Patient Treated Elsewhere Before: The First Consultation

The patient arrives saying "I already had it done elsewhere." The reasons vary: they moved cities, the professional stopped practicing, they were unhappy, they want a second opinion, or they simply prefer you. In every case, the first consultation has an extra task: rebuilding a history you did not witness, without disrespecting the person who wrote it.

Why is the first consultation more delicate?

Because information is missing and emotion is plentiful. The patient may be frustrated, guilty or distrustful. And you may be facing an unknown product, accumulated volume or a result the patient blames on the colleague. Any word from you carries disproportionate weight.

• Incomplete history. The patient doesn't remember the product or the volume.
• Frustration with the result. They arrive wanting a correction.
• Expectation that you will "fix it". And that you will criticize the previous provider.
• Clinical risk. An unknown product or a short interval calls for more caution.

What should you ask?

Ask open, objective questions and note them in the medical history. The more precise the information, the safer the approach.

Which records should you request?

The patient has a right to their record and can ask the previous professional for a copy. Guide them to request it, without exposing or accusing anyone. If they already have the product card, an invoice or before and after photos, ask permission to keep a copy in your patient record.

What should you never say about the colleague?

The temptation to criticize is strong, especially when the result looks poor. Resist it. First, you don't know what the patient asked for, what the professional assessed or what conditions existed. Second, criticism creates a conflict that can come back to you. Third, the patient reads any negative comment as an attempt to win the case.

What if there is a sign of complication?

Put the patient first. If there is pain, redness, hardening, a nodule, change in skin color or any sign of complication, assess and treat or refer, according to your qualifications. When the material is hyaluronic acid, hyaluronidase must be available. If the product is unknown, take extra care and explain this to the patient.

How do you carry out the plan?

Even with a history, the first consultation is usually for assessment, not treatment. Examine, photograph with permission, listen to the concern and propose a gradual plan. If the patient wants to be treated the same day, assess carefully. In many cases it is better to wait and reassess.

How do you record it?

In the patient record, note the reported history as an account, what was observed, what was advised and what was agreed. Keep the informed consent aligned with what will actually be done. See also the patient who has had too much done and aligning expectations when switching professionals.

In short, the first consultation with someone treated elsewhere is an investigative consultation. Ask, record, don't judge, and only then decide.

How do you handle the patient's dissatisfaction with the other professional?

Many patients arrive wanting to vent. Listen, without agreeing or disagreeing. You hear only one version of the story, and the venting helps the patient feel welcomed. When they ask your opinion about what was done, answer about the face today and what you propose, not about the colleague's conduct.

If the patient asks whether to sue or file a complaint, clarify that this is not a matter for the consultation and suggest they seek the proper channel, such as the professional board or legal advice. Your role is to care for the patient, not to arbitrate the case. Staying out of that ground also protects you from being cited in other people's disputes.

Finally, if the patient wants to continue follow-up with you, explain that the plan from now on is yours, and that you take responsibility for what you do, not for what was done before. That clarity avoids confused expectations about who answers for what.