In The Checklist Manifesto, Atul Gawade makes an important distinction between knowing what to do, and remembering to use that knowledge. Since then, safe surgery checklists have been indispensable in most clinical settings. The same principles apply to the pre-injection patient consultation, so we compiled the 4 essential items in any aesthetic practitioner’s Pre-treatment Consultation Checklist.
Cosmetic Consultation Checklist
1. Agree on realistic goals ☑
Patients often have high expectations of aesthetic procedures. How can you negotiate more realistic goals?
– Focus on the outcomes that are important to the patient – and which are achievable using the treatment. Involve the patient in actively defining ‘success’ in a realistic way. You should aim for an objective description of the outcome (“bigger” rather than “nicer”).
– Modify the patient’s current understanding of the procedure. For example, if a patient wants to ‘get rid’ of their laughter lines, then you can agree on the aim of ‘softening’ the nasolabial folds.
– Ask how the patient expects the treatment to affect their everyday life and gain and understanding of their existing knowledge. Do they know how long the benefits of the treatment will last?
Realistic pre- and post-treatment photographs are essential for agreeing realistic goals and evidencing outcomes.
2. Pre-treatment photographs ☑
Pre-and post-treatment photography is important for various reasons. Not only do they make talking through areas of concern together easier, but after treatment patients can become psychologically acclimatised to the effects. Directly comparing with follow-up photos means you can exhibit the scale of the outcome to the patient, increasing patient satisfaction.
For some insurance companies these photographs are a medico-legal requirement. In addition, they can sophisticate expected outcomes for future treatments, and of course add to your portfolio.
☑ 3. Consent
Consent may seem like an obvious one. But it’s more than just a signature on a piece of paper. Consent must be informed. Is the patient aware of:
– Both long and short term risks and possible complications?
– How complications will be managed – and paid for?
– Alternative options — including the option of doing nothing?
Consent must also take into account ethical issues — including those relating to the Mental Capacity Act 2005.
– Psychological screening tools are crucial. Ensure that these are included in your training. Take further training if they are not.
– Probe for signs of Body dysmorphic disorder. Talk through the history and nature of the patient’s concerns. Are their concerns proportionate? What impact have they had on their psychological well-being?
– Cover relevant psychiatric history. Eating disorders, depression, and anxiety should all factor into your decision. At the least these indicate the need for a more thorough psychological assessment before any treatments are performed.
‘High levels of anxiety regarding body image where appearance is within the normal range should trigger psychological referral.’
– Professional Standards for Cosmetic Practice
☑ 4. Pass on information
Has the patient discussed the procedure with their GP? As an aesthetic practitioner it is currently best pracice to inform the patient’s GP, unless the patient has actively chosen to not to.
‘Professional Standards for Cosmetic Practice‘ (Royal College of Surgeons, 2013)
Good Medical Practice in Cosmetic Surgery (Independent Healthcare Advisory Services, 2014)
For Doctors: Good Medical Practice (General Medical Council)
For Dentists: Standards for Dental Professionals (General Dental Council, 2009)
For Nurses: The Code: Standards of conduct, performance and ethics for nurses and midwives (Nursing and Midwifery Council, 2008)