How much of what was agreed do people recall?
That study was in heart and kidney clinics, outside aesthetics, but aesthetic plans also start as a conversation. The studies measure how much is recalled and do not explain why, so I have kept to what they measured.
A 2018 study in PLOS ONE (Laws) audio-recorded 189 visits to cardiology and nephrology specialists at one academic centre in the United States, in 2012 and 2013. It involved 101 patients and 19 physicians. The researchers coded 1,319 decisions and recommendations, then phoned patients about seven days later.
Without a prompt, 49% of the decisions were recalled accurately. Another 36% came back only with a prompt. The other 15% were recalled wrongly or not at all.
The second study is older and smaller. In 2003, Fleischman and Garcia gave 85 consecutive patients having Mohs skin cancer surgery information on ten possible complications, spoken and in writing. They recalled 26.5% of them 20 minutes later and 24.4% a week later. The full text is paywalled, so whether recall was tested freely or with prompts is unconfirmed. That matters, because the method changes the number: in the first study, prompting brought back another 36% of decisions.
Neither study was in aesthetics, and both followed patients for days, so a plan that runs for months goes beyond them. Forgetting was common in both. A patient who could not say what was agreed a week later was in ordinary company.
What does forgetting do to a treatment plan?
A plan is a set of decisions made in a consultation and lived out over months. Take a composite, not a real patient. The plan has three parts: something now, something in a month, and a review at month four. By month four they must remember what each part was for, from one conversation.
This is the pattern, in my own words:
"patients sometimes are recommended a program, but only choose 1 or 2 because of reasons like budget or whatever reason they may have, what happens is that they forget that they were supposed to have a whole program, and then now they expect the same results with just 1 or 2 treatment modalities" (Dr Ong Jin Khang)
That is an observation, and I do not offer it as evidence. Choosing part of a plan is a legitimate choice, and the reasons are the patient's to weigh. The difficulty I describe is memory: the plan is forgotten, and the whole plan's result is still expected from the part. What a part can be expected to give is its own question, taken up in choosing part of a treatment plan: what to expect. Nothing here argues for a bigger plan.
What helps, and how much?
Two fixes have been studied: writing it down, and saying it back.
A 2009 systematic review (Watson and McKinstry) covered 34 studies from 1979 to 2007, each with 30 to 318 patients, across nine kinds of intervention. They were too varied to combine into one figure. Written material after the consultation improved recall in 4 of 7 studies and made no difference in 3. Audio recordings helped in 5 of 10, and all five of the positive trials were in cancer care.
Most of the written-material trials covered the risks in surgical consent, a step away from a multi-session plan, so applying the result to an aesthetic plan stretches it. The skin surgery figures above include no comparison without the page, so they cannot show whether the page helped.
In 1995, White studied 50 patients having a lung biopsy. Those asked to recite the risks to the doctor until they got them right recalled them better four hours later than those given the standard statement. The study is small and did not describe how patients were allocated. The review advises asking patients to repeat advice back, though that point rests on this one study.
The evidence for both fixes is modest.
What can you ask for?
At any visit, you can ask for three things.
The plan in writing: each part, what it is for, what it will not do on its own, and when the result should be judged.
A moment to say it back in your own words, so the doctor can correct what you have got wrong.
A copy you keep somewhere you will find it before the next visit.
Before you go, botulinum toxin, hyaluronic acid filler and biostimulators compared sets three treatments side by side. For the diagnosis and the choice of treatment, three questions worth asking any aesthetic doctor is a fair place to start.
In White's study, saying the risks back cost up to five extra minutes.
