Managing patient expectations - Hamilton Fraser


As one of the founding members and a board member of the British Association of Sclerotherapy (BAS), Claire Judge is regarded as one of the most experienced microsclerotherapists in the country.  In this guest article, she draws on her extensive experience running her own clinics and shares her tips for managing patient expectations.

Managing expectations is a vital part of any client-based business, it is key to that person’s satisfaction with your service. If we allow them to hold unrealistically high expectations, clients will be unhappy, even angry, when they are not met. This can in turn lead to very poor outcomes for your business. In the world of aesthetics, it is therefore vital that, from the outset patients have a clear knowledge of what their chosen treatment can achieve and as practitioners it is essential that we facilitate this.

In the world of mass media, patients can research on many forums, and without direction they can be misinformed by misleading and unreliable material. It is therefore essential that patients can access your information with ease. Once speaking to a member of clinic staff, they can be directed to a reliable and trustworthy source of information relating directly to treatments you offer, such as your own leaflet or website, or a relevant professional organisation, for example The British Association of Sclerotherapists FAQs. This first point of call already starts the patient journey positively and ensures that they have a more realistic idea of the outcome of their treatment.

How to manage expectations

Over the past 25 years I have established and managed sclerotherapy (treatment for the removal of thread veins on legs) clinics in the South East of England. Many of these patients have been treated repeatedly over this time and I have had the opportunity to build a rapport with them. This has led to them recommending my clinics to friends, family and their wider community and these professional relationships have helped to expand both my reputation and business.

Building these relationships can only be successful by listening to and understanding your potential patients’ needs and managing their expectations. Often there is a large gap between the patients’ expectation and the reality of the possible outcome. As consultants it is our job to manage them.

Sclerotherapy is not a perfect treatment, it can take up to two to three months for the thread veins to improve. During this time some veins will go completely, whilst others may either fade or not go at all. Usually, it is necessary for patients to have more than one treatment and over time more veins will appear.

Without patients fully understanding this there is a high risk of patient dissatisfaction. This can affect patient outcomes, patient retention, and potential litigation. It can also cause negative word of mouth which can be very destructive. It is worth remembering that if we satisfy one customer, the information reaches four others. If we alienate one customer, it spreads to 10, or even more if the problem is serious. Potentially this could be many more if dissatisfaction is spread on social media.


The consultation is key when it comes to managing expectations and offers opportunities for both the patient and the practitioner.

  • First opportunity for patients to meet their chosen practitioner face to face
  • The onset of a professional relationship based on honesty, trust and joint decision making
  • The basis for bridging the gap between what your patient expects and what can realistically be achieved
  • Taking time to fully discuss the treatment is vital
  • Patients need to feel they are being listened to and their opinion is valued
  • Address patients concerns:
  • What they expect from the treatment
  • The time frame that they expect results
  • Set realistic goals together
  • What success rates do you have?
  • Quote potential side effects using your own statistics
  • How many sessions will be likely, when may reoccurrence occur?

It may be helpful to show patients before and after images and photos of potential side effects so they can fully visualise potential outcomes. After treatment the use of photos can be useful. They show patients the extent of change since treatment started, enabling them to see the progress made rather than visualising an ideal image of how their legs could look.

Managing patient expectations

Unsuitable patients

Practitioners should not be afraid to say no. Patients who do not have a comprehensive understanding of the potential outcomes and are prepared to sign a consent with no discussion should be avoided, and their motivation considered carefully.  In cases where body dysmorphia may be an issue patients should be carefully screened. No treatment would ever be sufficient for these patients and expectations could never be reached.

It may be that patients are not suitable for sclerotherapy. In this case other options should be discussed. Patients may need to be referred onwards. Building a good rapport with a patient, even if they are unsuitable, is never wasted if the consultation is managed well and the relationship you have built is positive. These patients have the potential to refer you and post positive information on social media. All this is beneficial to your business and reputation.

In summary

  • From the very first interaction you have an opportunity to establish appropriate expectations, closing the gap between expectations and reality
  • This process of narrowing the gap happens through communication, education, listening
  • Every patient interaction includes an opportunity to understand the patient’s needs, perceptions, expectations
  • Successful education increases patient satisfaction leading to better compliance and hence outcomes

Mark Copsey – Associate Director Hamilton Fraser Cosmetic Insurance says:

“Hamilton Fraser have long valued and expressed the importance of the consultation process between practitioner and patient and agree with everything in this informed article. From an insurance point of view, should a claim occur, the first action from insurers is to request all details from the consultation process and subsequent action derives directly from that. With a significant number of claims being based around customer dissatisfaction, we strongly believe that managing expectations should be front and centre of that process, which will have a direct impact on the management of any claims that occur.”

About the author

Claire Judge British Association of Sclrerotherapists

Claire Judge

Claire Judge is a qualified nurse and independent nurse prescriber. She has 26 years’ experience in Sclerotherapy; and has clinics at the Royal Free Hospital, (London), Hadley Wood Hospital (Barnet) and The McIndoe Centre (East Grinstead). She has published chapters on Sclerotherapy and has written for aesthetic journals and she has spoken and demonstrated at conferences on this subject.

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