How important is patient selection?

Patient selection is an extremely important element of the aesthetics industry. The experts at Hamilton Fraser have recorded an informational video detailing the most important elements of this topic. We have also created a downloadable guide for you to refer back to.

The importance of patient selection

Managing patient expectations and ensuring you are selecting the ‘right’ patients is key to running a successful aesthetic practice. But it can be hard to turn business away, and in the aftermath of the coronavirus pandemic this might seem particularly counter-intuitive. Aesthetic practitioners were greatly impacted by the forced closure of non-essential businesses. In fact, our survey revealed that almost half were worried about going out of business as a result of the pandemic.

Emma Bracchi, Senior Claims Technician states, “Following the COVID pandemic, patient selection is even more important than ever. Your business may have taken a huge hit over the last few months and it’s your reputation that will bring you back on track.  Once you are fully permitted to carry out all treatments, you may experience a number of new clients approaching you from word of mouth of existing clients.  This pandemic has been incredibly hard on the majority of the population so many will want to try new treatments to make themselves feel or look better.

During your consultation, please 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. Hamilton Fraser are here to assist if you need guidance on declining patients.”

However, 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.

The impact of COVID on patient selection

The mental health consequences of the COVID-19 lockdown are widely recognised as a serious concern, and the pandemic has also raised awareness of mental health as an issue more broadly. While some patients may have taken the pausing of cosmetic treatments in their stride, for others the forced lockdown and associated isolation may have fuelled body insecurities, contributing to a demand for cosmetic treatments from some more vulnerable patients which is not necessarily healthy. Although the majority of patients eager to resume their treatments will be fine to do so, it is important to make sure they are, to manage their expectations and not be overly influenced by their desire to make up for gaps in treatments.

The extra measures that practitioners need to take to ensure the physical safety of their patients following the pandemic should be accompanied by an awareness of the impact the virus may have had on patients’ mental health when assessing their suitability for treatment.

What factors do you need to consider when selecting patients and how can you assess a patient’s suitability for treatment?

1. Understand and manage the patient’s expectations

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 a rapport with the patient during the consultation is key to understanding their expectations. Select patients you are more likely to be able to build a long-term relationship with and they are in turn more likely to be open and honest about what they are hoping to achieve from the treatment and their motivation in electing to have it.

Developing an understanding of your patient’s motivations will allow you to identify any issues relating to how they perceive their physical appearance and body image. If they appear to be particularly anxious about a defect that is not noticeable or they dwell for longer than usual periods of time over their appearance then this may be an indication of Body Dysmorphic Disorder (BDD).

When discussing their expectations it is important to be honest with your patient. If you are 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. In this instance you may decide to say ‘no’. The coronavirus pandemic has been a time of great stress for many people, particularly those with underlying mental health issues, so it’s vital to be aware of the impact it may have had on your patients.

2. Check your patient’s medical history

This may seem to be an obvious part of the consultation process, but it is very important to ensure you take an honest medical history from your patient. It should include any medical conditions they have which may have contraindications with the treatment they are requesting, as well as any aesthetic treatments they have previously undertaken. For more guidance read our article, A patient’s medical history – what should you include?

This will allow you to identify a potential ‘red flag’ patient, for example, someone who is perhaps having too many treatments or suffering from any self-image concerns. Also, during these conversations, the patient may suggest that they have been dissatisfied with previous treatments or other practitioners. This could be a sign that they might not be satisfied with any treatment they receive, which may indicate a potentially litigious patient. In this instance, you may wish to avoid carrying out the procedure.

3. Educate the patient about the treatment

Explain to the patient how the treatment works, including any side-effects, what the recovery entails, how many sessions they will need and how it can assist them in achieving their realistic aesthetic goal. An educated patient will have a much better understanding of what is involved, as well as more realistic expectations of the outcomes, enabling them to make an informed decision as to whether the procedure is right for them.

4. Manage aftercare effectively

We would always recommend that, as well as discussing the necessary aftercare face-to-face with a patient, they are also either given a physical copy of the information to take away or are emailed a copy for their reference.

It is likely post-treatment that the patient will not take in all of the advice provided as they are excited about the outcome. By supplying a copy of the recommended aftercare and FAQs, they can refer to it once they have left the clinic. This also gives the patient a lasting feeling of support from you, which is beneficial to the longer term patient practitioner relationship.

5. Document everything

It is important to document all of the conversations about your patient’s expectations and your advice as to what is achievable. We also advise that the patient signs or initials the consent form to confirm that they are in agreement with the conversations and advice they have received. We recommend that the patient also signs or initials the aftercare information to confirm that it has been received and understood.

This is especially important in a claim scenario. At Hamilton Fraser Cosmetic Insurance we often see allegations that the patient was not aware of what they could expect during the treatment, what the realistic outcome would be or what the aftercare would involve. Ensuring that conversations about expectations and recommended aftercare are documented and signed within your consent form means that you have evidence that your patient made an informed decision.  This evidence makes any subsequent allegations against you more easily defendable. For more information on how to follow a robust consenting and consultation procedure read our in depth guide, 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.

6. Don’t be afraid to say no

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 incur, it is not worth taking the risk with a patient you do not think is suitable for a treatment.

The best way to say no to a patient is to be transparent and to explain that, having carried out a thorough assessment, you feel that they are unlikely to be happy with the outcome of the treatment.

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 the ones that are more likely to attract complaints or claims. Trust your gut instinct as more often than not it is likely to be correct.

Careful patient selection maximises the chances of your patient getting the very best results from your treatments. It is important to act in the patient’s best interests by trying to understand their motivation and educating them about the realistic aesthetic outcome and what the treatment entails. It can be difficult to know when to say ‘no’ to the wrong patient, but building and maintaining a good long term relationship means that you are less likely to encounter claims further down the line and helps to make sure not only that the patient is right for you, but that the patient is right for the procedure.

“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 are essential when starting out in aesthetics.”

–  Tristan Mehta from Harley Academy.

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