Practising with Caution

Adv Amit Kharkhanis aspotlights his findings on the complexities of aesthetic medicine, balancing patient satisfaction, legal challenges, and ethical standards.

In the context of the constantly developing field of aesthetic medicine, not only do the issues of practice go beyond attaining the objective of physical improvement and patient satisfaction.

There is also the legal vulnerability that medical professionals working in this field have to deal with.

Given that aesthetic practices can be performed by various specialities, including dermatology and aesthetic surgery, high expectations of patients combined with complex procedures make aesthetic medicine a challenging field in terms of medicolegal aspects.

The legal landscape

Aesthetic practitioners are increasingly under legal scrutiny due to the nature of their practice. Patients’ high expectations and emotional investments amplify risks. This legal landscape demands practitioners to be vigilant and well-informed about the medico-legal intricacies that govern their profession.

Central to the practice of aesthetics is the emotional connection patients have with their appearance. Aesthetic procedures are not just about physical transformations but also about addressing deep-seated emotional needs.

Aesthetic procedures are unique as they directly influence how individuals perceive themselves. As famously depicted in the Bollywood film «Jab We Met,» everyone cherishes their selfimage (“Main Apni Favourite Hun”). This emotional connection is particularly critical in aesthetic practices, where patient expectations can significantly impact outcomes and satisfaction.

Patients seek these treatments to enhance self-esteem, correct perceived flaws, or simply feel better about themselves. However, this emotional investment also heightens the risk of dissatisfaction and, consequently, legal repercussions.

Common medico-legal issues .

1. Lack of informed consent One critical issue is lack of informed consent. Supreme Court rules say that patients must fully understand the risks and benefits of procedures, as well as any possible substitutes.

2. Complications and risk management Aesthetic procedures, like any medical intervention, carry inherent risks such as bleeding, infections, and anaesthesiarelated complications. Proper risk assessment and management are imperative.

3. Expectation management Managing patient expectations is pivotal. Clear communication regarding realistic outcomes avoids unrealistic promises and aligns patient understanding with achievable results.

4. Product choice and liability Practitioners recommending cosmetic products must ensure their efficacy and safety, as they bear responsibility for any adverse reactions or complications arising from their use.

5. Documentation and legal protection Comprehensive documentation of patient history, consent forms, and treatment details serves as crucial evidence in legal proceedings, protecting practitioners against unfounded claims.

Why is documentation important?

I just had a case a few months ago, a 60-year-old retired man suffered a laser scar on his face during a treatment. The doctor admitted the fault, acknowledging that their staff was not properly trained and that the lasers malfunctioned. The patient is now asking for Rs 2 crore in the settlement, even though they only paid Rs 16,000 for the whole treatment.

The main problem is that the staff needs to be properly trained, which shows the concept of vicarious liability. The patient’s complaint about how his appearance had been damaged shows how important it is to have realistic standards during aesthetic treatment. Our argument in court is that the compensation claim is not based on enough money given his age and retirement status. We are fighting this in court with all our efforts, and the doctor is ready to take the case to the top levels of the justice system.

This case brings up important points, like how important it is to train staff, make sure patients are happy, and keep promises about outcomes. Right documentation is important but is often overlooked in aesthetic practices.

Getting a full medical background and getting informed consent is crucial, especially when anaesthetic risks are involved. Practitioners can protect themselves in legal disputes by keeping good records and full patient backgrounds. In the end, to reduce legal risks, the focus should be on having precise documentation and educating patients.

Industry challenges and ethical considerations

Society’s expectations of beauty, high patient expectations, and the commercialisation of beauty standards are some of the challenges that the aesthetic industry has to deal with. Professional integrity and commercial viability at the same time are two things that must be balanced to be ethical.

I have handled numerous cases where models have filed lawsuits against their dermatologists due to improperly executed skin grafting procedures. Iam aware that the physicians have recommended a course of action at the time of discharge; however, the patients did not follow that advice.

When it comes to aesthetic practices, medical knowledge and law duties are brought together. Practitioners need to be careful as they deal with these issues, putting patient safety, informed consent, and ethical standards first. By following these rules, professionals can lower their legal risks and improve the results for their patients.

Expert advice for practitioners

• Focus on the importance of fully educating patients and following the protocol for informed consent.

• Continuous professional growth and training should be a top priority to lower procedural risks.

• Strong documentation habits will protect you from legal issues.

• Encourage honest behaviour and do the right thing in aesthetic clinics.

Overcoming legal challenges

The field of aesthetic medicine is not limited to the goals of attaining physical enhancement and patients’ satisfaction but it also implies numerous legal challenges that dermatologists and plastic surgeons face. While such procedures are performed across different specialities, the expectations of patients and elaborate processes increase medico-legal risks. It is therefore crucial for practitioners to understand these issues and find ways of overcoming them.

Specifically, the legal issues that one has to be aware of while practising aesthetic medicine include informed consent, risk management, patient expectations, and documentation. Legal risks can be reduced through proper training of employees and compliance with ethical measures. This is especially important in communication and the promises that are made to the patients since they have an emotional attachment to their appearance.

The concept of patient safety, informed consent and documentation can be used to help aesthetic practitioners avoid legal issues, while at the same time, building patient confidence and quality care. Lastly, a combined and moderated approach of medical, legal, and ethical perspectives will lead to a stronger and less risky practice in the constantly evolving area of aesthetic medicine.

The above article has been extracted from Adv Amit Kharkhanis’ recent presentation at the Aesthetic Medicine India Conference 2024.

“The legal issues that one has to be aware of while practising aesthetic medicine include informed consent, risk management, patient expectations, and documentation. ”

About Adv Amit Kharkhanis: A Senior Panel Lawyer for Union of India, and Founder, Chambers of Amit Karkhanis, with over two decades of experience, Adv Amit Karkhanis specialises in medico-legal laws, surrogacy, the healthcare sector, and intellectual property rights. He was one of the foremost lawyers to practice medicolegal and surrogacy laws in India. He holds a three-year law degree from Mumbai University and a Master of Laws degree in International Trade Laws from the University of Newcastle upon  Tyne, United Kingdom.