselves.

As a Triad Asthmatic, I get sinus polyps every few years or so.

When they get bad enough, if I can afford it (not now) or have insurance (not now) I get them removed.
(I'd like to now).

When I was 23 yrs old and quite confident that I was beautiful in my own unique way, an ENT offered plastic surgery to make me look "less ethnic", "while I'm in there"

I told him to effe off and got another ENT.

I would go further today and report him.

When I was 13, I went to a new dentist for my annual cleaning and check-up. Half way through the check-up, he called my mom in to the room and began to give her quotes on the different ways he could "fix" the gap in my teeth (ya know, like the one Madonna AND Maya Angelou rock).

My mom hadn't asked for a quote. I hadn't indicated a desire to change anything about my teeth. It's purely cosmetic and in no way affects the health of my mouth (and I happen to find it darling).

We never went back there.

I can't stand health professionals who try to cash in on our perceived insecurities, or create insecurities where there were none.

As annoying as it is to have products pitched at your that you know you don't want, I can't fault the medical staff here. They are obligated to serve their customers as they are, and not as we might wish them to be. As such, it is entirely reasonable that they would point out the savings involved because many people in your position would be sincerely interested in hearing about them.

What's sad about this is that if I had lower self-esteem like I used to, I would have fallen for their B.S.

Although telling someone that their nose is crooked as though they wouldn't already know is clearly a waste of breath, I'm not seeing the BS. Nothing they said was untrue or deceptive, and the only difference between you and someone for whom finding our about the savings meant the difference between getting the procedure and not, is a value-judgment about the worth of a straight nose. And who are you to tell them that they're wrong, or that the surgeon is wrong to provide a service that a lot of people obviously consider themselves better off with than with their money?

Alice, I disagree.

Perhaps your reasoning would make even the slightest bit of sense [although I still would NOT agree] if they had simply asked her whether she wanted it.

However, the fact that they not only *assumed* she would, but also that they pressed the issue further after she responded saying that she wasn't interested in it, is plain old capitalistic tactics. In this case, those tactics were meant to prey upon the insecurities that many people have about their appearance.

She didn't come in seeking a rhinoplasty. She said she wasn't interested. They mentioned it more than once after she declined. Not only is that horrible manners, it is also inappropriate.

However, the fact that they not only *assumed* she would, but also that they pressed the issue further after she responded saying that she wasn't interested in it, is plain old capitalistic tactics.

You say "capitalistic tactics" as though it's a bad thing. Informing someone about something they didn't know they needed, or enlightening them that your product isn't as expensive as maybe they think, are perfectly valid sales strategies.

She said she wasn't interested, but the receptionist isn't a mind reader and wouldn't have immediately known why she wasn't interested. Maybe she got quoted a price and decided it wasn't worth it. Well, some quick research shows that the anesthetic fee for such things is $600 to $1,000, so it's pretty easy to imagine someone saying they're not interested, then considering otherwise after being reminded that the marginal cost is now that much lower.

I've sold hats retail, and there have been plenty of times that someone wouldn't be interested in a hat, but would become interested in 2 hats when informed that there was currently a 2 for $20 deal. To put it simply, you shouldn't expect a salesperson to take you at your word when you say you're not interested, because a lot of the time that they hear that, they are, in some sense, being lied to.

Alice, there's a HUGE difference in surgery which permanently changes the way you look and a hat.

It is NOT the receptionist's job to tell this woman she doesn't look good enough, which is essentially what she did.

I'd get another ENT and tell that doc why I was leaving.

Surgery may be different from a hat, but the subjective judgments of people thinking of buying either are fundamentally the same. In either case it's a question of whether the expected gain is more than the expected cost, and the salesperson has the exact same job in either case of convincing them that it is. The only difference is that the potential buyer will generaly put more consideration into the latter, but then again, I have spent more time deciding on a hat than I have deciding on possible medical procedures, so I guess that's not a given.

Personally, I'm fairly happy with my teeth, but I've received pitches and follow-up pitches for various cosmetic services from dental staff. I just don't see what the big deal is. I just accept that I'm probably in the minority in finding my present smile acceptable, and decline.

Alice- Yes, I do think capitalism can be a bad thing, and this is a good example to illustrate why. Your condescending attitude toward my beliefs about this as well as toward the author of the original post say a lot about your views on things, for sure. From my reading of the post she was asked whether she was interested, declined the offer [at this point you are right, she might not have known it was less expensive, and if you are in love with capitalism you might think the person should have tried to "make the sale"], was given UNSOLICITED CRITICISM OF HER APPEARANCE [?!] in addition to what you define as a "sale", at this point she declined AGAIN, making it clear she was NOT interested because she did not want to alter her nose, which should have indicated that her decline was not purely based in economics. I fail to see how that is acceptable in the least. Actually, it is so clearly UMacceptable that it disturbs me that you are defending it, especially with a hypothetical about a HAT, for goodness sakes. If that is not dismissive, I don't know what is. flyinfur hit the nail on the head: appearance-altering, non-medical plastic surgery is NOTHING like buying a hat.

My example wasn't a hypothetical about selling a hat. Rather, it was about hats I've actually sold. Reading comprehension, please.

I don't think the actual product involved matters in the slightest. The point is, people who say they aren't interested in something will change their minds when told about things that change the cost in their favor. I used hats in the example because I have personal experience selling them, but the behavior shown occurs with just about anything.

But on what the receptionist actually said, as opposed to the mere fact that she made the pitch at all, I must now admit I was wrong in my first comment, and that she can be faulted. It would seem that a lined is crossed when she actually goes so far as to try and convince her that she should want the procedure in the first place, instead of merely explaining how, if she wanted it, then there are savings to be had if she did it now. Thanks for pointing that out. I shouldn't have missed it in the first place.

Note: I told her I KNEW my nose was crooked, but I didn't care about that. Also, let me explain that the damn doctor had already told me 2 or 3 times about how I would be "saving" money. And I would be surprised if the receptionist assumed the doctor did NOT tell me. Since I was the person who was given unwanted beauty advice AND I have worked in retail for 6 years, I can tell you that selling hats and selling rhinoplasties are two different pitches. It's so much more personal when someone is talking about your body, especially your face. After I left that office I was actually crying because I couldn't believe I was being hassled so much (despite the fact that I do have high self-esteem and I don't have a problem with my nose.) It was just embarassing and awkward to have been placed under a microscope like that. A few years ago, when I was less sure of myself, all of that scrutiny would have probably convinced me that I should go through with the "good deal." That's what I meant when I said I would have fell for their B.S.

Alice, do you understand that there is a difference beween a doctor and a salesperson? And between a medical procedure and a HAT?

Again with the fixation on the fact I used hats in my example. I only did that because I could pull an example from experience; if I had held a job selling elective medical procedures I'm certain I'd have examples of the exact same thing.

Also, let me explain that the damn doctor had already told me 2 or 3 times about how I would be "saving" money.

Well, then there's a problem with him as well. You should have mentioned that in the OP, since as it is, only the receptionist comes across as troublesome.

I think the big disconnect here and the reason for the fixation on the hat example is that health care and retail are qualitatively very different. Ethics in medicine are not comparable to ethics in retail.

I would bet that the majority of people (including many who support capitalism and privitization in health care), would balk at the idea of a doctor giving them a sales pitch for something that wasn't medically necessary.

A non-judgmental, factual presentation of options for legal, but medically unnecessary procedures? Fine.

An effing sales pitch!? No thanks.

Alice, I am not sure it's entirely reasonable to say that the OP should have remembered every single detail of her exchange with the doctor and receptionist in the original post. I know when I am composing a post or any other recollection of an experience that I've had that I often omit things by accident. The OP also likely believed that her exchange with the receptionist would do a good job illustrating the situation she was in; considering that you are the only person who has seemed to take issue with the story she *did* relay, I think that it is safe to say that the spirit of her post was understood by the majority of readers despite her forgetting to put in every tiny detail of her exchange with the doctor.

The only thing that her clarification of what the doctor said changes for me as a reader is that she should run not walk away from the ENTIRE office. This is clearly more than an instance of a tactless and sales-driven receptionist. It is symptomatic of the attitude of the entire office. I personally wouldn't feel comfortable working with any of them.

Tofu is also spot on with noting that the "sales pitch," as you seem to characterize the exchange, was judgmental rather than factual. That's pretty gross, if you ask me.

Jeez, I hate when people do this. While I haven't ever gotten that same degree of hassling, I once had a dental hygienist tell me my teeth were too short. And, of course, it could be fixed by just cutting (!) off some of the gums covering them, which, coincidentally enough, my dentist's office just happened to offer. Funny, that. But, on the bright side, it wasn't mentioned again after my "hell no" in response (well, more of a garbled "uh-uh" since she had her instruments in my mouth).

Yeah, oftentimes the doctors are either trying to just make extra money or help out their colleagues. My bf's eye doctor actually tried to refer him to a neurologist for this reason: He was 6'3. The doctor said that because he was taller than his parents, it could be a sign of ... get this: a brain tumor. And conveniently, he had a buddy who was a neurologist. I know this is kind of veering off of the body image discussion, but the scenarios I have encountered and/or heard about make me lose a little faith in these medical "professionals."

I consider those noses prominent on ladies too. Don't let the haters hate.

I adore large noses on ladies. They are very regal, and every time I see a woman with a prominent nose I want to paint her.

I used to want a nosejob just because I have a small bump, I've since learned it's nice to not look like a clone of everyone else. Good for you for telling them what you think!

I think that there is a real problem with the health care industry if doctors are making sales pitches for procedures with no health benefits.

I'm certainly not willing to condemn plastic surgeons for offering unnecessary procedures at all, but I most certainly do condemn trying to sell them to someone who came into the office for a medically necessary procedure.

Mentioning it once is one thing, but a sales pitch from a doctor or nurse on a procedure that will not improve my health is inappropriate.

I have learned plenty of big nose jokes from my father and his siblings, from whom I inherited my own and who used to tell the jokes to each other as kids. (I guess this is what happens in a household with five brothers and one sister, all smart, troublesome and merciless.) My favorite, because it's so weird: "Has anybody ever told you you have a Roman nose...? Yeah... Roamin' all over your face."

I agree with Destra re: large-nosed people as artistic subjects. I suspect the nose (uh, plus my big cheeks) is why photographer friends like shooting me.

And mland45, that situation is appalling. I agree with everyone who said a sales pitch might be one thing if you'd expressed any interest in a rhinoplasty, or if you'd shown up for some other cosmetic procedure, but trying to sell a nose job to somebody who's just looking to address a medical condition is ridiculous. And there is no excuse for the receptionist's behavior after you had already visited with the doctor. Since when is it a receptionist's job to sell additional surgeries at all?

I suspect you're hardly the only patient of the ENT branch of the practice to be inappropriately badgered about cosmetic surgery. It sounds like the receptionist, at the very least, can't properly differentiate between patients of each and understand the different needs of both groups. If I were treated like that I'd probably seek out a new doc.

Yech, the sales pitch at the doctor's office is the worst.

Good for you for not caving. I, too, have a large nose. Fuck prominent. The thing is long and pointy AND wide. When I was in 6th grade and at that stage where one's features dont' really jive with each other yet, the kids called me Pinocchio. But these days I don't want plastic surgery or anything else for it. It's my nose, and this is the face I've lived with for 27 years. It's who I am. Why would I change that? I LIKE who I am and I don't need to have a teensy little Anglo-Saxon schnozz, because I don't and never will.

My orthodontist did this to me when I was 14 or 15 and discussing the possibility of, well, basically breaking my jaw so there would be enough room for all of my teeth. That part was medically necessary, but then in the explanation he slipped in how I was going to get a chin implant as well. He did this so slyly that it wasn't until I got home and was mulling it over in my mind that I finally parsed that the implant was totally unrelated to my skeletal problem. At the time I was actually excited at the prospect of sneaking in a little cosmetic work under the premise of a legit surgery, but now it pisses me off.

(I ended up not getting any of it done and got a great result with braces, but I'll have to wear a retainer at night for forever because I don't have the bone structure to hold my teeth in place. It's not ideal, but it didn't cost $20-40k either and my retainer doesn't bother me a bit.)

This situation reminds me of a quote from an article I just read here:
http://www.rd.com/living-healthy/41-medical-secrets/article75920-1.html

"Twenty years ago, when I started my practice, my ear, nose, and throat procedures financially supported my facial plastic surgery practice. Today, my cosmetic practice is the only thing that allows me to continue to do ear, nose, and throat procedures, which barely cover my overhead."
--Ear, nose, throat, and facial plastic surgeon, Dallas/Fort Worth

While the unsolicited pressure you received is extremely offensive, it probably has as lot to do with the overhead costs (particularly medical malpractice) in the fields that don't make the big money these days. That said, it still hinges on the idea that most women will jump at the opportunity to slice open their faces to look more like the cultural standard.

To the OP: I agree that the way the physician and receptionist interacted with you was inappropriate and you had every reason to walk out of that office feeling upset.

I am upset with the way the receptionist spoke to you - not only was she rude, but whatever medical procedures you elect to undergo are between you and your doctor, and have NOTHING to do with her.

As for the physician. I think most of us physicians know that communication with our patient is at least as important as nailing a diagnosis and treatment plan. However, I think we also know that we do not communicate nearly as well as we would like. Some of us are completely clueless when it comes to empathy and the art of communication in medicine (the stereotype is that these are mainly surgeons, partly because they are megalomaniacs, and partly because of the nature of their job - cutting someone open - they need to maintain a certain emotional distance from their patients), some of us are aching to be better and trying to be better but are yet limited by the constraints of our health care system non-system.

I don't know the ENT to determine which category he falls in. To play devil's advocate for a second: I think Alice has a point when she says that sometimes her clients will choose to purchase something they normally wouldn't get if the price is right. We see this in medicine too, though more often with therapeutic treatments than cosmetic ones. Especially if a certain intervention is controversial (cosmetic surgery, Viagra, birth control, abortion, etc), patients are often afraid to ask for it even if they truly want it. This is where the art of medicine comes along - if you sense that your patient has something else they really want to talk about, how do you bring it up with them while remaining sensitive to their anxiety and insecurities?

The advice to simply ask the patient - to defer to the patient when you're in doubt about his or her needs - is sage. You always run the risk of offending your patient no matter how thoughtful you are trying to be (would you have bristled still if your doctor had just asked, "How do you feel about rhinoplasty?") but at least the conversation would end there, and not twenty minutes into a discussion about what he wants to "fix" about your beautiful nose!

From what you've mentioned, it doesn't sound like you were giving your ENT any reason to think that you wanted something other than treatment from your sinusitis. As a doctor, he made the mistake of assuming what you wanted. Perhaps he assumed this because you were coming to see an ENT who was also a cosmetic surgeon? Perhaps he saw you glancing over a rhinoplasty brochure before he walked in? Or maybe, as I hope he is not, he really is just a self-serving physician who wants more cosmetic business/cash. (Sadly, I admit those people do exist). I have no idea. I was not there. Regardless, I wish he could have been a little more tactful and respectful. And on behalf of the medical profession, I'm sorry for the way that you were treated.

***FYI: Septoplasty - the correction of a deviated septum - is an actual treatment for chronic and/or recurrent sinusitis, among other upper respiratory problems. It doesn't sound like this was the treatment of choice for you since you told us that your ENT recommended a different type of surgery, but I just wanted to put that out there so Feministing readers aren't seeing red flags every time their ENT recommends correction of a deviated septum!

***Regards to the posting from the woman who stated that her bf's eye doctor was concerned about a "brain tumor" because he was tall, and wanted to refer to a neurologist. This intrigues me greatly. There is a condition called Marfan's Syndrome which some of you might have heard of (some famous people have had it, including Jonathan Larson - the man who wrote the play Rent). People with Marfan's tend to be very tall and lanky and can have a constellation of medical issues, including ocular problems and vascular aneurysms (aortic and berry aneurysms). The latter - berry - tends to be intracranial. Not a brain tumor per se, but rather an outpouching of an artery in the brain that can rupture if not treated. I'm not sure what the eye doctor was thinking here - did he see the classic subluxated lens in an eye of this tall patient and think about Marfan's? Or did he see nothing and is just a douche making up stuff to help his buddy out? I don't know. (I know nothing about the patient and doctor other than what was presented, and I'm just here making hypotheses. Not trying to be alarming). It sounds like, regardless, once again we have an issue of poor communication. But, if your doctor says something that sounds CRAZY - don't assume it's crazy right away. Ask why. Medicine, and the human body...it is full of surprises.

I think it is quite unethical for an ENT to attempt to push purely cosmetic surgery on you. Doctors are not supposed to be your standard capitalist pigs. They are supposed to abide by certain ethics and standards. If someone repeatedly tried to push Prozac on you, although you said no, would you think it was ok? How about when someone tries to talk you into having a c-section, even though you don't want one?
It is not ok for a doctor to push services, as if his office were a hair salon, For one thing, it's surgery, it carries risks (including death), it's expensive, and it's not like you can just put it back the way it was if you don't like it.
Also, a Doctor is considered a person of authority, is it really acceptable to abuse that authority by offering services that you did not seek or require? Would it be ethical for a Police Officer to also sell security systems? Is it ok if a teacher uses the classroom to sell study aids?

Alice,

These sort of underhanded "capitalist tactics" are one of the many reasons I am a feminist. You call it "enlightening someone to something they didn't know they needed", I call it convincing women that their value lies in their appearance and telling them they need cover-up, eye-liner, eye shadow, mascara, lip-liner, lipstick, lip plumpers, blush, foundation, hair dye, hair straighter, hair curlers, fancy conditioners, mousse, gel, hair spray, wrinkle reducer, sun-less tanners, moisturizing deodorant, hair bleachers, hair removers, diet pills, diet clubs, diet food subscriptions, supplements, stapled stomachs, liposuction, collagen injections, padded bras, breast lifts, breast increases, face lift, Botox, nose jobs...

am I forgetting anything else?

This is what is giving young girls warped ideas about beauty because all they're being taught is that they're never good enough. But it's ok, because beauty is something that can be bought! The only thing WORSE than that, is masking that kind of deranged thinking as medical advice. Surgery is hardly a "you might as well" endeavor. I don't care how cheap it is, there are still some things I wouldn't buy and wouldn't buy into.

I can't believe Alice is defending this horrible doctor. The doctor didn't just ask once ... the patient was HARASSED by the receptionist!

Alice (and anyone else)

This is patently wrong. The patient never asked for any cosmetic surgery. To try to tag on a rhinoplasty when a patient comes in for a medical procedure is ridiculously lecherous--and just plain wrong. If patients feel uncomfortable with their bodies and want something changed, that's their decision. The doctor has no reason to try to suggest cosmetic surgery without prompting except for reasons of profit (not health), and to use a person's insecurities to try to obtain that profit is indefensible.

This is dual problem involving the relation of self-image to misogyny in our society, coupled with a broken health care system that relies more on money than on treating patients.

Finally, it's always bothered me that doctors who perform cosmetic surgery for non-medical reasons would even be considered "doctors." Now, I know that lots of doctors are in plastics for reconstructive/rehabilitative reasons. I also know that these surgeons who do cosmetics require an MD. However, a doctor who relies entirely on cosmetic procedures for his/her income isn't performing a procedure that relates to MEDICINE, and therefore shouldn't be considered medical professionals.

P.S. Does this experience remind anyone of the McDonalds cashier who asks "do you want fries with that?"

ick.
i understand the plight of an ENT who's trying to pay the bills doing nose jobs and everything, but this approach was completely inappropriate. i'd like to THINK they wouldn't have said such rude unsolicited things to an adolescent patient, but unfortunately they may very well have.

i think part of the issue here isn't just about capitalism or whether or not doctors should make sales pitches the way that retail salespeople would, but that women are always being told by someone (someone who always "knows better" than they do) that their bodies are wrong/flawed/unacceptable and that for a nominal fee, that problem can be remedied. it's the intersection of the beauty myth with marketing that disturbs me the most. criticizing someone's appearance and offering a solution for a price is just a particularly loaded pitch, designed to hit women where they are often most vulnerable due to a lifetime of being held to superhuman, unattainable beauty ideals.

i have no issue with rhinoplasty per se, or plastic surgery per se. i just wish we weren't told we NEED it to be worthy of love 24/7.

I've had similar run-ins with doctors twice. When I was twelve, as I was getting my braces put on my mother fondly mentioned that I had my father's smile--to which the orthodontist responded that he could "fix" that with "corrective" surgery to "repair" my upper lip--I have a gummy smile (kinda Julia Robertsish), but it's caused absolutely no health problems, so I'm at a loss to think about what sort of "repairs" would have been needed.

The second time was more recent. I was visiting a dermatologist for a yearly mole check and he started lecturing me on recent tattoo work. This wasn't quite the normal (and awful) "What will it look like when you're 60?" kind of lecture, but rather he was instructing me not to get them colored because that makes them difficult to remove. And then he told me, oh so helpfully, that he does tattoo removal services in his office! This wasn't a little blurry tattoo either, but very expensive, extensive, and extensively thought out work. I was pretty much appalled, as, if I were interested in tattoo removal, clearly I would have asked him about it.

rileystclair said:

"it's the intersection of the beauty myth with marketing that disturbs me the most."

I agree completely with this passage and the rest of your post. The only thing I would add is how absolutely CONVOLUTED even that already messed up myth/marketing intersection becomes when it is coming from the mouth of someone who is allegedly a medical professional. To a lot of people, this doctor's comments could be confusing, blurring the line between cosmetic, medically-unnecessary surgery, and the medical procedure they were actually seeking from that doctor. The position of authority enjoyed by medical professionals in a situation like this actually amounts to coercion.

llesbianllama, excellent point. it's a lot easier for me, and probably most people, to recognize an unadulterated, appearance-based sales pitch when it comes from the clinque counter than when it comes from a doctor. i'm totally guilty of often giving medical professionals the benefit of the doubt. this is an abuse of power.

To put it simply, you shouldn't expect a salesperson to take you at your word when you say you're not interested, because a lot of the time that they hear that, they are, in some sense, being lied to.

You. Seriously. Can't. Be. Serious. When I tell anyone, salesperson included, that I'm not interested...I expect them to take me at my word. Because, it's my word. My word, my face, my body, my money. My word. The only word that counts. It's one thing to hammer away about a procedure that has health benefit, but inappropriate to hammer away about something that improves (subjective, by the way) aesthetics. And I guarantee that they only employ this policy with perceived flaws. As a lot of people can attest, many people get cosmetic surgery when there is no perceivable flaw (again, subjective). So unless, they are pushing nose jobs at every person getting this particular procedure, or better yet everyone walking through the door, you can not make an argument on behalf of how 'appropriate' or 'acceptable' this is.

This story is so familiar to me. I am yet another prominently nosed lady, and I too was nicknamed Pinocchio in middle school. My mom has a sister who grew up in the 60s with the same nose as mine, and had always felt incredibly bad about it, and my mom knew that I had been teased about it when I was younger. So in a backwards attempt to make double plus sure that I was going to be comfortable with my body in the future, my mom began asking me if I would be interested in getting a nose job while I was still covered under my parents' insurance when I was about 16. Granted I do have a deviated septum that has caused me some breathing problems, so she would bring it up along with getting that fixed. I was pretty opposed to the rhinoplasty from the beginning, but mildly curious about the deviated septum surgery. My mom brought up the subject so many times that I eventually conceded to consulting a doctor.
I had thought that if I were to get anything cosmetically changed, it would just be reducing the size of the bump in my nose. When we arrived the doctor took a look and started going into the details of how I would look best with no bump, a smaller nose entirely, and then he started to bring up all the other minor imperfections he would fix while he was in there. Lengthening my top lip, something about the area under my eyes. It was ridiculous, and not anything that a 17 year old should be hearing about her face. We left and I decided Fuuuuck This. I am not going for any amount of invasive surgery for this nose.
These days that decision has worked out incre