MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.
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LEGAL ISSUES During this process, the physician provides a treatment recommendation and shares the reasoning behind the rec- ommendation with the patient. Comprehension on the part of the patient is equally as important as the information pro- vided. Consequently, the discussion should be carried on in nonmedical terms as much as possible to ensure complete and thorough understanding. The physician should stop to assess the patient's understanding throughout the process. The type of information included in the informed consent process is relative to the procedure recommended by the physician. An abdominoplasty, for instance, requires a higher level of informed consent than a mild glycolic acid peel, due to the increased risk and recovery period. Keep in mind that informed consent may also apply to procedures performed by nonmedical providers in your facility. This is certainly true of all laser procedures regardless of who—and what scope of license—is performing the treatment. Noninvasive or minimally invasive treatments, for which there is a consensus that the procedure is the best option (e.g., neurotoxin for glabella lines) or that the procedure is relatively low risk, require only basic informed consent with a low level of patient involvement. If a patient does not consent under the paradigm of basic consent, then a fuller informed consent discussion is warranted. WHAT TO INCLUDE? Given the wide range of treatment options and modalities in cosmetic medicine, practices are best served by creating multiple informed consent forms and processes based on the type of procedure performed. There are three basic approaches to determining the amount of information required for informed consent: 1. Reasonable physician standard: This standard allows the physician to determine what information is appropriate to disclose based on what a typical aesthetic physician would share in regard to a particular procedure. This standard may be inadequate for most procedures for two reasons: First, it is generally considered inconsistent with the goals of informed consent, as the focus is on the physi- cian rather than on what the patient needs to know. Second, there is little standardization of care in aesthetic medicine. For example, protocols for liposuction vary widely, making it diffi cult to assess a "reasonable physician standard" for a liposuction procedure. Most aesthetic physicians utilize some variation of this standard, though it may not be suffi cient or appropriate in today's medical, legal and ethical environment. 2. Reasonable patient standard: This standard focuses on what a typical patient would need to know in or- der to understand the decision at hand. It involves stepping into the patient's shoes and considering what the average patient would want or need to know in order to make an informed decision regarding the procedure. 3. Subjective standard: This standard is the most chal- lenging to incorporate into practice, since it requires cus- tomization of information to each patient. In this case, the physician must determine what this particular patient needs to know and understand in order to make an informed deci- sion. Based on the wide range of treatment options available, the many variations in the delivery of a particular treatment and the subjective nature of patient satisfaction with outcomes, this may be the best option for most aesthetic medical practices today. Informed consent has evolved over the years, and it is important for aesthetic physicians to review their consent guidelines regularly. This involves more than a review of the forms presented to the patient for signature. Physicians should review their entire education and information exchange process, including a review of any patient coordinator functions and any new procedures that have been introduced into the practice since the last informed consent review. Always keep in mind that true, informed consent in- volves a consideration of the risk, benefi ts and alternatives to treatment; legal and fi nancial considerations; and current ethical guidelines. Padraic B. Deighan, JD, PhD, is president of Aston McLaren, a medical and spa consulting fi rm, and the former president and CEO of DermAmerica, the nation's largest network of dermatology and plastic surgery centers. Contact him at 877.557.9669, medicalandspaconsulting.com. 36 SEPTEMBER 2014 | Med Esthetics Comprehension on the part of the patient is equally as important as the information provided. Minors and Informed Consent If a procedure is being performed on a minor, the patient's parent must provide informed consent. Unfortunately, there are cases in cosmetic medicine where the parent wants an aesthetic treatment performed on the child more than the child actually wants to have the procedure performed. Therefore, it is sound policy to require additional informed consent when performing a treatment on a minor. This may include an interview with the minor patient absent the parent's presence as well as further discussion and a review of the patient's healthcare records, es- pecially if the minor has received emotional or mental health counseling services.