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The Importance of Informed Consent

By Crystal Wilson, CNP

Time and time again, I have had patients come to see me for injectable procedures after going to a different injector, and I could tell they were not properly informed about the procedure to consent. A lot of individuals think aesthetic medicine is “fluff medicine” when in fact, it should be treated just like any other medical procedure that is performed. That includes a proper informed consent by the provider to the patient before the patient signs. Explaining the procedure, risks, benefits, outcomes, complications, and post-treatment care, as well as answering all the patient’s questions before having them sign and getting started with the procedure.

Before I even begin going over the informed consent with my patients, I determine if they are an appropriate candidate to be receiving the injectable procedure in the first place. It is known that pregnant and breastfeeding women should not receive neurotoxin, dermal fillers or PDO threads, no questions asked. I also have concerns about patients with autoimmune diseases, anyone on an antibiotic/immunosuppressant and/or patients who may be taking blood thinners. These are all questions/concerns that I address with all my patients before getting started. Each patient fills out a health history form that not only includes their medical history, like diagnoses, but also their surgical history and current medications and allergies. If I see anything on the form that concerns me regarding receiving injectables, I ask the patient more questions. For example, if a patient includes facial reconstruction as part of their surgical history, that will spark more questions from me, especially if the patient was wanting dermal filler. I typically do not treat patients who have had major reconstructive facial surgeries, because their anatomy will most likely be different, which means their risk of some kind of vascular compromise happening from a dermal filler procedure increases. To me, it is not worth the risk. Once the patient is “cleared” for neurotoxin, dermal filler or PDO threads, then the consent process begins. I thoroughly explain whatever procedure they are receiving and make sure they understand the possible complications that can occur, as well as how to monitor for these complications at home. They always have a way to get in contact with me at any time if they run into questions or concerns. I always suggest having an emergency line or emergency email that patients can contact you through in case of complications that require urgent attention. I make sure to talk about post treatment care instructions and answer all questions the patient may have.

Results should also be discussed in a thorough manner. I would rather under promise a result, than overpromise one and under perform. Realistic expectations are key in this industry, so making sure your patients understand these expectations is essential. Once I feel confident that the patient is well informed and prepared for the procedure, I then have them sign their consent and get started. The consents are also signed by me as a witness. These are the steps I follow every time I am doing a procedure on a patient, new or existing. If the patient has had the procedure done before and is aware of the risks, complications, post-care, etc. I just make sure there hasn’t been any changes in their medical or surgical history, medications and/or allergies since the last time. If there have been any changes, I add them to their health history forms and have them re-sign all consents. If there are never any changes to a patient’s health history over the year, I still always make my patients re-fill out and re-sign all paperwork and consents at the beginning of the year.

Taking the time to do a proper informed consent is imperative to save you time from dealing with future potential issues that could have been avoided. I have never regretted taking the time to sit down with my patients and make sure they are informed about the procedure they are consenting to and making sure all their questions are answered. This has saved me ample time afterwards because my patients hardly ever reach out with any questions or concerns because they were well informed beforehand. We must remember as injectors, that patients have the right to be informed, and even though we may not be performing surgery on them, it is still a medical procedure that needs to be taken seriously. A lot of patients believe getting lip filler is innocent, when, it could cause some serious complications. I know that if I were the patient, I would want to know everything about the procedure, what product was being used, and any complications that could arise, as well as how these potential complications would be handled. I would also hope that my provider would take the time to make sure all my questions and concerns were answered. I always try to remember how I would want to be treated if I were the patient and always do that for all my patients.

All informed consents that patients sign should be saved on file and be easily accessible at any given time. I use an electronic medical record for my patient charting, and every document they fill out and sign is saved within their profile. It is nice because it is easily accessible, and any document can be printed to be saved in paper copy as well. It is also important to note that patients receiving these aesthetic procedures should be at least 18 years old and able to sign for themselves. As a personal preference, I do not treat anyone under the age of 21. In conclusion, all these aspects should be addressed and taken seriously when it comes to informed consent of an aesthetic procedure. I would much rather be prepared, overly cautious and safe than sorry later, and I am sure most injectors would agree with me on that.

 


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