The Canadian Medical Protective Association’s (CMPA’s) latest Know Your Risk report was developed for physicians who perform cosmetic procedures, providing data-informed insights and advice on reducing medico-legal risk. This resource is one in a series of specialty-specific research articles that identify key factors associated with patient harm in medico-legal cases in Canada, types of patient complaints, and peer expert criticisms of clinical interventions. Each report features learning resources that can help physicians improve patient safety.
Many Types of Specialists Perform Cosmetic Procedures
Several specialists perform cosmetic procedures in Canada, including plastic surgeons, family physicians, ophthalmologists, dermatologists, otolaryngologists, and general surgeons.
Roughly half (46%) of the 644 medico-legal cases included in the report (closed in CMPA between 2019 and 2023) involved plastic surgeons. These were followed by cases involving family physicians (15%), ophthalmologists (10%), and otolaryngologists (6%).
Some of the procedures explored in the report include common procedures such as breast augmentation/reduction, abdominoplasty, face lift, hair transplant, rhinoplasty, blepharoplasty, and varicose vein treatment. Regardless of their specialty, physicians who perform cosmetic procedures can benefit from information on the medico-legal risks related to these treatments.
Patient Complaints and Peer Expert Criticisms
Complaints reflect the patient’s perception that a problem occurred during care. Patient complaints are not always supported by peer expert opinion.
Within the Canadian medico-legal context, peer experts refer to physicians who interpret and provide their opinion on clinical, scientific, or technical issues surrounding the care provided. They are typically of similar training and experience as the physicians whose care they are reviewing. Peer experts may not be critical of the care provided, or they may have criticisms that are not part of the patients’ allegation.
Regarding cosmetic procedures, the three most common patient complaints were:
- Deficient assessment
- Inadequate consent process
- Insufficient knowledge or skill
These complaints generally align with the most common peer expert criticisms, though inadequate office procedures was also a common criticism from peer experts.
In light of these findings regarding patient complaints and peer expert criticism, physicians should ensure that both informed consent process occurs and adequate documentation processes exist, which include a discussion of the patient’s expectations.
Case Example
A patient in Canada complained to their Canadian regulatory College that their family physician failed to inform them of the number of syringes of cosmetic injectable that would be necessary to obtain the expected result, the time required to obtain this result, and possible complications.
The peer expert stated the family physician’s documentation was thorough and detailed as to the consent discussion, cost, and total number of Botox units to be injected.
Top Factors Associated with Severe Patient Harm
Many factors are associated with patient harm, which is defined as symptomatic, requiring additional medical/surgical intervention, or resulting in prolonged hospital stay, a shortened life expectancy, or permanent or temporary loss of function.
The report explores both patient and provider factors. Patient factors included obesity, complications from previous surgery, and non-adherence to medical advice (e.g., not limiting activity after abdominoplasty, resulting in seromas forming).
Provider factors included insufficient knowledge or skill, poor decision-making regarding patient management, suboptimal medication choice, and deviation from clinical procedures—for example, not having an anesthetist present to monitor patients’ vital signs and hemodynamics during a surgical procedure.
How CMPA Provides Medico-legal Advice and Supports Physicians in Canada
CMPA physician members are eligible for assistance with medico-legal events related to the practice of medicine. Canadian physicians can contact CMPA to get advice on how to provide safe medical care, prevent patient harm, or get help to navigate a medico-legal issue.
CMPA’s team of experienced physician advisors speaks with members directly to provide peer-to-peer support to help them handle medico-legal or patient safety challenges. Each year, these physician advisors respond to over 24,000 calls from doctors.
Turning Data into Research and Learning
In supporting doctors from across the country, the CMPA collects and maintains medico-legal data, the largest collection of its kind in the world. These data uniquely position the CMPA to conduct important research to foster system change and improve patient safety. Through these research efforts, CMPA publishes risk management articles in peer-reviewed journals, and develops resources as well as practice-improvement learning opportunities for doctors.
The CMPA’s Know Your Risk reports for specific clinical specialties are one example of how the Association helps identify areas of risk and enhances patient safety in Canada. There are currently 17 Know Your Risk resources available on CMPA’s website, and more reports are continuously in development, addressing many specialties.
Empowering Better Healthcare
The CMPA empowers better healthcare by delivering efficient, high-quality physician-to-physician advice and assistance in medico-legal matters. Importantly, the CMPA provides appropriate compensation, on behalf of our members, to patients proven to be injured by negligent medical care. Our peer-reviewed research results in evidence-based products and services focused on enhancing patient safety and reducing patient harm.