Managing patient expectations is key to the success and reputation of your aesthetic practice. An unsatisfied or unhappy patient can not only jeopardise your business through potential claims but also tarnish your hard-earned reputation with negative online reviews. Both of these situations can tie up your valuable time and resources, and divert attention away from other patients, as well as cause you a lot of stress. This is why it is important to learn to say “no”. 1
It can be hard to turn down a patient after all the effort you’ve put into getting them through the door in the first place. But while turning down a patient may seem daunting, it’s a crucial skill that can protect both your practice and the well-being of your patients. At Hamilton Fraser, we would like to help give you the confidence to manage these awkward conversations better, ultimately supporting you in making your business a success.
In our recent survey, it was evident that many practitioners have experienced situations where they had to decline to treat a patient. A total of 30.7% of respondents said they had turned patients away once or twice, while another 30.7% had done so at least three times, and 24.8% said they had said no to treating unsuitable patients more than three times. Only 13.7% said they had never turned a patient away.
When asked if they had ever regretted treating a patient, it was almost a 50/50 split, with 48% saying “yes” and 52% saying “no”. Of those who answered “yes”, the main reason given was that they felt the patient had unrealistic expectations of treatment. Practitioners also stated body dysmorphia, patients wanting treatments for low costs, difficult or demanding patients and gut feelings as other reasons to say “no”.
Encouragingly, 91.5% said they were routinely looking out for patients displaying any mental health problems, in particular, body dysmorphia, with questionnaires and screening during consultation being the main methods of analysis. This proactive approach demonstrates a commitment to patient well-being and that treatments are both safe and appropriate.
"Patient selection has always been an important part of ensuring optimal treatment outcomes. In an unregulated sector, with lots of competition, your reputation can set you apart. During consultations with patients you should take extra care to look out for ‘red flag’ signs and if you feel they are not suitable for treatment, do not be afraid to say ‘no’. The team at Hamilton Fraser is here to assist if you need guidance on declining patients."
- Emma Bracchi, Senior Client Services Technician
One critical aspect of patient selection involves assessing their mental health and psychosocial well-being and identifying red flags.
Dr Vincent Wong, speaker at The Aesthetics Business Conference on 8 October 2024, about how to say “no,” comments”, “Key red flags include patients having unrealistic expectations or desiring changes that aren’t clearly visible to others. Another red flag is when a patient seeks results that are more typical of surgery from non-surgical procedures. We have to be very careful in these cases to manage expectations or even turn the patient away if necessary.”
Conversations surrounding mental health can be challenging as they touch upon intimate and personal matters. However, understanding the psychosocial components underlying aesthetic treatments is essential for providing comprehensive care to patients.
Some patients may express unrealistic expectations that could suggest underlying psychological concerns, so practitioners have a duty of care to delve into their mental health history and address any psychological issues that may impact their treatment outcomes as part of the consultation process.
When faced with the decision to refuse treatment, it's essential to handle the conversation with tact and empathy. Trust your instincts and communicate openly with the patient about your concerns. Discuss why you believe the proposed treatment may not be appropriate or yield natural-looking results, emphasising that your primary goal is their well-being.
Dr Wong explains, “Saying ‘no’ it is not only appropriate but necessary at times. If a patient’s expectations are unmanageable, or if they have medical or psychological issues that make a certain treatment unsuitable, it’s important to say no. This refusal is part of ensuring patient safety and satisfaction.
“Communication is key. We explain why we are refusing the treatment and try to educate the patient about their options and what is realistically achievable. Sometimes, referring them to a therapist or suggesting alternative treatments is the best approach. If a patient insists on a procedure we consider unsafe or inappropriate, we might suggest they seek a second opinion elsewhere.”
Sometimes, patients may insist on a treatment despite professional recommendations. In such cases, it's crucial to maintain firm boundaries and prioritise the patient's health over their desires. Refusal should be conveyed respectfully, with a focus on patient education and understanding.
Dr Wong says, “I have had people who push back, and then what I would say is, ‘Maybe this is not the right clinic for you, and maybe I'm not the right practitioner for you.’ In the past, I have been on that journey where I'm like, "I'll do whatever the patient wants," but with these patients, even if you get the best results, it will still be wrong to them.”
It's essential to remember that as a practitioner, you are under no obligation to treat anyone. Your primary responsibility is to provide care to patients who are suitable candidates for procedures, prioritising their well-being and safety.
Refusing treatment may be uncomfortable, but it is sometimes necessary to uphold professional integrity and make sure of patient safety. In fact, refusing treatment can actually serve as an effective marketing tool, preserving the integrity of your practice and demonstrating a commitment to ethical standards.
By communicating openly, empathetically, and respectfully with patients, you can navigate these challenging situations while preserving trust and maintaining positive clinician-patient relationships. Remember, saying “no” is not a reflection of inadequacy but rather a commitment to ethical practice and patient care.
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