Is your provider keeping current?

A client asked me last year, politely and a little nervously, how I keep up. She apologized for asking, which she should not have. It is one of the better questions anybody has put to me, and I have been thinking about how to answer it properly ever since.

Why it matters that this field moves

The way I work now is not the way I was taught. Guidance on where things are placed, at what depth, in what quantity, and what to do the moment something does not look the way it should, keeps being revised as more people do the work and publish what they saw. Products change. The anatomy has not changed, but our picture of it has become a good deal more detailed, and some of the older assumptions have not held up.

None of that is a flaw in the field. That is the field working the way any clinical field is supposed to. But it does mean that a practice which stopped learning eight years ago is running on eight-year-old information, and the awkward part is that neither the practice nor the client will necessarily notice. Things can look fine and be based on guidance that has since been rewritten.

How I keep current

Several ways, none of them glamorous. I fly out to a national aesthetics conference most years, which is expensive and takes me out of the building, and I go anyway because the hallway conversations are worth the fare on their own. I take hands-on courses when a technique is worth learning properly rather than reading about, because there are things you cannot learn from a diagram.

I read, which is the least interesting part and probably the most useful. I talk to peers, including people who do this differently than I do, and especially the ones who will tell me plainly when they think I am wrong about something.

And I review my own work. That is the part people do not expect. I keep notes on what I did and on what I saw at follow-up, in the file, for me. Over enough appointments the notes start telling you things about your own habits that you would not have noticed from the inside, and some of them are not flattering. That is the point of keeping them.

What you can listen for

You are not going to audit anybody's training record, and you should not have to. There are three things you can hear in a normal conversation.

Somebody who can tell you why, not only what

Ask why a particular approach and not another one. A person who is keeping current will have a reason, will give it in plain language, and will be able to say what the trade-off is. A person who is not will describe what they do without ever getting to why, or will answer with a product name, which is not a reason.

Somebody who mentions changing their mind

This is my favorite sign, because it cannot really be faked. Listen for a sentence in the shape of: I used to do it this way, I do not anymore, and here is what changed. Anybody who has been practicing a decade and has never revised anything either has not been paying attention or is not telling you the truth about it.

Somebody who knows what they will not do

A practice that is genuinely current has a clear list of things it does not offer, and can tell you why each one is off the list. Some of it is training, some of it is equipment, some of it is judgment about what is worth doing at all. A menu with no edges usually means nobody has thought about where the edges belong.

Why you are entitled to ask

People feel rude asking. I understand the instinct, and I would put it aside. You are about to let somebody put a needle in your face, and asking how they stay good at that is not an imposition. It is the ordinary diligence you would apply to almost any other decision of the same size.

From this side of the chair, the question is not an insult either. When somebody asks me how I keep current, I take it as a sign that they are thinking carefully, and careful people are easier to look after well. If you want to ask me in person, there is room for it in a consultation, and there are a few other questions worth bringing along while you are at it.