Patient selection: How to say no to patients - Hamilton Fraser


Managing patient expectations is key to the success and reputation of your aesthetic practice. An unsatisfied or unhappy patient can not only jeopardise your business through potential claims but also tarnish your hard-earned reputation with negative online reviews. Both of these situations can tie up your valuable time and resources, and divert attention away from other patients, as well as cause you a lot of stress. This is why it is important to learn to say “no”. 

It can be hard to turn down a patient after all the effort you’ve put into getting them through the door in the first place. While turning down a patient may seem daunting, it’s a crucial skill that can protect both your practice and the well-being of your patients. At Hamilton Fraser, we would like to help give you the confidence to manage these awkward conversations better, ultimately supporting you in making your business a success.

Our survey says 

In our recent survey, it was evident that many practitioners have experienced situations where they had to decline to treat a patient. A total of 30.7% of respondents said they had turned patients away once or twice, while another 30.7% had done so at least three times, and 24.8% said they had said no to treating unsuitable patients more than three times. Only 13.7% said they had never turned a patient away. 

When asked if they had ever regretted treating a patient, it was almost a 50/50 split, with 48% saying “yes” and 52% saying “no”. Of those who answered “yes”, the main reason given was that they felt the patient had unrealistic expectations of treatment. Practitioners also stated body dysmorphia, patients wanting treatments for low costs, difficult or demanding patients and gut feelings as other reasons to say “no”.

 Encouragingly, 91.5% said they were routinely looking out for patients displaying any mental health problems, in particular, body dysmorphia, with questionnaires and screening during consultation being the main methods of analysis. This proactive approach demonstrates a commitment to patient well-being and that treatments are both safe and appropriate.

"Patient selection has always been an important part of ensuring optimal treatment outcomes. In an unregulated sector, with lots of competition, your reputation can set you apart. During consultations with patients you should take extra care to look out for ‘red flag’ signs and if you feel they are not suitable for treatment, do not be afraid to say ‘no’. The team at Hamilton Fraser is here to assist if you need guidance on declining patients."

- Emma Bracchi, Senior Claims Technician

Identifying red flags 

One critical aspect of patient selection involves assessing their mental health and psychosocial well-being and identifying red flags

Conversations surrounding mental health can be challenging as they touch upon intimate and personal matters. However, understanding the psychosocial components underlying aesthetic treatments is essential for providing comprehensive care to patients.

Some patients may express unrealistic expectations that could suggest underlying psychological concerns, so practitioners have a duty of care to delve into their mental health history and address any psychological issues that may impact their treatment outcomes as part of the consultation process.

There are a number of questionnaires you can use to identify body dysmorphia.

These recent papers may also be of interest to read. 

How to approach refusing treatment with patients

When faced with the decision to refuse treatment, it's essential to handle the conversation with tact and empathy. Trust your instincts and communicate openly with the patient about your concerns. Discuss why you believe the proposed treatment may not be appropriate or yield natural-looking results, emphasising that your primary goal is their well-being.

Sometimes, patients may insist on a treatment despite professional recommendations. In such cases, it's crucial to maintain firm boundaries and prioritise the patient's health over their desires. Refusal should be conveyed respectfully, with a focus on patient education and understanding.

Here are some top tips on how to effectively communicate with patients when declining treatment:

Be honest

  • Clearly communicate to the patient that the results they are looking for may not be achievable through the proposed procedure and would not meet their expectations if you agreed to undertake the procedure
  • Emphasise that even though another practitioner might agree to proceed, it would likely result in disappointment for both parties
  • Explain that going through with the procedure would be a frustrating experience for both patient and practitioner because it would involve spending time, money and effort on unrealistic goals that would not be achieved


  • Provide detailed explanations as to why the patient's goal is not feasible, backed by your professional expertise
  • Offer alternative solutions or treatments that may better align with the patient's expectations and desired outcomes
  • If applicable, advise the patient on steps they can take to become eligible for the procedure, such as lifestyle changes or pre-treatment preparations. This may also include being referred for further psychological support, which some clinics offer in-house

Be gentle and empathetic

  • Approach the conversation with empathy and understanding, acknowledging the patient's concerns and desires
  • Explain gently why they are not a good candidate for the procedure
  • Tell your patient that you would recommend a referral to their GP if you think they might suffer from Body Dysmorphic Disorder (BDD)
  • Express regret for being unable to fulfil the patient's request but emphasise that it is in their best interest to avoid disappointment and pursue more realistic options

Saying no to patients: In summary

It's essential to remember that as a practitioner, you are under no obligation to treat anyone. Your primary responsibility is to provide care to patients who are suitable candidates for procedures, prioritising their well-being and safety.

Refusing treatment may be uncomfortable, but it is sometimes necessary to uphold professional integrity and make sure of patient safety. In fact, refusing treatment can actually serve as an effective marketing tool, preserving the integrity of your practice and demonstrating a commitment to ethical standards. 

By communicating openly, empathetically, and respectfully with patients, you can navigate these challenging situations while preserving trust and maintaining positive clinician-patient relationships. Remember, saying “no” is not a reflection of inadequacy but rather a commitment to ethical practice and patient care.

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