Selecting the right patients is a crucial skill for aesthetic practitioners. The goal of any aesthetic procedure is that the patient is happy with the result, so choosing appropriate candidates for treatment is essential. By identifying any red flags early on, you can avoid many common complaints from dissatisfied or unhappy customers who may have unrealistic expectations of what can be achieved.
We have created a comprehensive video packed with practical advice and essential guidelines on patient selection in aesthetics to help you navigate this important but potentially challenging aspect of aesthetic practice.
The importance of patient selection
Managing patient expectations and making sure you are selecting the ‘right’ patients is key to running a successful aesthetic practice.
The consultation is perhaps the most vital part of the patient selection process. It's where you get to know the patient’s motivations for treatment, expectations, and relevant medical history.
During your consultation, take extra care to look out for ‘red flag’ signs, and if you feel the patient is not suitable for treatment, do not be afraid to say ‘no’.
Aesthetic clinics work hard to get patients through the door, so it can be hard to turn business away. But Emma Bracchi, Senior Claims Technician at Hamilton Fraser, explains why patient selection and saying ‘no’ is so important:
“Treating an unsuitable patient for short-term financial gain can have devastating long-term repercussions, so it’s important to know when to turn down a patient who is there for the wrong reasons or does not listen to your guidance and advice. Understanding when to say ‘no’ to unsuitable patients could prevent a claim against you in the future.”
Encouragingly, our annual survey showed that, in terms of identifying red flags and saying ‘no’ to patients, the majority of respondents had done so on more than one occasion. 30.7% said they had turned a patient away once or twice, 30.7% said they had said ‘no’ to treating unsuitable patients 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.
The team at Hamilton Fraser understands that saying ‘no’ can be hard, but remember, you are under no obligation to treat anyone, and refusing treatment is sometimes necessary and in the patient’s best interests. We are here to assist if you need guidance on saying ‘no’ to patients. You can also read our separate blog on how to say no to patients for more advice.
Six key steps to consider when selecting patients and assessing suitability for treatment
1. Understand and manage the patient’s expectations
As we mentioned above, the initial consultation is crucial to understanding and managing the patient’s expectations. It’s important to allow enough time to assess the patient’s suitability for treatment. The consultation should involve a psychological assessment that focuses on the patient’s motivations and expectations of the treatment.
Building rapport with the patient during the consultation is key to understanding their expectations and shouldn’t be underestimated. Try to select patients with whom you feel you are more likely to build a long-term relationship. It’s a two-way street, and they need to be the right patient for you as much as you need to be the right practitioner for them. They are, in turn, more likely to be open and honest about what they are hoping to achieve from the treatment and why they are choosing to have it.
“The big difference with aesthetic practice is that the patients are electing to have the treatment, unlike an NHS practice where generally it's a reactive treatment where you're looking to deal with a specific medical problem. With aesthetic practices, the patient generally knows what they want, so their expectations of walking into your clinic are going to be a lot higher than they would be walking into an NHS practice. It's really important that you spend real quality time with that patient to really get underneath not only what they want but why they want it. If you don’t understand what the drivers are, it can be a recipe for disaster.”
- Hamilton Fraser founder and CEO Eddie Hooker
Once you've developed an understanding of your patient’s motivations, you will be in a better position to identify whether there are any issues around how they perceive their physical appearance and body image. If they seem particularly anxious about a defect that is not noticeable or dwell for longer than usual periods of time on their appearance, then this may be an indication of Body Dysmorphic Disorder (BDD).
When discussing their expectations, it's important to be honest with your patients. If you're unable to achieve the results that they are hoping for, you need to explain what can be achieved and make sure that they understand this information. If they do not appear to be listening or digesting the information, this could be a sign that they are the wrong patient. If this happens, you may decide to say ‘no’.
2. Check your patient’s medical history
While it may seem obvious, taking a thorough and honest medical history from your patient is a vital part of the consultation process. This history should cover any medical conditions that might contraindicate the intended treatment, as well as any previous aesthetic treatments. For more guidance, read our article, A patient’s medical history – what should you include?
Gathering this information helps identify potential ‘red flag’ patients. These might include individuals seeking excessive treatments or those with self-image issues. During these discussions, patients might express dissatisfaction with past treatments or other practitioners. This could be a sign that they might not be satisfied with any treatment they receive, which could indicate a potentially litigious patient. In this scenario, you may prefer to avoid carrying out the procedure.
3. Educate the patient about the treatment and give them a cooling-off period
Explain to the patient how the treatment works, including any potential side effects, the recovery process, the number of sessions required, and how it can help them achieve their realistic aesthetic goals. An informed patient will have a better understanding of the procedure, leading to more realistic expectations of the outcomes. This understanding enables them to make a well-informed decision about whether the treatment is suitable for them.
You should also always give a cooling-off period. “Wherever possible, don't do the treatment immediately after the consultation”, advises Eddie. “Always have a good period of time between discussions when you send them away to think about things and see if they've got any additional questions. The best practitioners are the ones who take their time. Never feel frightened to say, ‘I can't fit you in this week; can you come back next week, and we'll have another chat?’.”
4. Don’t be afraid to say ‘no’
We have discussed this above, but if you feel at any point during the consultation process that the patient is perhaps not suitable for the treatment or you are unable to manage their expectations, then you may need to decline their treatment. Taking into account the amount of stress, time and potentially money that treating the wrong patient could involve, it's not worth taking the risk with a patient you don't think is suitable for a treatment.
The best way to say no to a patient is to be transparent and explain that, having carried out a thorough assessment, you feel that they are unlikely to be happy with the treatment's outcome.
We often receive calls from practitioners who have felt sorry for a patient or been pressured into performing the treatment despite having trepidations. In our experience, these scenarios are more likely to attract complaints or claims. Trust your gut instinct, as it is more often than not likely to be correct.
5. Manage aftercare effectively
We always recommend that, in addition to discussing the necessary aftercare face-to-face with a patient, you provide them with a physical copy of the information to take away or email it to them for future reference. Post-treatment, patients might not remember all the advice given due to their excitement about the results. Providing a copy of the recommended aftercare and FAQs allows them to review the information at their convenience. This also fosters a lasting sense of support, which is beneficial for building a long-term patient-practitioner relationship.
6. Document everything
It's crucial to document all conversations regarding your patient’s expectations and your advice on what is achievable. We advise having the patient sign or initial the consent form to confirm their agreement with the discussed expectations and advice. Additionally, the patient should sign or initial the aftercare information to acknowledge receipt and understanding.
This practice is especially important in case of a claim. At Hamilton Fraser, we often encounter allegations where patients claim they were unaware of what to expect during treatment, the realistic outcomes, or the aftercare involved. Documenting and having patients sign off on these discussions provides evidence that they made an informed decision. This documentation can make any subsequent allegations against you more defensible. For more details on implementing a robust consenting and consultation process, refer to our comprehensive guide on consenting and consultations.
And don’t forget that documenting can now be digital. Find out more about how becoming a ‘paperless practitioner’ can help you to be not only more organised but compliant, too.
To sum up
Careful patient selection maximises the likelihood of achieving the best results from your treatments. Acting in the patient’s best interests involves understanding their motivation and educating them about realistic aesthetic outcomes and what the treatment entails. Knowing when to say ‘no’ to an unsuitable patient can be challenging, but fostering a solid long-term relationship reduces the risk of future claims. Making sure that both the patient and the procedure are a good match is crucial for successful outcomes.
“We find that the most common reason practitioners end up going against their gut feelings and treating a patient who ultimately isn’t suitable for treatment is because they are inexperienced and struggle to say no. This could be because they are trying to please their patient or because of financial strain when starting out. Initially, it may also be harder to identify red flags and develop an intuition for when a patient is approaching treatment from an unhealthy perspective. Awareness of patient psychological drivers for treatment, robust documentation and practising within your limits is essential when starting out in aesthetics.”
– Tristan Mehta, Harley Academy
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