Right time, right advice

By Wendy Lewis / 01 Jan 2014

Wendy Lewis on the delicate art of patient screening and how to turn patients away

There is an art to communicating with cosmetic patients that is quite different from how a GP may speak to a patient with stomach pains. The great divide between aesthetic treatments and standard medical care is that the former is usually purely a want, and the latter is about a need. No one really needs to smooth out his or her wrinkles or plump up their lips. Rather it is something one wants to have done. That is a huge difference.

A cosmetic patient who does not respond to you or just doesn’t really like your personal style may not be a good t for your clinic. In that case, the patient may actually be doing you a big favour by choosing another doctor. Ultimately, how comfortable prospective cosmetic patients feel with you and your clinic staff determines their decision of whether to stick with you or go to someone else. Therefore, if the relationship doesn’t start out on a solid footing, it usually will not improve. In many cases, it is harder to say no than to say yes.


The consultation is a vital aspect of a successful outcome in medical aesthetics. The key purpose of a cosmetic consultation is developing a rapport and educating the patient on the procedures that may be appropriate to suit their needs. Setting realistic expectations for your patients is also a critical factor. What you want to do to the patient is less important than what the patient wants you to do to them. At the end of the day, it is his or her face or lips in question and they have to be happy with the outcome. It is the practitioner’s responsibility to present a wide spectrum of potential procedures, both the ones being recommended as well as the alternatives: you should cover risks, potential complications, and alternative treatments, as well as a realistic estimate of recovery time. It also helps to be sensitive to the patient’s budgetary concerns by having a clinic staff member review fees. For example, if the patient is anticipating that a filler will cost £300, but you use two syringes costing twice that amount, the overall impression the patient may be left with is that she was either misled or overcharged. Working with your patients to arrive at a sensible solution takes extra time and e ort, but the pay off is immense in patient satisfaction and loyalty.


Regrettably, practitioners don’t always know enough about a patient from an initial visit to decide whether they want to move ahead with treatment. The staff member who assumes the pivotal role of patient screening can help to identify potentially challenging patients. Every member of the clinic staff should be adept at interfacing with patients, including the practitioner. Aesthetic medicine is a service business, and strong interpersonal skills are paramount to success. The impression you should leave with patients is “We’re here if you need us”, rather than having patients feel that they are being sold too many procedures, or procedures they did not come in for. Good communication and listening skills are essential.

If you listen carefully, you should be able to pick up why the patient came to your clinic and what his or her priorities are. Inquire about what research has been done already to establish a starting point, and what, if any, aesthetic treatments the patient has already had. Patients who bash previous doctors or complain about treatments they have had should also raise concerns, as this is indicative of a pattern of behaviour. Their distrust for doctors and dissatisfaction may run deep, and you could be walking into a negative situation.

The mission of the cosmetic consultation is two-fold; it allows the patient to interview the practitioner, and it is the primary opportunity for the practitioner and the staff to screen the patient. Any clinic that boasts about operating on a 100% closing ratio is missing the point. Your goal should never be to treat every patient who walks into your clinic, for a long list of reasons that should be obvious. In the first place, not every patient can afford to have the treatment they want. Some will be unsuitable due to their health and medical history, while others may need something entirely different to what you can offer, i.e. excisional skin surgery instead of energy based skin tightening. Still others may not be good candidates for psychological reasons such as body dysmorphia, and OCD. Your closing ratio is the number of patients you close (i.e., sign up for a treatment) compared to the number of patients you see. For example, if you consulted with 10 patients in a week and four of them had a treatment as a result, your closing ratio would be 40 percent.

In a medical aesthetics clinic, the consultation is more about relationship building than it is about making a pure clinical diagnosis and arriving at a treatment protocol. It is not always feasible to shorten the clinic visit when it comes to dealing with cosmetic patients, because the direct contact and follow-up factors into developing long-lasting patient relationships. It is generally accepted practice to have a clinic manager or patient coordinator pre-screen new patients; however, the ‘real’ consultation is always between the practitioner, who will be doing the actual procedure, and the patient. 


Ideally, the best time to end a doctor-patient relationship is before it technically begins. Therefore, when a patient steps foot into the clinic and the practitioner decides that he or she is not a good candidate for the treatments you offer, or will not be happy with what you can provide, the optimum chance to cut the cord is right there on the spot. If instead, you suggest that the patient thinks it over, or comes back for another visit, you are in essence prolonging the inevitable. This carries some risk that the patient may be lulled into thinking that you are willing to treat them. When there comes a time that they ask to schedule a procedure in your clinic, and you decline or your staff has to try to dissuade them, she or he will most likely be angry with you. In this climate, patients who feel misled or poorly treated by a practitioner have many outlets to share their dissatisfaction. The most obvious of these are Yelp.co.uk and other ratings and reviews sites. Consider another scenario; a patient you have treated previously returns and requests a procedure that you as the practitioner feels she is unsuited for. Instead of leading her on, honesty is the best approach. But in all cases, refrain from using language that can be construed as insulting, offensive or derogatory. For example, a practitioner who tries to say to a woman that she needs to lose some weight before he will do a body contouring procedure on her should proceed with caution. Under no circumstances would this be considered good news by the patient. Statements like “Lose a few stone, and come back to see me,” or “Non-invasive fat melting won’t do anything for you,” will not be well received. You can turn it around so that you come off as a caring physician who has only the patient’s best interests in mind, by saying, “I don’t think you will get a good result from this device, and I want you to be happy,” or “This device works best as a part of a programme of diet and exercise, so let’s come up with a plan that meets your long term goals.” While no woman wants to hear this, when positioned in this manner, it may be well accepted without creating an awkward situation or animosity between the clinic and the patient.

Lastly, discharging a patient from care can have medicolegal rami cations. If you are eager to get rid of a patient whom you have treated and is driving you and your clinic staff mad so you wish never to see them again, you may be well advised to seek legal advice. In this case, depending on the circumstances, a formal discharge may need to be in writing with proof of delivery and a referral to another practitioner for follow-up care. It is important to bear in mind that good documentation in the patient’s medical chart is necessary in all of these instances to protect the practitioner in the long-term. 

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