Dr Olha Vorodukhina delves into the importance of establishing a referral pathway in aesthetics and how it can contribute to the success of your clinic
Delivering exceptional results to patients and running a thriving medical aesthetics practice isn’t solely dependent on being the best at what you do. Success in this field is more about the approach you apply to your practice. Over the last decade we have learnt that in order to achieve good results we often need to combine different therapies and treatments that target different layers of the face. But it is also understandable that not every clinic or practitioner is able to offer all these treatments under one roof. For example, some patients may benefit from surgery more than having non-surgical treatment.
It is important to recognise this and be able to make appropriate referral to other medical professionals in order to achieve better results. It also will help to build an honest long-term relationship with your patients, as well as reputation among your peers.
In medical aesthetics, the referral pathway model resembles that of private medical or dental sectors. While it may be a concern that referring elsewhere will cost you a patient, it actually demonstrates you as an honest, ethical practitioner. In my experience, the patient will return to you after completing referral treatment.
There are many professions you could create referrals for, such as nutritionists, dietitians, hormone specialists, performance or professional coaches, fitness coaches, among many others. However, the most common are the following.
Dentistry plays a significant role in medical aesthetics practice, particularly in the field of facial aesthetics. Dentists are skilled in performing comprehensive facial analysis as part of their training. They assess the patient’s facial features, bone structure, and soft tissue characteristics to provide personalised treatment plans. Dentists with expertise in temporomandibular joint (TMJ) disorders can also address facial asymmetry, jaw pain, and limited jaw movement, thereby improving facial balance and function. Referral to a dentist may be necessary for cases involving an enlarged masseter muscle, crooked teeth, gingival dysplasia, or gummy smile treatment.1,2
Plastic surgery plays a significant role in enhancing and improving the appearance of the face. Surgical procedures such as blepharoplasty, rhinoplasty, lip implants, lip, face, and neck lift can provide long-lasting results. While non-surgical treatments have gained popularity, there are cases where plastic surgery remains a viable option. During consultations, surgical options should be presented to patients as a possible choice of treatment. Effective communication between the patient’s surgeon and the aesthetic practitioner is vital to maintain the desired results.3
Collaboration with psychiatrists provides insights into the psychological aspects of patients’ treatment journeys, enabling a holistic approach to patient care. Referral to a psychiatrist or mental health specialist is necessary when diagnosing or suspecting body dysmorphic disorder. In cases where patients require assessment and treatment beyond the scope of a practitioners’ expertise, referral to an appropriate mental health specialist is essential.4
In addition to the mentioned specialists, collaborating with general practitioners (GPs) is crucial in aesthetics. GPs play a vital role in overall patient care and can provide valuable insights and medical expertise in various scenarios. Here are some common scenarios where referral to a GP may be necessary:
Pre-existing medical conditions: If a patient has underlying medical conditions such as cardiovascular problems, autoimmune disorders, or uncontrolled diabetes, it is important to consult their GP before performing any aesthetic treatments. The GP can assess the patient’s overall health and provide guidance on whether the procedure is safe for them.
Medications: Some medications can interfere with aesthetic treatments or pose risks during the procedure. For example, blood thinning medications such as dabigatran, rivaroxaban and apixaban and patients on long courses of oral steroids and oral vitamin A. It’s crucial to consult their GP to find out if they are on any medications and what these are so that the treating practitioner can assess if there are contraindications or a higher risk of complications
Allergic reactions or adverse events: In the event of an allergic reaction or other adverse event during or after a procedure, it is important to provide the patient with necessary treatment and care. It will be considered good practice to inform the patient’s GP about the event, and the GP may decide to provide appropriate medical care and further evaluation if necessary.
Suspicion of an underlying medical condition: During the initial consultation or assessment, if you notice any signs or symptoms that raise concerns about an underlying medical condition, it is prudent to refer the patient to their GP for further investigation and diagnosis.
Post-treatment complications: If a patient develops complications or experiences unexpected side effects after an aesthetic treatment, the GP may provide appropriate medical management or refer the patient to a specialist if needed.
Emotional or psychological concerns: Aesthetic treatments can have a significant impact on a patient’s self-esteem and body image. If a patient expresses emotional or psychological concerns related to their appearance, referring them to their GP or a mental health professional can ensure that their overall wellbeing is addressed.
By involving GPs in the referral pathway, aesthetic practitioners can ensure comprehensive care for their patients, considering both the aesthetic and medical aspects of their wellbeing.
Dermatologists’ opinions and assessments are valuable in cases involving conditions such as acne, rosacea, melasma, or moles. Their expertise in diagnosing and managing these conditions can significantly contribute to the overall treatment plan and patient outcomes. Whether you refer them to a consultant dermatologist or another medicalprofessional who has dermatology training will depend on the severity of the skin problem and what their previous treatment history is. For example, usually, skin concerns such as acne, melasma and rosacea can be referred to a practitioner with a special interest in dermatology. In rare cases such as severe acne or suspicious moles, it would be wise to refer to a dermatologist on the specialist register.
It is advisable to build a good relationship with clinics/practitioners who offer more specialised treatments such as non-surgical rhinoplasty, PDO threads, or laser skin resurfacing if you lack the expertise to perform them safely. When it comes to complication management, it is good to plan ahead and have contacts who are willing to offer you support and have the right experience and equipment. For example, someone who has an ultrasound device or holds stock of hyaluronidase if you are unable to.
To implement effective referral protocols in your practice, I would recommend practitioners follow these five steps:
1) Evaluate your professional skills: Determine the treatments you are comfortable and competent in offering. Create a list of treatments that may require referral to specialists. Remember, just because you don’t perform a specific treatment doesn’t mean it should not be offered to the patient.
2) Approach clinics/professionals in your area: Find those that are willing to accept referrals for complex cases. Look for clinics equipped with ultrasound for diagnosing and managing complications. Training providers with whom you have completed your training can be a valuable point of contact for referring advanced and complex cases.
3) Collaborate with earlier mentioned specialists: Establish collaborative relationships with dentists, plastic surgeons, psychiatrists, dermatologists, and other specialists mentioned earlier. Building a professional network ensures seamless referrals and effective patient care.
4) Update your team: Educate and inform your team about the referral system at the clinic. Clear communication within the team helps streamline the referral process and ensures everyone is on the same page.
5) Maintain effective communication: During the referral process, maintain effective communication with your colleagues, including specialists and referred practitioners. Follow-up with your patients to ensure their continuity of care.
One of the best ways to start establishing your network of colleagues is attending professional events and conferences such as CCR and ACE, and utlilise networking opportunities to find like-minded professionals. You also may ask your initial training providers about available support. I have found that social media can also be a great tool to do your own research and reach out to your colleagues in the area, or even speaking to other people within the industry to gain recommendations.
In my experience, these seven crucial steps can help when deciding on a referral plan:
1. Initial consultation: During the initial consultation, patients visit an aesthetic practice to discuss their concerns and desired treatments with a primary healthcare provider who is a medical aesthetic practitioner.5
2. Assessment and treatment plan: Based on the patient’s needs, the practitioner assesses their condition and recommends appropriate treatment options. However, if specialised procedures or services beyond the expertise of the primary provider are required, a referral may be necessary.
3. Referral decision: The practitioner determines whether a referral is needed and identifies the appropriate specialist or healthcare professional to whom the patient should be referred. Factors considered include the complexity of the procedure, the patient’s unique circumstances, or the need for specific expertise. Of course, a patient may refuse a referral. If this occurs, remember you don’t need to provide treatments yourself just because you’re feeling under pressure.
4. Referral process: The practitioner initiates the referral process by communicating with the specialist or healthcare professional who will be receiving the patient. This may involve sending medical records, test results, and a detailed referral letter outlining the patient’s condition and treatment history.
5. Specialist evaluation: The referred specialist evaluates the patient’s condition and determines the most suitable course of action. They may conduct further assessments, order additional tests, or provide specialised treatments or procedures.
6. Continuity of care: Throughout the referral process, effective communication between the referred practitioner, the specialist, and the patient is essential to ensure continuity of care. Updates, treatment plans, and necessary adjustments are shared to ensure a comprehensive approach to the patient’s care.
7. Follow-up and feedback: Once the specialist has provided the necessary treatment or procedure, they communicate the outcomes and recommendations back to the practitioner. This information helps the primary provider maintain a complete medical record for the patient and coordinate any required follow-up care or future treatment.
By establishing a well-defined referral pathway, aesthetic practices can ensure that patients receive the most appropriate and specialised care for their specific needs. Collaborating with specialists contributes to better patient outcomes and an enhanced overall healthcare experience. Remember, success in a medical aesthetic practice is not just about being the best, but also about implementing a collaborative approach for delivering exceptional results. Practitioners should follow General Medical Council (GMC) ethical guidance on the referral pathway that is available on the GMC website.7
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