Client consultation, contraindications and treatment planning
Domain 3 tests the consultation as a clinical safety process, not a conversation. You must gather information, identify contraindications, decide whether they are absolute or relative, plan the treatment, document decisions and refer when needed. ITEC questions often give a client scenario and ask what you would do next.
Consultation structure
- Ensure privacy, establish identity and obtain informed consent.
- Take a medical history: conditions, medications, allergies, pregnancy, surgery, recent treatments, skin disease.
- Explore lifestyle and occupation: sun exposure, smoking, hobbies, occupation-related skin contact.
- Analyse the skin or nails, agree goals, explain the procedure, perform patch tests where required, and give aftercare.
- Record facts, advice, consent and referral in a signed, dated, legible record.
Contraindications
- Absolute: treatment must not proceed - for example active infection, fever, deep vein thrombosis, recent isotretinoin for waxing, or a pacemaker for electrical facial treatments.
- Relative: proceed only with caution, medical advice or an adapted plan - pregnancy, anticoagulants, controlled diabetes, epilepsy, recent surgery, cancer under treatment.
- Local versus general: a local lesion affects one area; a systemic condition affects the whole treatment decision.
- Medications matter: retinoids, anticoagulants, steroids, photosensitising drugs and isotretinoin change skin fragility and healing.
Treatment planning
- State products, method, frequency, home care, review date and any referral.
- Patch test colour products, adhesives and tint 24–48 hours before first use, and record the result.
- Re-consult at each visit rather than relying on an old record.
Worked example
A client on warfarin asks for a leg wax. Warfarin is a relative contraindication because of bruising and skin lifting. The therapist checks that the INR is stable, seeks medical advice if unsure, performs a patch test, uses warm rather than hot wax, avoids varicose areas and documents the decision. If the client cannot confirm medical stability, the therapist declines and explains why.
Traps that cost marks
- Accepting 'I'm fine' as a full medical history.
- Treating a relative contraindication without medical advice or adaptation.
- Forgetting to re-consult on a return visit.
- Recording opinions rather than facts and advice given.
- Assuming pregnancy is always an absolute contraindication.