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Clients vs. Patients

Marc Ronert, MD, PhD

Abstract: Knowing the difference between a patient and a client can be an essential distinction for a medical aesthetics business. By distinguishing the different needs and treatments necessary for patients versus clients, you can stay on track with the business services you provide, as well as avoid sticky ethical issues. Both clients and patients need to be able to trust you, but knowing what you should expect from them, as well as what they expect from you, can really aid in forming a trusting relationship.

There is a fine—and often blurred—line between the client as a necessary source of revenue for a medical practice and the patient as a human being seeking medical attention. Nowhere is this ethical dilemma more pronounced than in plastic surgery. While both sides of the argument certainly have negative aspects, it is true that both also have fundamental elements necessary for the success of any plastic surgery practice.

Ethical differences

As with any medical professional, plastic surgeons are held to a code of ethics that must be recognized as superseding the physician’s own interests. According the American Medical Association’s Code of Medical Ethics, physicians, including plastic surgeons, must be “dedicated to providing competent medical care, with compassion and respect for human dignity and right.”

The code goes on to say, “a physician shall, while caring for a patient, regard responsibility to the patient as paramount.” This code of ethics, to which every practicing medical professional must adhere, clearly leaves no doubt that a patient’s rights take precedence over any personal benefits the physician may realize. However, this question of ethics is actually much more complex.

A fundamental difference

The fundamental difference between a patient and a client is as follows: a patient presents a physician with a medical condition seeking a diagnosis. It is the physician’s obligation to find the right diagnosis and subsequently treat that patient in order to restore a healthy, normal condition. Without finding the right diagnosis, a treatment could potentially harm the patient, or the harm could arise from not treating the patient at all.

A client, on the other hand, will self-diagnose but expects treatment from a physician in order to enhance an existing normal body function or appearance via elective surgeries or procedures. Even though the diagnosis already exists, any respectable physician will verify its accuracy before treating. The tricky part is that any treatment or elective surgery could lead to complications or worsen a condition, such as when a face lift treating lax skin damages a facial nerve that was properly functioning before the procedure.

A segment of clients also exists that obsesses about flaws in appearance that are either minor or imagined due to a chronic mental condition called body dysmorphic disorder. There is no course of treatment or elective procedure a plastic surgeon can offer someone who suffers from this disorder, as it is not resolved through body modification. Plastic surgeons are trained during their education to identify these clients, who then turn into patients with a need to seek psychiatric help.

The client is always right?

From rhinoplasty to liposuction, the popularity of cosmetic and elective procedures is skyrocketing, as is pressure on insurance companies to cover these costs. Plastic surgery is more popular than ever, and physicians are left to determine on a case-by-case basis whether to proceed with a client.

Loose guidelines exist, such as proceeding with clients whose decision to have surgery is not based solely on a body-image issue. But without an official set of guidelines set by a governing organization, such as the American Society for Aesthetic Plastic Surgery (ASAPS), physicians often report feeling pressure to move forward with a procedure regardless of the client’s condition.

With millions of procedures performed and billions of dollars spent on cosmetic and elective surgeries every year, it is impractical to think most physicians do not want a slice of the pie. And to some extent, it is understandable. Most procedures are not covered by insurance, and not having to deal with negotiated rates and red tape is a luxury most doctors don’t enjoy. This makes plastic surgery not only more appealing, but also more profitable.

Competition is also tight as a result of the rising trend in cosmetic surgeries and the influx of new surgeons available to perform them. Turning customers away is a decision that could greatly cost a plastic surgeon and, in some markets, provoke a negative reputation. So the question remains, when should a doctor step in and refuse to perform a procedure? At what point should the doctor turn away a client? Who is the judge if someone does or doesn’t need surgery?

The answer is that a good physician needs to be the judge, making sound judgment calls based on medical experiences and ethical understanding. The physician also needs to weigh potential health risks for the patient or client, and if the procedure’s risk outweighs the benefit, it must not be performed under any circumstances.

Enough is enough?

Without a clear set of standards for determining the limitations that should be placed on customers seeking procedures, the decision remains with the physician, and the code of ethics will have to be the guide. Therefore, every physician has the responsibility to view everyone as a patient first, whose best interests are of chief concern. This facilitates the need to sometimes decline procedural requests.

However, declining procedures can be easier said than done. Many patients of plastic surgeons are considered clients because they are repeat customers. These physicians can often see the same person again and again for different procedures, and because the client primarily pays for cosmetic and elective surgeries, when and how often they get a procedure is done entirely at their discretion. For someone with endless means who abuses cosmetic surgery, the only system of checks and balances may be the physician.

Maintaining your reputation

To maintain a quality reputation and good standing in the medical community, the goal is to achieve positive and profitable relationships with patients, giving appropriate attention to the cost of doing business and ethical concerns in different amounts. Patient first, client second. Ethics and the medical background of each case must come before profits are considered. And while reserve must be shown in deciding who deserves a procedure, it is imperative the question be asked for every procedure and patient.

When physicians stand strong behind their principles, to turn down some potential clients can turn into a positive reputation and support a healthy, reputable and ethical practice. And that can be the most telling factor of all to a multitude of potential patients and clients.



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