Home' Clinical Aesthetics : CA issue 6 Contents No matter how well trained, skilled
and experienced you and your team
are, things don't always go to plan --
at least, in the eyes of a patient.
Even when you have followed a procedural
protocol to the letter and delivered on what
you promised, haven't caused an injury or
misled a patient, you could still find yourself
subject to legal action if they are not happy.
According to Dr John Flynn (see Page
20), around 70 percent of medico -legal
complaints go against practitioners because of
inadequate or improper consent. This is even
if, technically, they have done nothing wrong.
Ergo, if you don't have solid proof of
having given your patients "informed
consent", the odds are that a judgement will
go in favour of a complainant.
Dr Flynn regularly presents around the
country on the topic of the importance
of informed consent, something he is
"It is by no means enough to have a
patient just fill out a standard consent
form," he says. "Proper documentation and
counselling of patients is important in any
"It must be preceded by disclosure
of sufficient information. Consent can
be challenged on the grounds that
adequate information was not revealed
to enable the client to take a proper and
"It cannot be a patient's signature
on a dotted line obtained routinely by a
"When you are talking about side effects
such as, say, bruising, redness or swelling,
it is not enough to just leave it at that,
according to Dr Flynn.
"You need to go deeper, to explain very
clearly - or even present photographic
examples - to show `what this means is ...', so
the patient isn't under any misconception as
to how side effects can manifest.
"It could mean explaining that bruising,
swelling or redness could be mild or severe
and last from a few hours or days to a week
or more, and why these symptoms occur.
"So if a patient comes back to you upset
that side effects have been more severe or
lasted longer than they imagined, you then
have the opportunity to say: `Remember, we
talked about that ...'."
In the unfortunate event, for instance,
a patient is burned and develops blisters
or scars after laser, IPL or a peel, or suffers
hypo - or hyperpigmentation despite all due
care, if you have not explicitly explained in
advance that these are risks of the treatment,
your footing will be very shaky.
Informed consent also means explaining
to a patient that they may just not achieve
the result they desire.
As a practitioner, you well know
that some people are "responders" to
treatments, and others simply aren't. It
all comes down to individual physiology
and factors like age, skin type and texture,
weight and body shape.
An all-encompassing consent to the
effect "I authorise so-and-so to carry out any
procedure in the course of my treatment"
is not valid. It should be specific for a
particular event. If, for instance, consent is
taken for microdermabrasion, it's not valid
for any other procedure.
Dr Flynn says that under-questioning
patients' impulse decisions can make or
break your business.
"Consumers will often come to us telling
us what they `need'. Some practitioners
may be intimidated by this approach or just
want clients to be happy rather than doing
This is a recipe for disaster. You have
a right to say no if you do not believe a
treatment is right for a patient. Remember
that, in the end, it will also rebound on you.
Legible notes must be kept primarily to
assist the patient when receiving treatment.
But, secondly, should there be any future
litigation against your practice the notes
will form the basis of your defence.
Notes are a reflection of the quality of
care given so get into the habit of writing
comprehensive and contemporaneous notes.
• Always date and sign your notes, whether
w ritten or on computer. Don't change
them. If you realise later that they are
factually inaccurate, add an amendment.
• Any correction must be clearly shown as
an alteration, complete with the date the
amendment was made, and your name.
• Document decisions made, any discussions,
information given, relevant history, clinical
findings, patient progress, investigations,
results, consent and referrals.
• Medical records can contain a wide range
of material, such as handwritten notes,
computerised records, correspondence
between health professionals, lab reports,
imaging records, photographs, video
and other recordings and printouts from
• Do not write offensive or gratuitous
comments -- eg. racist, sexist or ageist
remarks. Only include things that are
relevant to the health record.
Make it your golden rule to offer patients informed consent,
not only for their wellbeing but that of your reputation and business.
22 | CLINICAL AESTHETICS
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