Protect your practice
Many things can go wrong in all types of cosmetic procedures – poor patient selection, treatments not being fully explained or possible complications not being mentioned. The majority of complaints and unsatisfactory outcomes tend to arise from elective patients in comparison to medical patients due to higher expectations for a treatment they will be paying a considerable amount of money for.
Over the last ten years within the aesthetic industry, many more experimental procedures have been introduced, and existing products and treatments are being used for different areas of the body. There are a lot of adverse outcomes with these pioneering treatments, some of which go away quickly, some of which can linger, but the whole purpose of aesthetic medicine these days is to offer much more of a temporary procedure. Most of the initial side effects do wear off, but practitioners aren’t always explaining this correctly to their patients. Complaint management is probably one of the biggest areas where we see things going wrong, complaints are made and the practitioner doesn’t know how to deal with them.
Aftercare is another area which in many cases is pretty poor and could do with improving. There is a growing problem with the quality and composure of patient notes by the practitioner. This may sound surprising as you would not imagine medical professionals would make poor notes, however, this is the area where most claims end up being worse than they should be.
Consent
Consenting, consulting and talking with your patient are probably the most important things to do to avoid a claim. However, even if you do consent, and do it properly, it doesn’t necessarily mean you won’t lose a lawsuit if it’s brought against you, or that a claim won’t occur just because you’ve had the correct conversation with your patient. It’s the quality and the depth of the consenting that is important.
Informed consent is fundamental. Without consent you will have no defence. We can’t defend you, the lawyers can’t defend you and the defence bodies can’t defend you. You will need to provide evidence, so the rule of thumb is: if it isn’t written down, it never happened – that’s very, very important to remember.
Some tips for taking consent
- Practitioner and patient guide each other between information. Make sure that the patient isn’t overloaded with information, but that enough information is provided, so that they can make an informed decision.
- Don’t use technical language – most of your patients are going to be everyday people, so terms that are easy for them to understand.
- I know it’s very difficult sometimes, but try and keep it as simple as possible.
- Make sure that the patient can comply with the necessary aftercare, so for example, if they’re going on holiday to a hot country and they’ve had some laser work done, they shouldn’t be going in the sun.
- Try to avoid patient disappointment. Make sure that you understand what effect they’re looking for, and why they are having these treatments, and then you can manage their expectations. Use diagrams where possible and ask the patient if they’ve got any specific concerns, if there’s anything worrying them.
- Some of the best consenting happens when the patient goes home, so make sure that the consenting doesn’t happen on the same day as the actual treatment. They should have an opportunity to go home and think about things. Also, remember a lot of patients will research on the internet and will probably think they’re an expert before they’ve even turned up at the clinic, so make sure that you’re explaining everything to them.
- Ensure that consent is clearly documented and well evident. Make sure that the patient understands what you’re writing down and understands what you’re telling them. Aftercare leaflets are important too, rather than just telling them to go home and put various products on, show them what these treatments actually do and provide them with leaflets on their particular procedure or manufacturer.
- Before and after photos are very, very important. Make sure that you take before photo, so if anything goes wrong after the event you’ve got something to compare to, and then make sure any concerns which the patient has are documented with your response to them. It seems straightforward, but in the heat of the moment, when you’re actually doing those treatments, a lot can get missed.
- Over the last four or five years, the vast majority of the claims we have taken relate to laser, body contouring and other fat reduction treatments. 18% of our claims are to do with hyaluronic acid fillers and 14% relate to botulinum toxins. So between them, more than a third of our claims are now coming from the non-invasive treatments.
Cost of a claim
The most expensive claims we see relate to laser and body contouring treatments. The cost of claims, similarly to the cost of defence, is rising quite rapidly at the same time as premiums and costs and there’s a struggle for the industry on what to do with that.
Let us consider a case study involving a body contouring procedure. The treatment cost £2,800 – not an insubstantial amount of money for anybody to spend. The defendant was a registered doctor. He did consent with the patient and he did provide leaflets and documents relating to the procedure and potential side effects. On the face of it, he did everything quite correctly, but then something went wrong – the patient developed scarring on her thighs following the procedure.
She alleged negligence, as there was an indentation remaining – a 5cm by 3cm mark left on her left thigh. She then claimed for psychological effects, which is natural. If you think about the motor insurance industry, whiplash is the big issue. With cosmetic treatments you get the psychological issues: I can’t go out, I can’t wear short skirts, I can’t wear my bikini etc. The patient became embarrassed and self-conscious about her appearance.
The defence was that the doctor claimed the indentation was a natural side effect, a seroma, which was created and would subside over a period of days and weeks.
A big consideration with any type of claim like this is that if it ends up going to court and getting into serious litigation, expert opinion will be sought by the defence lawyers. In this particular case, they used a plastic surgeon, so a step above the normal practitioner for these types of treatments. He disagreed with the defence saying that the surgery was badly performed and the note taking and consenting was well below the standard expected for this type of treatment.
The message here is that the more expensive and complicated the particular treatment is, the better the consenting and the more detailed the note taking will need to be. In this case, the note taking and the evidence that the doctor provided, wasn’t good enough. The outcome was £32,000 damages. £14,000 claimant’s costs, defence costs, and our defence costs were just over £3,000. When you add it all up the cost was £50,000, for a £2,800 treatment.
The insurance cost for that doctor was somewhere in the region of £2,000 to £2,500. It doesn’t take a genius to establish that the claim will affect his performance going forward as well as presumably causing him considerable stress by going through the process.
In conclusion, these types of claims do occur, and the recent claims that we are seeing coming though are getting more and more expensive as the years go on.
Dos and don’ts
- Listen to your patient. Keep detailed and updated notes. If you get a complaint, remember that not all complaints go to a claim.
- If someone doesn’t turn up to an appointment, especially after it’s onto their second course of treatments, then give them a call and make sure everything’s alright.
- If there is any discussion on refunds of money, ask why the patient wants a refund. If anyone asks for patient notes, make sure that you understand whether they are going to pursue you for something or not.
- Never admit liability. Never say: I’ve actually done that wrong – always respond with sorry, that’s never happened to me and I’ll ring my insurance company straight away.
- You can always deal with a complaint by saying: I’ve never seen that happen before, or: Leave that with me and I’ll come back to you.
- Make sure that you give yourself a bit of breathing space and you can take some advice. Never offer a refund or complimentary treatment without asking your insurance company for permission. That can actually sometimes be seen as an admission of guilt, even though you don’t intend it to be.
- Don’t indicate you have insurance, because that always puts the cost of a claim up in my experience. And don’t ever put your head in the sand and pretend it’s all going to go away, because generally it doesn’t.
About the author
Many thanks to Eddie Hooker of Hamilton Fraser insurance for this guest blog.
Inspired Cosmetic Training are fully accredited Recognised Trainers by Hamilton Fraser, as well other key cosmetic insurance companies.
