PUTTING THE PATIENT FIRST

Dr Sophie Shotter talks us through how she ensures her patient’s needs are at the forefront of every stage of the treatment process

DR SOPHIE SHOTTER

Dr Sophie Shotter is a cosmetic skin doctor and renowned injector. She sits on the complications board for Allergan and most recently joined the British College of Aesthetic Medicine (BCAM) board. Dr Shotter is the founder and medical director of the Illuminate Skin Clinic in Kent. Currently, she splits her time between there and her private practice on London’s Harley Street. www.drsophieshotter.com

INITIAL CHECKS

The initial enquiry and how it is handled is so important, as often the person dealing with this gets a real measure of a patient and their motivation for treatment. At a baseline level, it’s important to take the patient’s date of birth. Not only should this form part of their medical record, but it is now illegal to perform aesthetic treatments on people under the age of 18. Remaining ethical checks can be difficult to do in the ‘pre-consultation’ stage, as although an administrative team may get instinctive feelings about a patient and whether there may be underlying concerns, they are not medically trained to ask the right questions or to impart a lot of medical information. I always ask my team to flag any concerning patients to me ahead of the consultation, however.

CONSULTATION PROCESS

A consultation should always be patient-centric. My assessment of a patient begins the moment I meet them, as so much can be determined by their body language, but I always start the formal consultation process by asking them ‘How can I help you today?’ This helps me gauge their ideas and agenda for the consultation. I also get a fair measure of their personality style – are they analytical, need a lot of reassurance and have many questions to answer, or are they very direct, already confident in the process they are following and need information in short, sharp bites? I always try to tailor my consultation style to an individual’s unique personality wherever I can and flex my style to suit theirs. I then take time to understand their concerns and answer any questions they may have. Ultimately, it’s my medical duty of care to recommend an appropriate treatment plan for them, and this may not always be what they think they want or need. I explain this as thoroughly as I’m able to and also explain that sometimes I work as part of a wider team and may cross-refer. This could be to a plastic surgeon or a dermatologist if I think those specialisms are better suited to a patient’s needs. But it could also be a recommendation to see a clinical psychologist if I feel the patient has body image or mental health issues, and treatment wouldn’t be in their best interests. It’s also very important to ensure that consultation and first treatment are during separate appointments, to give patients a cooling-off period and a chance to reflect on what has been suggested and discussed.

COMMON CONCERNS

Body image issues: If I feel that a patient is focusing on a concern that either doesn’t exist or is much more minor than they perceive it to be, I may say that I think they may suffer from a body image disorder. This can be a very difficult conversation, but I will always recommend referral to a clinical psychologist for formal assessment and any appropriate treatment. A patient requesting a treatment that I don’t think is suitable for them: This can happen when patients come in with a set idea of what treatments they want. I will always try to educate them as to why I think a different route may be better, and sometimes that works, but other times it doesn’t. Ultimately, if a patient tries to insist on a treatment that I don’t deem appropriate, I have to refuse to treat and may offer a referral to a colleague for a second opinion.

Vulnerability: Sadly, I have had several situations where patients have disclosed difficult subjects like abuse during a consultation. I have had to follow safeguarding processes, and consider whether a referral to social services needs to be made.

Complications/unsatisfactory results: Sometimes patients seek treatment with you following problems or unhappiness with treatments performed elsewhere. This can be a difficult situation as sometimes the relationship with the treating practitioner has broken down. However, we also need full information to safely proceed with any corrective, remedial or future treatment. This can be a difficult conversation, but ultimately it’s important to encourage the patient to have this remedial work with the original practitioner. If this isn’t possible then I do insist on having medical notes from the previous treatments, so that I can ensure my proposed plan is a safe one.

ETHICAL EDUCATION

I think education about the possible ethical dilemmas we face is crucial. This then gives us a possibility to think about how we would handle possible difficult situations before the patient is actually in front of us. I also think a useful tool can be training about our personality types, and how that can fit with other people. I did this through Insights (in association with the Allergan Business Consulting Team), and, for me, this has really enhanced how well I can read my patients and flex my consultation style to best suit their needs.