Ahead of his talk at The Aesthetics Business Conference on Tuesday 8 October, we chatted with Dr Vincent Wong about how to assess and manage patients' expectations, select the right procedures to match patients' needs, identify red flags, and say “no” with compassion.
Hamilton Fraser: Can you explain why patient selection and the power of saying no are crucial in your practice and what you will be covering in your talk at The Aesthetics Business Conference?
Dr Vincent Wong: Patient selection is critical because aesthetic treatments are readily available today, and a lot of people are influenced by social media and celebrity culture. They often come in with specific demands they may not truly need. There are so many different reasons why we would say no. Either the patient has an underlying medical condition unsuitable for a particular treatment, or they don't actually need it or need something else. Or it could be down to more severe things like body dysmorphia and health issues, so those are the things that I'll be covering and also why it's important to say no from a medical-legal point of view as well. And I'll be sharing certain tips and tricks on how to make it easier to say no. Obviously, we are saying that we also need to show that as physicians, we care about the patients and support them, but just in a different way.
Hamilton Fraser: What are the biggest challenges in assessing and managing patient expectations?
Dr Vincent Wong: Managing expectations is probably the most difficult part of the job. Sometimes, patients come in, and they want a certain line or wrinkle erased from their face, but then you can't really see what they're referring to. That is a huge red flag that we need to be aware of. Also, sometimes they would come in, and they would want surgical results, for example, with injectables or non-surgical treatments. Again, that is very important to explain. I normally do it as a percentage. I say, "You might see a 50 or 60% improvement – it is not going to get rid of your issue completely." It's also important to find the motivation behind having it done.
Sometimes, you find key clues in those conversations that will help you say no a little bit better and manage their expectations. Another part of managing their expectations is downtime because everyone feels differently. I normally give my patients the worst-case scenario, and if they heal faster, then that's great for everyone. But if they heal a bit slower, that is still within the timeframe that I've given them, so then they don't panic first and foremost. In terms of tools, I use the QuantifiCare 3D camera in my consultation. I take the before photo, and then we look at whether we can improve what bothers them. Most of the time, people forget that what they see in the mirror is a mirror image. It's not what other people see, and when they see it in three-dimensional terms, "I don't actually see that problem anymore."
Hamilton Fraser: How do you select the right procedures to match a patient's needs?
A: We start with a detailed consultation to understand the patient’s motivations, and I create a treatment plan. For someone new to aesthetics, we might start with less invasive procedures and gradually progress to more intensive treatments if necessary. It's about matching the right treatment to the right patient at the right time.
Hamilton Fraser: How do you identify red flags in a patient's presentation?
A: 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.
Hamilton Fraser: Is it appropriate to refuse treatment to someone?
A: Absolutely, it’s 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 guaranteeing patient safety and satisfaction.
Hamilton Fraser: How do you handle patients who react negatively when you refuse treatment?
A: 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.
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.
Hamilton Fraser: How powerful do you think saying “no” is, and how does that affect your professional relationship with the patient?
Dr Vincent Wong: I think with the right patients, you won't lose them if you say “no”. With the wrong patients, you'll lose them, but that's a good thing.
Hamilton Fraser: What do you hope people who come to ABC are going to take away from your talk?
Dr Vincent Wong: I hope that they will understand the power of communication and communicate clearly and in a transparent way. And I hope that they will leave the talk feeling more comfortable in saying “no”.
See Dr Vincent Wong speaking on the power of saying “no” to patients at The Aesthetics Business Conference on Tuesday 8 October at The Royal College of Physicians London.
Read our ‘Ultimate guide to patient selection’ and our article, ‘Patient selection: How to say ‘no’ to patients’ for more advice on this topic.
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