More Than Skin Deep: CMPA Reports on the Medico-Legal Risks of Cosmetic Procedures
A recent report from the Canadian Medical Protective Association (“CMPA”) regarding the medico-legal risks of performing cosmetic procedures reinforces the need for a thorough assessment and informed consent process for all patients. In this context, “cosmetic procedures” refers to medical and surgical treatments performed for cosmetic reasons, i.e. those that are not covered under a provincial health insurance plan or are not performed for health reasons.
The authors of the CMPA report reviewed 644 medico-legal cases that were closed by the CMPA between 2019 and 2023 and were related to a physician performing a cosmetic procedure to determine what factors contribute to complaints or litigation against this group of physicians. The CMPA report provides both the patient and peer expert (i.e., physicians with similar training and experience) perspectives regarding what the issues in each case were. The most common issues were identified (in order of prevalence) as:
Deficient assessment
Inadequate consent process
Insufficient knowledge or skill
Inadequate monitoring or follow-up
Inadequate office procedure
Inadequate communication with patient
Professional misconduct
Poor decision-making regarding management
Unprofessional manner
Both patients and peer experts agreed that deficient assessment and inadequate consent processes were the most prevalent issues in the cases that were reviewed. Fortunately, these are factors that are largely under the control of the professional who is seeking the consent to treatment and can therefore be controlled for by implementing strong procedures for assessing patients and obtaining their informed consent to treatment.
The CMPA report applies these observations and suggests that physicians whose practices include cosmetic procedures take the following steps to help reduce their risk in these areas:
Physicians should gather an appropriate medical history from each patient, including co-morbidities and current medications, and conduct an appropriate systematic physical examination with vital signs.
In obtaining informed consent, physicians should discuss the following with each patient:
o the nature of the proposed treatment,
o risks (including rare but important risks of major consequence),
o chances of success or anticipated results,
o breakdown of charges and additional fees that may apply,
o alternative treatments (including non-treatment and its potential consequences),
o the material risks and special risks associated with the proposed and alternative treatments, and
o pre- and post-operative precautions.
During the informed consent discussion, physicians should also ensure that their patients’ questions and concerns are acknowledged and addressed and then documented in detail in the patient’s medical records.
Physicians should also be mindful of their patient’s health literacy and observe their reactions for apparent confusion during the informed consent discussion. One strategy for doing so is to ask a patient to explain what their expectation is of the procedure in their own words to decrease the potential for misunderstandings.
Physicians should ensure that all consent discussions are properly documented in the medical record and avoid solely relying on generic consent forms.
A big takeaway from this CMPA report is that good patient communication can help protect patients and physicians alike. While this should not come as a surprise to health care providers, it is an excellent reminder that consent is a discussion and not just a form. When health care providers skip this discussion and rely on a generic consent form, they are missing a key opportunity to reduce their own medico-legal risks and establish strong lines of communication with their patients.
If you would like to discuss your practice’s assessment, delegation, or informed consent processes, or if you are interested in training on informed consent for your organization, please contact us.
