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Aftercare- Who is responsible?

treatment gone wrong...

Ask Dr Imaan: Who is responsible for you after your treatment?

“I went to this clinic, to get my lips done. I bruised badly, and after a week of bruising and swelling, my lips deflated back to their normal size. I feel cheated out of my $389! When I complained, the manager said the injector was a professional and so I had no grounds to complain.”

“I went to this clinic, and had some anti wrinkle to my forehead lines. But, now I feel like it wasn’t enough and I want more but they say I have to pay for the extra units. Why? It’s not cheap at $4 or $12/unit.

“I had a half ml of filler to my eye, cos it was cheap, but I don’t think it’s done much for the eyebags.”

I see comments such as these on forums, and hear them when I see patients for the first time.

What is one to do, when we spend good money, in good faith, and things don’t go according to our expectations?

Who is to blame, if anyone?

The injector?

The clinic?

The product?

You and your physiology?

It is human nature, when things don’t go as planned, to look to blame someone.

Until recently, I worked for a large chain clinic one day a week; I was happy there and loved the staff and the clientele for the most part. BUT…there were issues we could not adequately negotiate and I left.

When I worked with them, I was not on-call for them after I physically left the building barring emergencies. Patients had no access to my contact information- I wasn’t allowed to give them any, and their point of contact was the clinic only who would act as an in-between. This was problematic for many reasons and I imagine it is similar for anyone who is not ultimately responsible for their work.

The process of informed consent, done prior to the procedure, involves exploring expectations, for the dose used, and whether one is likely to be happy with the result; side effects and risks, both common and rare, covered here; when to worry or to contact the injector and when to wait till the review at 2 weeks; who pays if more product is required if the dose is inadequate, or if results are asymmetrical, as can commonly happen with anti wrinkle treatment; Who to contact IF there is something urgent and worrying.

In my opinion, it is not informed consent if this is not done, even if the patient signs the forms and it can be the biggest causes of dissatisfaction and fracturing of relationship between injectors and patients.

So what have I seen and heard of?

In many of the larger chain clinics, because they offer such big discounts on products, people are used to haggling and negotiating on prices. When I used to work in one, it was common for people to try and haggle with me, who didn’t understand that I was simply the technician and it was not my business or my products.

So, while I can’t speak for other clinics and especially larger chain clinics, who often have a high turnover of staff and clientele and primarily nurse injectors, I can advise what I do that is different as I feel ultimately responsible for the aftercare of every patient that I have laid hands on

 

  1. I offer obligation free consultations. There is no set time limit on how long this can take, and I allocate a half hour to get to know you as well as your expectations and to advise if your goals are realistic and fit your budget and whether that budget will soften lines, or freeze your face. I’m also honest about my preference for softening lines over freezing areas of the face. At this stage, you are welcome to take my advice and walk out and see someone else. 100% Obligation free.
  2. If we do proceed with treatment, you are free to choose when to do this. There is no pressure from me, to treat on the day; in fact I would prefer it if we didn’t, especially when it comes to fillers. I like to plan what I would like to do to best enhance your natural features and assets. After all, you are spending your money and trusting me to do a good job. Most people underestimate how much filler they’ll need, and the associated cost so it often takes time for you to plan and budget. If you do book in, and there are no reasons why you cannot proceed, I will usually email you the consent form to read before the appointment so you can read it, and have true informed consent, or have your questions answered before signing.
  3. Product is not cheap. I have discussed elsewhere that I do not price-match; I will put packages together for larger amounts of products used, but I won’t compete on price. Injectables are far more than just beauty treatments. They are medical procedures with rare but very real risks.
    1. As a small business, I do not buy large quantities like bigger clinics do so I don’t get much in the way of discounts so I cannot and do not price match. If that does not work for someone, I am happy for them to go elsewhere.
    2. A famous plastic surgeon says that the cost of a procedure is : the cost of the product + the expertise of the injector + the risk associated with the procedure. I am a doctor of 16 years with surgical training between 2002 and 2011.
    3. Would you trust someone who’s only been injecting for 2 weeks the way you may trust someone who has been injecting for 2 years? Likewise, someone who has trained in surgery for years, like I did over someone who has not? Someone who has formally trained in anatomy over someone who has done a crash course? That, to me, is what informs the final cost of a procedure. There is absolutely no pressure from me, and I respect your choice to spend your money how you wish. But I don’t price match.
  4. Assuming you have had your free consult, and you have decided you liked me enough to trust me with your face, and are willing to pay the non-competitive price for your treatment, what next? You book an appointment with me here, or by calling 0478589171. Depending on what you plan, I will set aside appropriate time and we go from there.
  5. During the procedure, I am personally responsible for you; if you feel faint, I look after you; if you have an allergic reaction, I look for you; if anything terrible happens, the buck stops with me, even if you end up needing to go to hospital for example (rare but not impossible).
  6. After the procedure, you are able to contact me 24/7/365 (though I hope you won’t abuse the privilege) if you have any non-standard concerns. I will arrange to see you if it is anything urgent, or else see you when we are mutually free.
  7. There is a routine 2 week followup for anti wrinkle treatment, 4-6 weeks for fillers and once we know the correct result and dose for you, with your consent, I set up an automated reminder system to let you know by email when it is time for reviews/ rebooking at 3 and 6 months.
  8. If I don’t see you for a few months, I disable the automated reminders in the interest of not spamming you.

IF the result is disapointing, we will talk about it and work out why- not to allocate blame, but to work out what happened; it’s a learning opportunity for me, and you as every face is different and injectables are not inject by numbers.

If you need a topup of the anti wrinkle treatment, and it is a small dose, I’ll usually do so without charging you extra. Next treatment, we know you’ll need the bigger amount and you’ll pay accordingly. (exception, masseters for grinding/ TMJ/face slimming).

The point I am making is, my promise to you, as my patients, and as your doctor, is that I will be open and honest with you at all stages and I won’t shirk my responsibility to you; yes I am not as cheap as the larger clinics; and at the same time, what you will trade for the higher price is access to a trained doctor and ex surgeon, continuity of care and no upselling of services you don’t need. Any nurses who work with me, do so with my direct knowledge of their skill levels, and safety and I am still responsible for their as the scripting doctor.

The first principle in Medicine is “First, do no harm”. That requires integrity and honesty. If the trust is broken, there can be no further progress and to me, the relationship is always more important than money. Ask any of my patients!

Whether that is worth your while and your dollar, only you can decide.

Any questions? Contact me here and ask away!

For an upcoming blog post, I have a favour to ask- if any of you is happy to send me photos for me to analyse your face (anonymously if you wish), to suggest what I would do to treat, I’d love to show people what is and isn’t realistic with injectables. Feel brave enough? Contact me! As a thank you, if I use your photos and you decide to proceed with the suggested treatment, I’ll give you 10% off the total RRP as my way of saying thanks.

 

  • Dr Imaan Joshi has been working as a doctor since graduation from the University of Sydney in 2001. She spent years between 2004-2011 as a surgical trainee before switching to a different speciality program for work-life balance. She is passionate about her work in Medicine and especially about procedural Medicine, and loves her work as a Cosmetic Physician. When she isn't working, she is busy focusing on an active life with her family, which includes 4 active children! Dr S Imaan Joshi BSc, MBBS, FRACGP

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