Consultations: How to inform patients about side effects and risks

Recently, Dr Tim Pearce welcomed his apprentice winner, Nurse Charlotte to a podcast to discuss her concerns, as a beginner in aesthetics, about managing patient expectations during the consultation and consenting process, including informing them about potential side effects and risks prior to administering a cosmetic injectable treatment. On the one hand, you do not want to scare your patients and deter them from having treatment, but on the other hand, you cannot downplay the risks and potential for known complications, as that would be unethical. So, how do you strike a balance?

In this blog, we share the key points from their conversation and Dr Tim explores what can be a daunting process for many aesthetic clinicians. They discuss strategies for effectively explaining the risks to patients, ensuring they are well-informed and confident in their decision to go ahead with the proposed treatment.

Do you feel anxious about causing complications? Many clinicians feel so overwhelmed with the thought of causing a vascular occlusion that it stops them growing their aesthetics business. Dr Tim is currently hosting a webinar series to help you overcome your fear of complications so that you can uplevel your knowledge, and increase your CPD-certified learning to build a successful aesthetics business. Sign up here >>

How do you warn a patient about the risks of dermal filler treatment without them making a run for the door?

Nurse Charlotte explained that she worries about complications but knows she must explain the potential risks to her patients, whilst hoping that they still trust her to inject them with dermal fillers. She asked Dr Tim how she can effectively explain this and warn her patients about swelling, bruising, or possible vascular occlusion, all of which could have a significant effect on her patient, without them turning tail and making a quick exit from the consultation.

Dr Tim agreed that there is a skill to achieving this objective and described the two, flawed methods often employed by aesthetic clinicians when starting out in clinical practice.

Downplay the risks

Some aesthetic practitioners will tend to downplay the risks and fail to give their patients enough information because they are worried about their reaction. This is risky behaviour because if you do encounter a problem or complication, the patient feels there is an injustice, and this is often what leads to legal action.

The patient will come back for their follow-up and state that they would never have had the treatment if they have known that the outcome could have happened. As aesthetic professionals, we know this is not true because informed patients still go ahead with treatment. What they mean is that they did not get the chance to avoid the outcome, and that is where the feeling of injustice lies. Even a simple bruise can be a catastrophic issue if they were not expecting it to happen.

Leave them hanging

The trick is to use a story structure when explaining the potential side effects and complications to patients, said Dr Tim, but often, practitioners just spew out facts.

You must tell them the truth, but not simply a list of ‘bad news’ and nothing else – do not be tempted to only say “you might get an allergic reaction, a blocked artery which could blind you, or anaphylaxis and death” – this would leave them hanging in the conversation and utterly terrified. This information is crucial, but the delivery presents the maximum conflict in the moment, whereupon you must continue the story by explaining the likelihood of occurrence of these bad things and give them a real-life comparison that helps them to put the risk into some kind of scale. Without a scale or comparator, humans tend to maximise associated risks. Knowing how likely something is to happen will reduce the terror.

To compare the likelihood of filler blindness with something they understand, for example, you could say that your chance of being in a car accident that causes a significant injury is approximately one in seventeen thousand, but then you say that you still drive every day. Explaining that the risk of blindness from dermal filler treatment is less than being in a serious car accident helps to put the risk into some perspective for the patient.

Explain to your patient how you will mitigate the risks of cosmetic injectable treatments

Once you have explained the low risk of many of these complications, which must be explained to patients as part of the consenting process, you can then describe how you, as a trained aesthetic clinician can reduce that risk further by doing certain things that will enhance the safety of the procedure – this could be injection technique such as the avoidance of danger zones, using aspiration etc. You can also quote published studies, and anecdotal knowledge you have gained from your trainer, or mentor.

By teaching your patient about the additional steps you will employ to try to mitigate risk, you put them at ease and show them your skill, training, and extended learning, detailed Dr Tim. Similarly, you can broadly explain the steps that demonstrate that you know how to manage a complication, should one occur, such as a vascular occlusion being dissolved using hyaluronidase.

The more questions the patient goes on to ask you, the better. Although, you will be daunted by this in the beginning, and perhaps not have all the answers in relation to published data or studies, but it will get easier to answer as your responses become more practised and you have the relevant information to hand if you go away and research something for next time.

Eventually you will become the person who brings certainty to the uncertainty of the knowing the risks and deciding to proceed with treatment.

By the time they have heard you go through all the things that you do to mitigate the risk and make the treatment safer, compared with another local practitioner who simply waved a consent form in front of them without explanation, they will believe you know what you are talking about. This will be a considerable factor to help them determine that they want to go ahead with treatment and why they choose you as their aesthetic clinician.

The patients who do not care about this knowledge do not make a great patient base upon which to build your aesthetic clinic. If they only care about the price and are not interested in the technical details of the procedure or the safety measures, but favour speed and a discount deal, they should not be the patients you seek. Ideally, you want patients who value the safety measures you take, your time and your expertise, and will be loyal to you because of this, and not someone who is hunting for the cheapest offer.

Check out more from Dr Tim on consultation skills with a range of blogs including:

• How to manage patient expectations and avoid complaints like a Pro
• How to say “no” to an aesthetic patient without making them angry
• Managing patient expectations: “I want to look like a celeb”
• How to consult patients on the downsides of Botox without losing them

You can find Dr Tim Pearce on Instagram if you have any ideas for things you would like to see him discuss and you can also follow aesthetic nurse Charlotte on Instagram at Refined Aesthetics.

Aesthetics Mastery Show

How to inform patients about side effects and risks

In this episode Dr Tim and Charlotte discuss strategies to effectively manage this situation and explain the risks to patients in the best way possible, so that they feel well-informed and confident in their decision to undergo treatment. Watch the full Aesthetics Mastery Show here.

Is your worst nightmare causing a VO?

If you want to be a great injector then you need to get over your fear of complications. Register here for the next webinar to help you overcome your complications anxiety >>

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Complications eLearning Courses

If you want to increase your confidence by learning how to handle complications, Dr Tim Pearce offers two comprehensive courses that are highly rated by our delegates:

• Botulinum Toxin Complications Mastery
• Dermal Filler Complications Mastery

Both give CPD and certificates on completion.

In addition, browse our FREE downloadable resources on complications.

Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.