CMPA Perspective March 2016

Patient factors
Patients often have high expectations for the results of elective
cosmetic procedures. Psychological factors, personal or
second-hand experiences with previous cosmetic procedures,
and media portrayals can all contribute to patients’ heightened
expectations. Online photo galleries may show a biased sample
of the most outstanding surgical results. Not surprisingly,
inappropriate patient selection is often linked to consent issues
in these procedures. In a small number of the reviewed CMPA
cases, surgeons were inappropriately influenced by patients’
preference for a particular procedure over the recommended
approach. In a few instances patients had been turned down by
another surgeon for the same procedure.
Experts on patient dissatisfaction with aesthetic surgery
recommend that healthcare professionals first consider
the nature of a patient’s presenting concern and physical
appearance, the healthcare professional’s own ability to address
the concern to the patient’s satisfaction, and the patient’s ability
to tolerate complications. 1
In some CMPA cosmetic consent cases, patients were
healthcare professionals who presumably understood the risks
of the procedure. Still, even when patients are assumed to have
more knowledge of cosmetic surgery, such as those working in
healthcare, the consent discussion must be informed.
As with many procedures, communication barriers between
physicians and patients can compromise informed consent.
Yet, difficulties stemming from a patient’s language ability
or level of understanding can often be managed. Medical
interpretation services can be accessed, and discussions and
written materials can be worded for clarity and comprehension.
Generally, the courts expect physicians to overcome
communication issues when obtaining informed consent.
Physician factors
Patient expectations can also be influenced by the healthcare
professional’s description of procedures and the expected
outcomes. Many of the CMPA cosmetic consent cases
involved overly optimistic descriptions of expected results.
For example, patients were promised “beautiful” or “amazing”
results. Similarly, there were instances of downplaying the
potential for failure or the likelihood of complications.
In a small number of the cases, the courts’ decisions were
not determined by issues with the consent discussions, but
rather by other factors such as the physicians being found
to be practising beyond their scope or licence, or the type
of surgery being performed was deemed inappropriate
by the courts.
The consent discussion and documentation
As to the content of the consent discussion and its
documentation, peer experts in the CMPA cases reviewed
were generally critical of the following:
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reliance only on generic forms to obtain and document
informed consent
supplementary written materials that were difficult to
comprehend
inadequate discussion of:
--
the likely outcomes of the surgery
--
recognized risks and complications including those that
are rare but of major consequence
--
pre-operative co-morbidities, e.g. diabetes, obesity, and
other risk factors such as smoking
--
post-operative precautions, including the risks
of smoking, need for mobilization, and use of
support garments
--
the new or innovative use of non-approved approaches
or devices, or off-label drugs
The consent discussion was often found insufficient for
repeat or revision procedures and for patients who had
previous cosmetic surgeries.
14 cmpa perspective | march 2016