Patients with ADHD – the consultation process

Thorough and effective communication between a medical aesthetic practitioner and their patient is vital for the patient’s involvement in any decisions about cosmetic treatments and for ensuring their adherence to any pre- or post-treatment protocols. SE1 Medical Aesthetics medical director Lorenzo Garagnani and managing director Emma Costello explain why some patients, more than others, may find it more difficult to engage with their practitioner in the aforementioned process - especially those with ADHD.

Medical aesthetic practitioners should adapt their consultation style and the length of the appointment to the specific needs and characteristics of each patient so that they can gain the clearest understanding of the indications and treatment options. 

Key points to remember for an appropriate consultation include:

• Allocating sufficient time for the consultation. A consultation with a patient affected by ADHD is likely to require a longer time.
• Gathering a thorough medical history.
• Asking in the first instance some open-ended questions about the patient’s aesthetic goals, listening carefully to the responses and observing their behaviours, as these are likely to uncover certain aspects of their concerns. The practitioner can then proceed to ask more specific questions based on the patient’s initial assessment and their answers to the broader questions.
• Explaining the cosmetic aims of the treatment to the patient and openly discussing the pros and cons and the balance of risks and benefits of any proposed procedures. The discussion should be at the level preferred by the patient, and any technical jargon should be explained. Repeating information and asking the patient to summarise their understanding at each stage of the consultation are crucial aspects of the consultation and consenting process.
• Assessing the patient’s commitment and organisational skills required, including their adherence to the pre- and post-treatment guidelines, the possible effect of a treatment increasing their self-awareness, the challenging impact this may have on the person and the people around them, and the importance of long-term adherence beyond the duration of any initial programme (for example, by attending follow up/refresher appointments). Make reference to NICE guidelines on attention deficit hyperactivity disorder: diagnosis and management.
• Assessing the patient's capacity to make each decision based on the Mental Capacity Act 2005 principles. 

 To lack capacity, patients must either have an impairment of or disturbance or malfunction of brain and mind or (more likely, for a patient with ADHD), demonstrate a lack of capacity to:

•        understand the information relevant to the treatment
•        retain information for long enough to use it in the decision
•        use or weigh information as part of the process of making the decision
•        communicate the decision

If the patient has specific concerns, record a summary of the discussion, because this may be helpful in future consultations.

Be aware that the symptoms of ADHD may lead to the patient having difficulty adhering to treatment plans or staying in contact. Use reminders to ensure that any necessary aftercare guidelines or follow-up appointments are kept.