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Preventing Litigation With Assessment Procedures

By: Trish Henrie, PhD
Posted: May 3, 2010, from the May 2010 issue of
Physician speaking with a patient

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According to studies, a doctor’s failure to create a rapport with the patient is one of the major mistakes leading to legal issues. “A survey of 115 experienced cosmetic surgeons found that nearly one-half had been sued for malpractice. Of this group, 51.6% attributed the suit to lack of rapport (vs. 17% for the next highest cause: unrealistic expectations), and only 14.5% attributed the suit to poor surgical results. Thorough screening of patients is critical to insure that postoperative expectations are met, and can also be vital to identifying the patient who becomes a management problem.”6 Acquiring more knowledge about patients, as well as increasing time spent with them, builds a solid rapport that lessens the frequency of legal action.

Leading experts have identified that, “the challenge for the cosmetic surgeon is having enough time to properly assess the patient, and a 30–45 minute consultation is not enough time to learn about an individual’s psychological makeup. In addition, prospective patients are on their best behavior during the preoperative consultation and will often expend a great deal of effort to present as ‘appropriate’ for surgery.”7

Grossbart and clinical psychologist David Sarwer, PhD, an associate professor of psychology in psychiatry at the University of Pennsylvania Health System, further contend that an assessment by a well-qualified mental health consultant with a good understanding of body image dissatisfaction and BDD is a valuable asset to a cosmetic surgery practice.

However, recognizing that hiring an in-house psychologist is not feasible for every cosmetic medical business, industry experts have worked to develop an assessment tool that extends the surgeon’s reach into the patient’s psyche. This type of assessment and summative report tool provides the surgeon with salient information before the intake visit, facilitating a more in-depth interview process. See Assessment Tools for an example. Presurgical assessments also help build rapport and communicate to the patient that she is being treated as a whole person, rather than as a single medical problem.

Simple steps to a safer practice

As cited above, some patients can be disruptive to the office staff and other patients, even after a concerted effort to establish a rapport. How should you or your staff handle the problematic patient? The following bulleted points include a few suggestions that you can implement as part of your office protocol.

  • Take extra time to listen and build rapport. Think of the extra time you spend with each patient as malpractice insurance.
  • Follow up on phone calls within 24 hours. Make sure the patient understands the procedure, and address any concerns.
  • Be patient. These patients can be annoying because they take an inordinate amount of the staff’s and physician’s time. They tend to feel abandoned easily and will misconstrue impatience as a lack of caring.
  • Be careful not to advise the patient, but rather ask questions about what they would like to have happen.
  • Document, document, document.
  • Implement a special release form documenting that the patient has been informed about a specific mental disorder and has chosen to go ahead with the surgery even though it may be contraindicated.
  • Don’t argue with patients or discount their perceived defects. Problematic patients often exhibit unrealistic thought processes, and they won’t agree with you. Instead, talk to them about their dissatisfaction with life in general and refer them to a counselor.
  • Talk about unrealistic expectations, and about how the surgery is not a panacea for life’s problems.
  • Express empathy and build rapport.
  • Set rules and boundaries at the beginning of treatment about office protocol. Include extra consulting fees with problematic patients if necessary. If patients know what to expect, they are less likely to cause a scene or feel abandoned.