The Pre-treatment Consultation Checklist
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 beyond checking for allergies, pregnancy and breastfeeding, we chose four often overlooked items Pre-treatment Consultation Checklist.
Cosmetic Consultation Checklist
☑ 1. Agree on realistic goals
Non-surgical procedures have clinically significant results, unlike most topical skincare sold in the cosmetics industry. However, the prevalence of highly selected or touched up before and after photos means that patients often have unrealistic expectations of aesthetic procedures.
So 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 (“more defined” rather than “nicer”).
- Modify the patient’s current understanding of the procedure. Moderate language is essential here. Lines can for example be ‘softened’ or ‘reduced’, rather than ‘erased’ or ‘removed’.
- Although highly effective, dermal fillers often pose a particular difficulty. This is mainly due to lack of awareness over the required quantity. Whilst 1ml is often more than suitable for a cheekbone or lip treatment in a patient in their twenties, older patients often require several millilitres to achieve significant results. It is vital that the patient is happy with this and the associated expense. A single ml treatment in a fifty-year old patient is likely to leave a dissatisfied patient who feels short-changed.
- 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? Are they aware that e.g. lip fillers may take 2-4 weeks to settle and integrate?
After you’ve discusses these issues make sure that your patient understands them and can talk about each point. You should not be the only one talking!
☑ 2. Pre-treatment and post-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 – useful if you decide to certificate your prior experience.
☑ 3. Consent. Thoroughly.
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?
A surprising amount of consent for cosmetic procedures overlooks important ethical issues — specifically those relating to the Mental Capacity Act 2005.
- Psychological screening tools are crucial. Ensure that these are included in your practice. 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?
‘High levels of anxiety regarding body image where appearance is within the normal range should trigger psychological referral.’
– Professional Standards for Cosmetic Practice
- 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.
☑ 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)