Plastic
Surgery
Consultation

Learning objective

Given a fictional request for elective surgery, draft a consultation opening that identifies the person's question, distinguishes assessment from a treatment promise, names the responsible clinical roles, and lists three decisions that remain open.

In this lesson

• Frame the encounter as a decision dialogue: Open by asking what the person hopes to decide and what questions they want answered, then agree an agenda that includes assessment, options, and possible next steps. The GMC decision-making guidance treats information exchange as the way to learn what matters to the patient, while NICE NG197 recommends agreeing the agenda together.
• Separate consultation, suitability, and consent: A request for an operation starts an assessment; it does not establish that an intervention is suitable, beneficial, or accepted. For cosmetic interventions, GMC guidance calls for exploring the hoped-for outcome and medical history before deciding appropriateness, and the RCS consultation guide presents the meeting as discussion before consent.
• Make roles and limits of competence visible: Identify who is taking the history, who will assess suitability, and who can explain and seek consent for a proposed intervention within the local team; advanced trainees work under appropriate supervision. GMC Good medical practice requires working within competence, and its cosmetic-intervention guidance assigns the intervention-specific consent conversation to the professional who will perform or supervise it in the UK context.
• Keep all responsible outcomes available: Explain that the encounter may lead to further information gathering, a comparison of reasonable options including no intervention, another opinion, referral, or deferral. GMC decision-making guidance includes no action and second opinions among information relevant to choice; the GMC cosmetic standard requires an explanation when an intervention is unlikely to benefit the person.

Learning objective

Turn a fictional patient's broad request into a patient-worded goal statement that distinguishes two appearance or functional priorities, one quality-of-life concern, and two expectations requiring clarification.

In this lesson

• Elicit the person's own reason for seeking help: Ask what prompted the consultation now, what change the person notices, and what would matter most in daily life if the concern were addressed. The GMC consent dialogue calls for the patient's wishes, fears, activities, values, and priorities; GMC cosmetic guidance specifically asks why an intervention is wanted and what outcome is hoped for.
• Separate appearance, function, and wider life effects: Record a visible feature the person wants to discuss separately from a reported functional symptom and from work, comfort, or social effects; none can be inferred from the other. NICE shared-decision recommendations ask clinicians to align a healthcare aim with the person's wider goals, while GMC Good medical practice includes symptoms and personal context in assessment.
• Translate a desired result into testable questions: When someone says 'make it perfect' or 'restore confidence,' ask what observable change they mean and which outcome they would still value if the result were incomplete. The RCS consultation guide asks patients to define success and consider a reasonable improvement rather than perfection; this discussion should expose uncertainty, not promise an appearance or emotional outcome.
• Prioritize goals and check the summary: Reflect the patient's priorities in their own words, ask which tradeoffs matter most, and invite correction before discussing options. The GMC consent guidance cautions against assuming which outcomes the patient values, and NICE NG197 supports checking understanding and preferences during the dialogue.

Learning objective

From a fictional referral, compile a decision-relevant history that separates at least four known facts from four missing facts, explains why each gap matters, and assigns a source or owner for clarification before elective planning.

In this lesson

• Select history by the decision it informs: Ask about the presenting concern and course, relevant health conditions, current medicines, and other planned care because these can change the balance of likely benefit and harm. The RCS cosmetic-surgery standards name general health, comorbidities, ongoing medication, and other planned procedures in suitability assessment; GMC Good medical practice requires a history proportionate to the person's condition and priorities.
• Reconstruct prior care and the patient's experience: Record previous procedures or treatment in the relevant area, complications or incomplete follow-up, and how the person judges the earlier result, without inferring a diagnosis from dissatisfaction. The RCS standards include prior cosmetic procedures, outcomes, and satisfaction in preoperative discussion; a missing operative account remains a missing source rather than an assumed uncomplicated course.
• Connect baseline factors to questions, not automatic exclusions: For each reported condition or medicine, state the clinical question it raises and whether advice from another treating clinician is needed; do not apply a single risk score or medication rule to every procedure. GMC cosmetic guidance says to consider medical history and seek advice when a relevant condition is outside one's expertise, while the GMC consent dialogue links individual clinical circumstances to the discussion of benefits and harms.
• Make uncertainty and missing records actionable: Distinguish patient-reported facts, corroborated records, and unknowns, then request only information likely to change assessment or option comparison. If an important fact cannot be checked during the visit, record who will obtain it and keep the elective decision conditional; GMC Good medical practice calls for adequate knowledge before proposing treatment and appropriate colleague advice or referral.

Learning objective

Given three fictional consultation snapshots, distinguish observed findings from reported symptoms and unknowns, then justify for each a conditional elective review, deferral, or referral with a named receiving service.

In this lesson

• Match examination to the expressed concern: Examine the relevant area and function when needed to test the reported concern, recording what was actually observed and what could not be assessed; a photograph alone does not complete a clinical examination. GMC Good medical practice requires physical examination where necessary and an assessment grounded in the patient's history and priorities; the RCS consultation guide describes clinician review before a recommendation.
• Write a provisional suitability judgment: Bring goals, history, findings, available evidence, and remaining gaps together to explain why a proposed intervention may or may not meet the person's needs. The GMC cosmetic standard requires clinicians to explain when an intervention is unlikely to achieve the desired outcome or overall benefit, while RCS standards place health and prior care within case selection.
• Recognize when elective planning must pause: A changing or unexplained finding, a significant unresolved health issue, or an examination the current setting cannot perform should prompt qualified assessment before elective options are narrowed. GMC Good medical practice requires suitable advice, investigation, or referral where necessary and a safer consultation mode when remote assessment is insufficient; this course sets no universal diagnostic threshold or urgency interval.
• Make referral or deferral a responsible outcome: Name the clinical question, receiving professional or service, information to transfer, and who will review the answer with the patient; explain the reason for deferral without implying rejection of the person's concern. GMC cosmetic guidance calls for advice when a relevant condition is outside the clinician's field, and the RCS consultation guide describes colleague advice or referral before deciding whether to operate.

Learning objective

For two fictional elective requests, document the patient's stated motivation, possible outside pressure and support needs, then justify a proportionate proceed-to-discussion, pause or referral response without making a psychiatric diagnosis.

In this lesson

• Ask whose goal is being pursued: Invite the patient to describe the change sought, why now, what they hope it will affect, and whether anyone else is urging the decision. Distinguish the patient's own priorities from a partner's, employer's or clinician's preferences without assuming that an appearance concern is pathological. GMC cosmetic-intervention guidance; GMC decision dialogue.
• Recognize a need for support without diagnosing: Listen for distress, an expectation that surgery will solve unrelated life problems, or difficulty weighing the likely outcome. Explore the concern sensitively and arrange assessment by a qualified professional when indicated; if body dysmorphic disorder is suspected or known in a cosmetic-surgery request, NICE recommends specialist mental-health assessment. A body feature, photograph or checklist response alone does not establish that diagnosis, lack of capacity or unsuitability. GMC cosmetic-intervention guidance; NICE CG31; RCS cosmetic-surgery standards.
• Protect an unpressured choice: Offer space for questions, privacy from a person who may be exerting pressure, and a chance to revisit the request after reflection. If voluntariness, understanding or capacity is uncertain, do not convert the consultation into an immediate procedure commitment; follow the relevant local safeguarding or capacity pathway. Concern about pressure calls for inquiry, not an automatic judgment that the adult cannot decide. GMC guidance on a free decision; GMC cosmetic-intervention guidance.
• Document a supportive next step: Record the person's own words, the specific unresolved question, any support or referral offered, who will review it, and what decision remains open. A pause or referral is a clinically accountable option, not a punishment for distress or a promise that surgery will follow assessment. GMC cosmetic-intervention guidance; GMC record standard.

Learning objective

Construct a patient-specific option comparison for a fictional adult, including no intervention, with realistic benefit limits, material harms and unknowns that matter to that person's priorities.

In this lesson

• Start with reasonable choices, including no procedure: Frame the options around the question the patient is trying to answer: no intervention, time to reconsider, non-surgical measures where appropriate, further assessment or referral, and any surgery that is within the clinician's scope. Do not make an intervention the default simply because a consultation was booked. GMC decision dialogue; NICE shared-decision guideline.
• Relate possible benefit to the patient's goal: Separate a proposed change in anatomy or function from wider hopes about work, relationships or self-confidence. Explain what an option might and might not achieve in this individual case without promising an appearance, psychological benefit, symptom resolution or long-term durability. GMC cosmetic-intervention guidance; RCS cosmetic-surgery standards.
• Explain material harms and burdens: Select risks that are significant for the procedure and those this patient would particularly care about, such as scars, asymmetry, altered sensation, recovery burden or further treatment. Also disclose a serious harm even if its likelihood is low. Discuss anesthesia and facility questions with the responsible team. For privately funded cosmetic care, explain total charges, what is included, possible follow-up or revision costs, and financial consequences of postponing or withdrawing; a generic list or signed form does not show understanding. GMC decision dialogue; GMC cosmetic-intervention guidance; RCS consultation guide.
• State uncertainty honestly: When reliable and applicable numerical estimates exist, communicate risk in absolute natural frequencies with a clear denominator and timeframe, using the same denominator to compare options where possible. If estimates for the relevant person and intervention are unavailable, say so rather than inventing a percentage. Explain what further evidence could narrow uncertainty and how the patient may revisit the choice. NICE shared-decision guideline; GMC decision dialogue.

Learning objective

Produce a fictional elective-consultation decision record that documents the patient-specific options, material risk, uncertainty, questions, understanding and voluntary choice or deferral, while identifying who remains responsible for any later formal consent process.

In this lesson

• Make consent a continuing dialogue: Invite the patient's questions, explore what matters to them, check their understanding in a non-testing way, and allow time to reflect or change direction. For cosmetic intervention, the practitioner who will carry out the procedure retains responsibilities for the decision dialogue under the cited UK guidance; actual local law and scope govern practice elsewhere. Revisit a decision if material information or preferences change before treatment. GMC cosmetic-intervention guidance; GMC guidance on reviewing decisions.
• Check what the person understood: Ask the patient to describe in their own words the likely limits, most relevant trade-offs and available alternatives, and correct misunderstandings without steering them toward an intervention. Offer interpreters or other communication support where needed; a rehearsed phrase or a signature is not a substitute for a meaningful exchange. NICE shared-decision guideline; GMC decision dialogue.
• Keep the decision open when information is missing: Record whether the patient chooses further assessment, asks for more time, declines treatment or wishes to continue a qualified planning process. If suitability, risk information, capacity or voluntariness remains unresolved, document the reason to defer and the person who will review it rather than treating an initial consultation as permission to operate. GMC cosmetic-intervention guidance; RCS cosmetic-surgery standards.
• Write a useful decision record: Capture the patient's goal and priorities, options including no intervention, patient-relevant benefits and harms, uncertainty, questions answered, understanding checked, voluntary preference, remaining conditions and follow-up owner. A signed form may be part of a later process, but the record should show the conversation and any decision to postpone or decline. GMC guidance on recording decisions; GMC record standard.

Learning objective

Given a fictional consultation with language, access and accompanying-person complexities, design four justified communication adjustments, identify the patient's own preference, and state whether an elective decision can be made or should be deferred.

In this lesson

• Arrange language and access support before a consequential decision: Ask the person which language, format and accessibility adjustments would help them discuss the particular decision, rather than inferring their needs from appearance or a companion's answers. Arrange an interpreter or translation service where needed, offer suitable written, visual or audio information, and allow additional time under GMC decision-making guidance and NICE shared-decision recommendations; local language-access policy governs delivery.
• Include supporters without losing the patient's voice: Ask whom the patient wants present, what role that person should play, and whether the patient would value a private part of the conversation. Address questions to the patient and document their own priorities, while respecting confidentiality and seeking appropriate support if a companion appears to dominate; the GMC consent guidance and NICE guideline support patient-chosen involvement rather than automatic proxy decision-making.
• Reconcile complex information across formats and visits: A remote follow-up, an interpreter-mediated discussion or conflicting information from different clinicians can leave a material question unresolved even after a basic understanding check. Identify exactly which option, risk or expectation is still unclear, provide a consistent accessible summary, and arrange another discussion before a decision if necessary, following NICE's before-and-after discussion recommendations and the GMC's communication standard.
• Support decision-making without diagnosing incapacity: Start from the presumption that an adult can decide and address remediable barriers such as pain, distress, hearing difficulty, unfamiliar terminology or lack of interpretation. If uncertainty about this specific decision persists after proportionate support, pause the elective pathway and seek qualified assessment under local law; neither disability, limited English nor a choice the clinician disagrees with establishes incapacity, as reflected in GMC good medical practice and GMC consent guidance.

Learning objective

From a fictional elective consultation, produce an auditable note and a separate clinical-image decision that identify the purpose, permission or other authority, storage route, and any secondary-use boundary.

In this lesson

• Record the reasoning and the decision state: Write a dated, attributable note that separates the patient's stated goals and reported history from examination findings, unresolved questions, options, material concerns, and the current decision or choice to take no action. Record agreed actions and their owners without treating a signed form as a substitute for dialogue, consistent with GMC recording-decisions guidance and its good medical practice record standard.
• Decide whether a clinical photograph is needed: Explain what a photograph would add to this person's assessment or follow-up, what it would show, and whether a non-image note is sufficient if the person declines. For ordinary clinical photographs, obtain appropriate permission or other valid authority without pressure and record the purpose and discussion; GMC recording principles and its care-recording section distinguish these images from certain recordings for which separate consent is not required.
• Keep images and notes inside approved record pathways: A photograph made for care forms part of the medical record and needs the same disciplined security, access and disclosure decisions as written notes. Use the service's approved capture, transfer and storage route, identify who may access it for direct care, and follow local retention and privacy rules rather than assuming a personal device or informal message is acceptable; see GMC care-recording guidance and GMC confidentiality guidance.
• Separate care from teaching, marketing and other secondary uses: Permission for a clinical baseline image does not itself authorize a website, social-media, teaching or research use; assess each new purpose under local law and obtain additional consent or other valid authority where required. Even a cropped or coded image can remain identifiable through features or context, so check identifiability and the proposed disclosure against GMC recording principles and its care-recording section.

Learning objective

Build a conditional next-step plan for a fictional consultation that names two unresolved decision gates, a suitable referral or advice request, the recipient's required information, and a named owner for each action.

In this lesson

• Make the next step conditional on missing information: Separate what was decided today from what remains open, such as a missing health record, further examination, another specialty's opinion or more time to consider no intervention. State which finding would prompt re-discussion, deferral or referral, who will obtain it, and who will tell the patient the result, in line with NICE shared-decision recommendations and GMC recording-decisions guidance.
• Refer for a defined question within the recipient's scope: A referral should say whether the colleague is asked for diagnostic clarification, assessment of a health condition, psychological support or possible transfer of care, rather than imply that surgery has been approved. Give the patient the reason and expected next step, and send the recipient the relevant history and specific question under GMC delegation-and-referral guidance and GMC cosmetic guidance.
• Assign roles without transferring a consent duty by default: Document who coordinates records, who discusses specialist findings with the patient, and who owns any later intervention decision; a team member's preparation does not by itself make them the treating decision-maker. In the UK cosmetic-intervention context, the professional performing or supervising the intervention retains the relevant consent responsibility under GMC cosmetic guidance; actual roles and scope must follow the local jurisdiction and service.
• Close the handoff loop and share only relevant information: Specify the recipient, what was sent, the response expected, a review owner, and a route for the patient to ask questions while responsibility changes. Check receipt or acceptance when practical and explain the proposed information sharing to the patient, handling objections and disclosures under GMC referral guidance, GMC continuity standards and GMC confidentiality guidance.

Learning objective

Write an after-consultation plan for a fictional adult that states the present decision, a review trigger, a route for changing their mind, a named contact, and an escalation path for a new concerning symptom without remote diagnosis.

In this lesson

• Keep the decision open to reconsideration: Restate whether the person chose to proceed to further assessment, wait, seek another view or take no action, without treating an earlier preference as permanent consent. Invite reconsideration when goals, health information or the balance of options changes, and allow reflection without pressure, as described in NICE shared-decision recommendations and GMC cosmetic guidance.
• Give an accessible after-visit summary and contact route: Provide the agreed decision, unresolved questions, intended review and responsible service in a format the patient can use, checking that the route for further questions is clear. NICE recommends a clear summary, preferred-format resources and contact details after the discussion; the exact review interval and delivery channel should reflect the case and local service.
• Safety-net new concerns while assessment remains open: Explain what kinds of change should prompt the patient to contact the responsible team, such as a new or worsening symptom or a substantial change in priorities, and how to reach local urgent care if the concern cannot wait. Record who will assess an incoming message and avoid diagnosing, prescribing or reassuring from a brief photograph or text alone; GMC referral guidance supports clear responsibility and contact information, while NICE guidance supports later review of decisions.
• Reassess before any later intervention: At review, compare new information with the patient's original goals, re-open material options and risks, and confirm whether the responsible qualified clinician considers intervention appropriate. If an intervention later occurs, that treating service must establish its own monitoring, follow-up and out-of-hours complication contact under applicable local standards; GMC cosmetic guidance illustrates this obligation in its UK cosmetic context, rather than providing a universal postoperative timetable.