The aesthetic plastic surgery practice has specific risks inherent to potential legal liability. Managing patient expectations is critical to achieving their desired goals and limiting your risk. A disturbing trend among patients is the lack of patient accountability combined with an unrealistic set of goals. It can seem like any inherent risk or complication with their procedure generates a legal concern even if it was fully disclosed in an informed consent document. More than ever, patient selection is critical and choosing the most appropriate procedure is important. It is a common experience these days that after hours of internet research, television ads, and their friend’s experiences, patients will demand certain procedures; medical professionals need to educate the patient on the pros on cons of various procedures for their desired outcome, and make sure that the procedure requested is an appropriate fit for the specific patient.
Creating a more specific informed consent document specifying the additional risks of the procedures demanded by the patient does not eliminate your liability. In fact, a detailed document like that may create additional exposure for you, because it is your responsibility to ensure that the patient’s consent is appropriate to the procedure requested. For instance, many patient health conditions increase the risk of a poor outcome: a patient that smokes extends their recovery, adversely affects healing, and contributes to increased scarring. Merely outlining these risks in their consent form does not diminish their expectation of their outcome, nor does it eliminate your liability. In cases where you realize that the patient has unreasonable expectations given their underlying health conditions or desire to quickly resume normal activities, your practice is better served by declining to accept the patient. If the patient cannot be comfortable with a different procedure, a referral to a different physician is a better choice.
Nothing illustrates this trend better than a review of the litigation claims against plastic surgeons. Breast augmentations and breast lifts are the leading procedures that generate legal claims. Patients seeking these procedures have very specific notion of what they dislike about their current physical makeup and how they want their breasts to look after surgery. Social pressures and media influences create unrealistic expectations. Patients are often unwilling to accept that their health, physical makeup, or other underlying condition may make some outcomes unrealistic. Other family members and significant others are more than willing to offer aesthetic opinions on their surgical outcome, increasing patient anxiety and leading to potentially greater dissatisfaction with their result. After their procedure, any delay in healing, or a scar that does not meet their expectations, or a shape that differs from their desired outcome can lead to patient dissatisfaction and later, to a potential claim.
In-office cosmetic medicine has dramatically increased in the sheer number of procedures performed, and these health care professionals need to follow the same guidelines for risk prevention and mitigation. Each skincare treatment, toxin injection, and filler injection should have appropriate disclosures and a signed patient consent. Your practice needs to make sure that the health care professional providing treatments is acting within the scope of their license, that such procedures are permitted to be performed by them, that supervision and oversight is in place and is adequate, and that appropriate patient and procedure selection is done. Patient care guidelines must be established, disseminated to all staff, and followed throughout the practice. It is good practice to see prospective patients more than once before their procedure, so that you understand and agree on the procedure to be performed, and the patient has time to reflect on the information that you discussed with them. It also allows more time to discuss your financial arrangements, and to discuss the future costs of their ongoing care, particularly if a complication arises.
Cosmetic medicine is rife with fads, and new procedures are often heavily marketed directly to consumers. It is wholly understandable that patients desire increased satisfaction with their self-image, and are willing to try new procedures to achieve it. Use your professional judgment; don’t succumb to patient demands to try untested or inappropriate procedures merely to keep the patient as a client. You know when you are not completely comfortable with the decision to perform a procedure on a given patient; in those instances, follow your instincts.