Patient and staff treachery

Plastic surgeons, patients and office employees are supposed to be a united front, all dedicated to promoting beauty and self-esteem. But sometimes, not everyone on the team is playing the same game.

California attorney Robert Aicher, Esq., knows this better than most. He has served as general counsel to the American Society for Aesthetic Plastic Surgery since 1998. As he explained at this year’s The Aesthetic Meeting in Las Vegas, plastic surgeons face unique legal threats from those they know most intimately on the job — patients and staff.

But a few preventive measures may lower the risk that you’ll end up in court. Here are 3 tips from Aicher:

Chargebacks and HIPAA

They say there’s no free lunch, but you may occasionally come across patients who believe there’s a free procedure. For them, a common weapon of choice is the credit card “chargeback.”

Chargebacks are a nuisance for just about anyone who provides a service.

For example, Aicher says, “we buy something at the hardware store, and we don’t get satisfaction. Then when the bill arrives, we dispute the bill.” At that point, the credit card company launches an investigation and considers whether to deny the payment to the merchant.

In aesthetic medicine, a chargeback request can come from a patient who’s dissatisfied with, say, a filler injection or Botox. “I’m not sure there’s a whole lot anyone can do to avoid a chargeback,” Aicher says, “other than try to deliver the best service you can.”

But there’s good news too. As a plastic surgeon, you aren’t defenseless when Visa or MasterCard (or Discover or American Express) gets in touch and wants information about the procedure you provided. Aicher urges his clients to provide details about procedures in these cases. HIPAA, he believes, doesn’t apply when the patient has already raised the issue of a medical procedure to the credit card company.

“In my view, it’s not a privacy violation,” he says. “Our members routinely provide the medical records to prove the service was received, and they routinely win the cases.”

Patient Bullies

Physicians aren’t big on risk, and they aren’t big on confrontation. “They don’t train them in medical school to be fighters,” Aicher says. “They train them to be healers.”

That’s the way it should be. So what’s the problem for physicians? It’s simple, Aicher says: “This makes them great targets for bullies.”

And patients can most definitely be bullies. They might demand a free re-do of a procedure and threaten to tattle to Yelp if they don’t get their way. They may insult everyone in the surgeon’s office until the staff begs you to fire them as patients. And you, Dr. Nice Surgeon, end up in the middle.

What to do? Aicher suggests that plastic surgeons learn to say no. Not in an aggressive way, he advises, but firmly and unapologetically. “You’ve got to get them off their game,” he says. “Fold your hands and say no. Let the silence hang.” And don’t give in.

Aesthetician Patient Theft

Aestheticians come and go, and there lies the rub: They will sometimes head to another clinic and try to bring your patients along with them.

“You can’t completely prevent it,” Aicher says, but there are ways you can make patient-thieving by aestheticians less likely.

“It’s a good thing to have them sign a release, an acknowledgment that your customers are protected trade secrets,” Aicher says. Non-compete clauses are another option, he says, but some states have right-to-work laws that frown on contracts including these restrictions.

What if these measures don’t work or aren’t feasible? Don’t expect to turn to medical privacy laws. “Technically, patient theft is probably not going to be a medical privacy issue,” he says, “as long as they’re just stealing patient names and contact information, and there’s no medical information attached to the names.”

So what can you do after a theft? “I encourage our members to write directly to the new employer and remind them that these are protected patient lists, and the new employer is prohibited by law from marketing to them,” he said. (It’s OK, though, for aestheticians to provide basic information to patients about their job switches when they move to a new employer, he says.)

You may also be tempted to change passwords after an aesthetician leaves so the person can’t get into the system and swipe patient names. But Aicher is skeptical that this will work. “I’m afraid employees are smarter than that,” he says. “By the time you hear that they’re leaving, they’ve gotten what they wanted.”

Randy Dotinga

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