Guidance on supporting patients with a visible difference

People with a visible difference may experience anxiety and distress. Here are some things you can do as a healthcare professional to provide the best support.

People with a visible difference or disfigurement can experience anxiety and distress due to their condition. As healthcare professionals there are many things you can do to help address your patients’ concerns.

It’s important to recognise the myths that surround visible difference and disfigurement. This will help you properly understand the affect a visible difference can have on the emotional wellbeing of your patient. It is also vital to treat the whole person and not just their condition. You can do this by using appropriate language and asking them broader questions instead of focusing on their physical condition.

On this page, we explore in more detail what you can do as a healthcare professional when supporting patients living with a visible difference or disfigurement.

Myth busting

When supporting patients, it is important to cut through myths about visible difference, which often act as a barrier to good treatment. Here, we bust some of the most common myths:

1. If patients can cover up their visible difference, they won’t have issues with wellbeing or mental health

A visible difference on any part of the body can cause concerns for people and prevent them from participating in sport or being intimate with another person. (Clarke 2012)

2. Medical intervention is the only solution to appearance concerns

Research shows psychosocial interventions can be effective in improving quality of life and appearance anxiety. (Di Mattei et al 2015, Norman and Moss 2015)

3. Patients who have appearance concerns must be vain. They should be grateful for receiving successful medical treatment

Patients are often grateful for successful medical treatment but recovery is more than the medical outcome. We know that the way we look can affect ways we communicate and relate to others, and so it’s understandable that physical changes after treatment can also have psychological and social effects. (Griffiths et al 2019)

4. Only psychologists can help patients with their appearance concerns

While some individuals with more marked distress will need access from specialist psychological support, it has been shown that other healthcare professionals like nurses can make significant difference to many patients’ wellbeing. (Clarke & Cooper 2001)

5. A patient’s levels of distress and ability to cope is based on how severe their visible difference is

“Perceived” severity is a better predictor of adjustment than “objective” severity. (Kleve & Robinson 1999)

6. Asking a patient about their appearance concerns will make things worse

Giving patients the opportunity to talk about how they’re feeling can help them feel understood. (Konradsen et al 2012)

7. If a patient has appearance concerns, they will tell me

Patients are often concerned about taking up health professionals’ time and can feel uncomfortable talking about appearance concerns unless they’re invited to. (Williamson & Rumsey, 2017)

We would like to thank Dr Heidi Williamson, Fabio Zucchelli and Dr Olivia Donnelly for helping with this myth-busting section.

Assumptions by NHS employees

experienced by people with a visible difference

  • 77%

    Experienced assumptions based on their appearance

  • 67%

    Experienced assumptions about their emotional health

Language matters

The language you use can have a big impact on your relationship with your patient and your ability to support them:

  • It’s important to use neutral language when discussing your patient’s condition. For example, rather than saying they have a “funny” or “odd-looking” lump, say “swollen”, “soft” or “hard” lump. Words such as “ugly”, “abnormal” or “deformed” can stick with a patient and cause them distress. Use neutral, descriptive, factual words rather than emotive or judgemental words.
  • It’s important to keep it simple. Patient may be anxious or embarrassed so make sure they hear what you say and understand it.
  • Be open and honest about a prognosis or likelihood of improvement.
  • Listen to the words your patients use and try to reflect these back to them. Help them if they’re struggling to find appropriate words.
  • Be consistent with the words you use and be comfortable with them.
  • Prepare your patients for changes or what might happen in the future in relation to the condition.

Starting a conversation about wellbeing

Be aware that no matter how many times someone talks about their condition, it can still be an emotional moment for them. Do not make assumptions about the experience of having a visible difference or disfigurement, or how someone feels about this – each person’s situation is individual to them.

When starting a conversation about wellbeing, consider the following things:

  • Look out for potential signs of distress. For example, the patient may say, “I don’t go out anymore” or, “I’ve had to stop work” or they may come in with their skin covered.
  • Don’t just ask about the condition, mark or scar. Ask the question, “How are you?”
  • Reduce shame by using normalising language. For example, “People coping with skin conditions can often feel more anxious and self-conscious. Is that the case for you too?” or, “It’s understandable that…”
  • Try to find out if the individual’s skin condition prevents them from engaging with what matters to them.

If you’d like to know more about training, the Centre for Appearance Research has developed a training programme for non-specialist healthcare professional.

How Changing Faces can support your patients

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Advice & guidance

This section is full of self-help and guidance for adults and young people living with a visible difference, as well as for parents of children who look different.