Dr Sarah Townley, deputy medical director at Medical Protection discusses the common medicolegal risks with cosmetic medicine.
Cosmetic and aesthetic medicine is an ever-changing area of private practice, where procedures and technologies continue to develop rapidly. Patients are becoming increasingly aware of the options now commonly available to them – ranging from Botox, non-permanent fillers and cryotherapy, through to facial peels and microdermabrasion – and a growing number of clinicians are undertaking these types of procedures.
Such procedures may appear minor, and low risk, however each requires adequate training and comes with its own risks, which patients do not always appreciate. One of the main medicolegal risks however is managing expectations. Patients expect an improvement in appearance, and not seeing the results they hoped for can result in challenging conversations, complaints or poor reviews. Getting the consent process right is vital.
It is useful to consider the following points, whether you are an experienced practitioner undertaking cosmetic procedures, plan to expand the services you provide, or are considering this area of practice.
Obtaining informed consent
While in most cosmetic procedures you will not be curing a disease or treating a medical condition as such, any treatment should still be medically appropriate for your patient. It is also worth bearing in mind that some patients, especially those seeking to make continual improvements to their appearance, may even be more vulnerable than others.
You should ensure the patient is of the age and mental capacity to be able to consent to the proposed treatment. They should be aware of the balance of the risks and benefits of any treatment, and any available alternatives, including the option of no treatment. You may also want to consider how the consent process may need to be tailored to the individual depending on any comorbidities, medical or social history. Obtaining consent is a process, not a one-off event, and patients may benefit from a ‘cooling-off’ period between any initial consultation and agreement to undergo a procedure. You may also want to consider the use of supporting information such as patient information leaflets or online guides to ensure full patient understanding at a time that is convenient to them. Use of these documents should also be documented in the records and regularly reviewed to ensure they remain fit for purpose.
Patients may occasionally have unrealistic views about possible outcomes or what can be achieved. During your discussions, you should be open and honest regarding this, aiming to make clear the limits of any treatment or procedure.
Promotional material and advertisements developed by you or your clinic should not be misleading, and must adhere to any relevant regulations.
Training, skills and expertise
Doctors working in cosmetic medicine, like in any area of practice, should ensure they have the necessary training, skills and expertise to assess patients and undertake each procedure. You should work within your own area of competence. Your actions should do no harm and be seen to benefit the patient positively. It is important that even if experienced, you continually reassess your skills and undertake regular retraining. Assisting or observe an appropriately trained colleague may also be an option, to refresh your skills, knowledge and consider alternative therapies.
Working within relevant regulations and guidelines
Those seeking indemnity for cosmetic medicine, will be expected to comply with any relevant regulatory/government guidelines. They should also limit the scope of their practice to procedures and treatments for which they hold a valid licence or certificate, and those permitted under the terms of their membership, if different.
Failure to meet any of the above may affect indemnity provision, and it is useful to check with your provider.
Adequate indemnity
Appropriate and adequate professional protection is essential to protect patients and yourself in the event of a claim, complaint, or regulatory investigation. It is advisable to contact your indemnity provider if you are considering this work or expanding the services you provide, to discuss the scope of your practice. Your indemnity provider’s understanding of the type and nature of the procedures you perform will ensure you have the appropriate membership. Guidance may be different for specialists and non-specialists, so you should ensure that the scope of your practice is limited to what is specified in your indemnity provision.
Equipment and environment
When offering cosmetic treatments and procedures you should be mindful of the evidence of their effectiveness and their safety profile, so that you can explore and discuss whether they are suitable for any particular patient.
In addition, where you work is an important consideration. You should be satisfied that where you are performing the procedures is appropriate, bearing in mind any applicable regulations. For example, ensure you have access to the necessary equipment and support in case of a complication or medical emergency.
Record keeping
Detailed and contemporaneous medical records are essential and may be invaluable in the event of a complaint, claim or referral to the regulator. You should clearly document your assessment of the patient (including history and examination), the consent process, the details of the procedure or treatment performed, and any follow-up advice provided.
Before discharging the patient, you should consider if they have the necessary information regarding what to expect in their recovery, highlight any potential issues to look out for, and give details of who to contact in case of a problem.
Post-procedure complaint
Despite your best efforts, sometimes things go wrong or the results of a procedure will not match the patient’s expectations, even if you believe the outcome to be satisfactory. A detailed and conciliatory response may help reduce the chance of a complaint escalating. Medical Protection, or your indemnity provider, can advise and assist members in responding to complaints, as well as other medicolegal issues that may arise from clinical practice.
Second opinion
Some patients may be dissatisfied with the results of treatment carried out by other clinicians, and contact you for advice and further treatment. These cases such be approached with caution as they may be more clinically challenging, and patients’ expectations may be unrealistic or challenging. Of course, you are not obliged to treat patients if you do not feel treatment is necessary, nor should you assist if you do not feel you have the necessary skills or expertise.
