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Cosmetic/Plastic Surgery

Ten Tips for Managing Patient Expectations with Cosmetic/Plastic Interventions

Managing patient expectations, addressing unrealistic expectations and providing clear, accurate information about care and treatment is an important factor in reducing the risk of claims, particularly with cosmetic/plastic interventions.

Clinicians need to ensure that their patients have an informed understanding of the potential results of treatment. Failure to manage expectations and communicate clearly and truthfully may increase the risk of patient complaints, requests for refunds, litigation and disciplinary action. In a recent review of PMP cosmetic/plastic surgery claims over a six year period, ‘communication with the patient’ was a contributory factor in 63% of these cases*. The review highlighted how suboptimal communication impacted on patient outcomes and patient expectations.

*Contributing risk factors are failures in the process of care that appear to have contributed to the patient outcome and/or to the initiation of the case or had a significant impact on case resolution.

The following ten tips may help clinicians in the cosmetic/plastic specialties to manage patients’ desired outcomes and address unrealistic expectations:

  1. Ensure that advertising and marketing material is accurate and does not include any unintended commitments or promises that may result in unachievable standards of care. Encourage patients to take adequate time to reflect and understand the proposed cosmetic procedure.
  2. Practitioners should be cognisant of the potential for misunderstanding between what is achievable from cosmetic procedures versus the patient’s expectation of a nebulous vision of perfection.
  3. Assess the patient’s suitability for the procedure in terms of their medical history and psychological state. Only offer a procedure if it is considered to be beneficial to the patient and is capable of delivering the desired outcome. Failure to meet patient expectations can be a contributory factor to litigation.
  4. In accordance with the GMC’s Guidance for doctors who offer cosmetic interventions and Decision making and consent, have a meaningful discussion with the patient prior to the procedure to enable the patient to make an informed choice. This will include details of the procedure, risks, benefits and alternatives. Document details of the discussion in the patient’s medical records. Please note: consent for cosmetic/plastic interventions must only be undertaken by the doctor who will carry out the procedure. It must not be delegated to another healthcare professional. Please refer to para 16 of the GMC Guidance for doctors who offer cosmetic interventions.
  5. Ensure patient educational material is designed to assist their understanding and devoid of marketing hyperbole.
  6. Doctors offering cosmetic procedures must follow the regulatory codes and guidelines set by the GMC, Royal College of Surgeons and Committee of Advertising Practice.

    Please be aware that the Government announces its intention to introduce a new system of licensing for England for cosmetic procedures to offer greater protection to the public.

    An amendment to the Health and Care Bill tabled on Tuesday 1 March 2022 would give the health secretary the power to introduce a licensing regime for botulinum toxin and fillers, the scope and details of which will be determined in a public consultation.

  7. Although much of healthcare is performed to a high standard, when things go wrong and the patient experiences an adverse outcome, it is important to investigate, explain and apologise appropriately to the patient. Please refer to the GMC’s Openness and honesty when things go wrong: The professional duty of candour. If you receive a complaint from a patient or a patient suffers an adverse event, please notify PMP as soon as possible, in line with the terms of your policy. PMP can assist customers in preparing an appropriate response.
  8. An adverse event should be used as an opportunity to reflect, learn and adopt changes to a clinician’s practice to improve care.
  9. Undertake regular audits of intervention outcomes as a quality improvement measure. Any shortcomings identified in audits should be addressed and documented. This, and the reflection and learning from adverse outcomes, will provide useful evidence for a doctor’s appraisal and revalidation.
  10. Doctors should ensure they have adequate professional indemnity insurance to cover the procedures they undertake. In addition, they should notify their indemnity insurer of any changes to their scope of practice, in line with the terms of their policy.

If you have any queries or concerns surrounding the issues raised in this document, please do not hesitate to call the PMP medicolegal helpline. The medicolegal helpline is provided by our legal partners Clyde & Co. The helpline is open 24/7, contact details can be found on your policy documents or customer card.

Information correct at time of publication May 2021
This document does not constitute legal or medical advice and should not be construed as rules or establishing a standard of care. Because the facts applicable to your situation may vary, please contact your solicitor, legal advisor or other professional advisors if you have any questions related to your legal or medical obligations or rights, applicable law, contract interpretation, or other legal questions. © 2021 Premium Medical Protection Ltd. All rights reserved.
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