Consultant plastic and cosmetic surgeon Mr Adrian Richards and aesthetic doctor Dr Natalie Blakely argue for better standards and streamlining of consent within the speciality of aesthetics
Unlike other countries, the UK has traditionally had what is generally perceived as low levels of medical litigation. This, however, is changing, and many of us are seeing this change reflected in a rise in our indemnity costs. Many medical litigation cases hinge on the process of consent. They seek to address the following questions: Were the risks of the procedure fully explained to and understood by the patient? Is the risk and the patient’s understanding of the risk recorded accurately in the patient’s notes? During my plastic surgery fellowship in Australia in 2000, I was struck by the detailed nature of the Australian consent forms. In the UK, I had been used to a printed sheet with one line for the surgeon to write the potential complications of the procedure. In Australia, there were specific consent forms for each procedure and five to six pages detailing the pros and cons, as well as the potential risks associated with the specific procedures patients were undergoing. Patients were given the forms two weeks prior to surgery and, after having time to study the forms, were asked to sign their consent on the day of surgery, at the same time as the clinician. In some medical centres they were required to sign after each paragraph to demonstrate that they had read and understood all aspects of the form. Today, Australian surgeons still follow similar stringent consent guidelines. Acquiring consent for photographs is also essential. Under standard medical practice guidelines, practitioners should not show before and after pictures to other patients or publish them on or offline without specific written consent from the patient. We can all learn from this thorough approach. For the patient, a better understanding of the benefits versus risks of any procedure helps them to make a more informed decision on whether to undergo treatment. For the clinician, accurate, detailed and legible consent reduces the risk of litigation. At my clinic I have worked with our team to improve and standardise our consent process. This involves adhering to the following steps:
In the 12 years I have been practicing, I’ve been fortunate to have a very low rate of litigation
– I believe this is partly due to our robust consent process.
As our society becomes ever more litigious, it is vital that we as clinicians improve our consent process. Litigation rates in private practice and the NHS are reported to be rising at 20% per annum.1 In aesthetics, most doctors use consent forms that are normally provided by the manufacturer of the product. As they are product specific, most practitioners I have spoken to agree that they are more convenient to use. However, I found that I was constantly running out of these consent forms. During my personal research to find out how other practitioners dealt with the critical matter of consent, I came to the following realisations: