In the medical world, the provider-patient relationship is one of shared decision making based on the principles of mutual trust, ethics and appropriate attention to needs. This guidance is of especially high value in an aesthetic practice, where the patient electively wants to achieve an enhanced appearance and improved quality of life based on physician guidance.
More than anyone else in the practice, the physician needs to display the highest standards very conspicuously, noted Tess Mauricio, M.D., F.A.A.D., a dermatologist and cosmetic surgeon with practices in San Diego and Beverly Hills, Calif.
“It starts at the top,” she continued. “Anytime you are doing any kind of rejuvenation or cosmetic improvement, ethics becomes very important. Even if you don’t have a set of published guidelines, the common sense and professional rule of thumb is to treat the patient with the upmost respect at all times.”
An aesthetic practice can maintain high ethical standards with professional guidance. For physicians seeking relevant ethics instructions and related documentation, a good place to start is with the major medical societies serving the aesthetic / cosmetic surgery / dermatology fields.
For instance, Gordon Sasaki, M.D., F.A.C.S., a plastic surgeon in Pasadena, Calif., follows the code of ethics created by the American Society of Plastic Surgeons (ASPS).
“In that guide, like others, the essence of the provider-patient relationship is described as one of shared decision making based on the ethical principles of mutual respect, courtesy, dignity, privacy and confidentiality,” he said.
This can be developed with the patient during the process of informed consent, when the aesthetic procedure’s nature, indications, financial commitment, expected outcomes, side effects, probability and severity of adverse events, and approval by relevant regulatory authorities, as well as alternatives, are deliberated and understood.
For the practitioner, “It is vital to remember that an aesthetic procedure involves patient care well beyond the improvement in appearance,” Dr. Sasaki expressed. “For us, the most desirable qualities include professional judgment, aesthetic judgement, ethical behavior and quality care during multiple consultations and aftercare.”
Essentially, the foundations of ethical behavior – honesty and respect for the patient – are based in the Hippocratic Oath, said Deepak Dugar, M.D., a facial plastic surgeon in Beverly Hills, Calif.
“Practitioners and especially surgeons have to be honest about what they’re good at,” he expressed. “I think that is something that is getting lost on surgeons as they enter practice. They end up focused on trying to make money and they just want to become a business. Under those circumstances, they may not be very comfortable with the surgery, but they might still do it,” he said.
Therefore, not everyone is ethical, Dr. Dugar added. “Everyone thinks that physicians are apropos, but that may not be how they actually practice.”
Currently, the idea of ethics in medical aesthetics is under assault from a few different fronts. One area is a kind of training that goes beyond just learning the best procedural techniques and having a good understanding of anatomy.
“Any specialist that can be educated can acquire good techniques, but for even the best-trained physicians, it is not second nature to be aware of the psychological status of their patients,” stated Dr. Mauricio.
“It is not instinctual,” she continued. “Many times, physicians will understand the anatomy and be very technical, but they also need to understand and delve into more of the psychological status of people, as well as recognize the psychological effect of what we do.”
Practitioners should try to make sure their patients have a healthy and well-adjusted psychological status.
“This is a big part of what is behind the ethics of what we do, because you want to make sure that the procedures are healthy for the patients. I have turned away many patients that want me to blow up their lips or overfill. In my personal view, doing that makes people look unnatural. So, I just say, no, I’m not the physician for you.”
Know when to say ‘No’
Knowing when to say “no” to the unreasonable, untenable, unyielding and / or unstable individual presenting with any number of neurotic mindsets, body dysmorphic disorder (BDD) or other emotional problems is a prevalent challenge for any aesthetic practitioner. These often signal deeper psychological difficulties that need addressing prior to doing any aesthetic procedure.
For instance, it is estimated that BDD affects between 1% to 3% of the general population. In patients presenting for medical aesthetic treatments, studies have consistently suggested that the rate increases to between 5% and 15%. And the evidence indicates that treating these patients can lead to significant harm for both the patient and the practitioner.
“It is extremely important that we perform thorough consultations in order to screen all patients and ensure that we not treat those that may have BDD, and instead refer them for psychological evaluation,” stated Dr. Sasaki.
The instance of BDD has been increasing rapidly, agreed Gregory W. Chernoff, M.D. F.R.C.S., a cosmetic and reconstructive surgeon in Santa Rosa, Calif. and Indianapolis, Ind.
“Every week, I meet patients and refer them to psychologists,” he shared. “I tell them to come back once they get the help they need. Later, they are grateful that we didn’t take advantage of them and, eventually, some may become good aesthetic patients,” he expressed.
Categories of red-flag patients include the perfectionist, the litigious patient, as well as the unrealistic, indecisive and fawning patient.
“The biggest example is people that come into my office bad mouthing their previous surgeon or injector. That’s a huge red flag for me,” said Dr. Dugar. “Another is the patient that had multiple procedures and they’re still unhappy. For instance, someone that had three or four nose jobs and is unsatisfied. I try to talk them out of doing anything on their face, because they’re probably not going to be happy with the next result.”