We thank you for sending in your questions in the comments section during the 'Dealing with errors and the plight of perfectionism' webinar. In order to address all your unedited questions, the following is a summary we have split into a selection of general categories:
1. Any suggestions for good coaching book/ mainly dealing with how to prevent or treat doctor burnouts?
- The resilience factor by Karen Reivich, PhD & Andrew Shatté , PhD.
- Developing Resilience by Michael Neenan
2. I am not clear with confirmatory bias. Please explain in simple. Thank you.
This is our tendency to see what we want to see of expect to see. We tend to search for information that is confirmatory, we weight this evidence more heavily than disconfirming information, and we interpret ambiguous information as consistent with what we already believe or want.
3. Are the growth and set mindset a bit or nature vs nurture? To some extent some people just "got it" or don’t, right?
When it comes to fixed mindset it is common to think that is genetic; we either have it or we don’t. But we know from research is that the adult brain is malleable and there are also epigenetic factors at play. Thus, you may have inherited a gene, but it may not get triggered until you experience certain experiences in the environment and we also kno
w that genetics it is not synonymous with biology. When you practice and work on something the part of your brain that controls that function gets more neurons in it, more neural connections. You’re changing your biology. So, this is much more complex than we ever realised.
4. What are your tips for junior doctors who are trying to navigate a unbiased decisions but within the hierarchies that exist in medicine?
Do you mean if you see someone senior making a biased or incorrect decision? It’s important to speak up. You can do this respectfully by posing a question – “I was wondering if it might be possible that this patient is suffering from X”
5. The operational governance often clashes with clinical governance structure when it comes to risk management. How do you think we navigate through it? especially since a clinical mindset has different priorities than operational managers.
This is a difficult issue. It is the job of the organisation’s top leadership to make sure that operational and clinical governance align but unfortunately this often does not happen. For the clinician caught in this, talking with senior clinical colleagues, those in top leadership positions, can be helpful. Point out the gaps that you see, and how these gaps are interfering with good clinical practice, and then offer to help, perhaps by leading a project to close one of the gaps.
Thank you for attending our webinar Understand, respond and reflect – the art of active listening . We appreciate your engagement throughout the presentation and present to you below the answers to your questions received before and during the webinar.
1. I think I find it difficult when a patient has many doctors that talk to one another or don't care about what each other wants/needs.
Insufficient cooperation and coordination, together with poor communication practices, can pose significant barriers not only to achieving effective patient transitions and engagement while receiving primary care, but can also cause medical errors and unintentional harm to patients.
Efficient communication depends upon the healthcare practitioner taking practical steps to ensure they have really heard and recorded the patient’s needs so as to provide personalised and timely care.
You can actively decrease the risk of patient harm and communication errors, by adopting active listening skills and ensuring you maintain adequate health records.
To reduce your clinico-legal risk, MIPS advises you to:
- Implement active listening behaviours into your practice, to ensure your communication approach is clear and intentional. This includes:
- Avoiding unnecessary distractions.
- Looking directly at the person with whom you are engaged in conversation and asking questions to confirm your understanding:
- “Can you give me an example of . . .”
- “How frequently does this happen?”
- Rephrase what you understood and ask the patient to confirm what you have just said.
- “What I hear you saying is . . .”
- Let the patient finish speaking and then clarify their meaning before you formulate your response.
- Ask open ended questions and avoid making conclusions too quickly.
- Ensure the content of patient health records is accurate and up to date, including any lifestyle risk factors. Health records should include:
- How long a patient has been attending the practice.
- The management planning, preventive health interventions and referrals made for a patient.
- Evidence of care provided by other healthcare professionals for long-term patients.
- Timely review and action on tests and results:
- How long a patient has been attending the practice.
- The management planning, preventive health interventions and referrals made for a patient.
- Evidence of care provided by other healthcare professionals for long-term patients.
- Notify patients when a practitioner leaves your practice.
- Look back and review previous patient entries and test results.
- A patient sitting in front of you, even in a one-off consultation to get a prescription – is your patient and you have a duty of care.
- Failure to adequately do a handover to another practitioner or institution potentially gives rise to an adverse outcome.
2. It is critical that senior clinicians lead by example. if we practice with empathy, our junior colleagues learn from us and do the same.
Empathy has been recognised as a significant skill in healthcare. It is crucial for health practitioners to accurately assess their patients’ feelings, opinions and experiences in order to evaluate their real needs and act accordingly, offering patient-centred care. Reaching this goal makes the development of empathetic skills necessary. Empathetic modelling from senior clinicians, professors and healthcare leaders enhances junior practitioners’ empathy including mental flexibility, regulation of emotional self, and perspective taking practices.
3.Can you comment on the use of directing follow-up time to patients?
Follow-up is the act of contacting a patient or caregiver at a later, specified date to check on the patient's progress since his or her last appointment. Timely follow-ups can help you to identify misunderstandings and answer questions, make further assessments or adjust treatments. In addition, follow-up promotes good therapeutic relationships between you and your patients.
- Decide on the reasons for follow-up.
- Monitor health status and treatment progress.
- Re-state treatment instructions and action plans.
- Confirm medicine regimens.
- Book appointments.
- Verify follow-through on allied health referrals.
- Communicate laboratory results.
- Identify who will follow up with patients.
- Who follows up depends on the purpose of the communication (primary care clinician, nurse, other practice staff)
- Choose the ways your practice will follow up.
- Secure email
- Postal mail
- Automated calling system
- Track your follow-up
- Record all follow-ups in the patient’s health records
The materials provided are for educational purposes only. Whilst all reasonable care has been taken in preparing these materials, including the accuracy of the information supplied, MIPS does not accept any liability whatsoever arising out of the use or reliance of the information provided.
If you require further clarification contact MIPS on 1800 061 113 or via email@example.com
We thank you for sending in your questions in the comments section during the 'Self-esteem and Body Image - A growing social and community issue' webinar. In order to address all your unedited questions, the following is a summary we have split into a selection of general categories:
- Cosmetic surgery is higher in higher socio economic population. So is it a problem of riches?
No. People of all income and social levels are seeking surgery or less invasive procedures. This is now the third most common reason to get a bank loan (after a mortgage and a car……)
- As a practitioner, how do we access the PAT to be able to incorporate in our practice?Access agreements are under discussion.
This will either be via an organisation (such as MIPS), or as an individual. We hope to have this in place by the beginning of April 2023.The difficulty is that there is no ACM accredited college for aesthetic medicine currently, yet many of us would benefit from being part of the pilot. I would very much like to be kept updated in the progress of rolloutThank you. We will let you have details of how to use the PAT as soon as they are finalised.
- Do you think religion can play a role? Preaching created from God image therefore not to change
For those with strong religious beliefs this might be helpful – but an understanding that appearances have a less strong role in happiness, social & occupational success etc is also necessary to reduce levels of dissatisfaction & distress.
- What about people who are ugly and feel fine?
This is to be encouraged! These people are usually more psychologically resilient and have higher levels of wellbeing/happiness.
- What are the characteristics of the 20-33% of people who are not bothered?
This group have higher self-esteem, a sense of self-worth that is built on a variety of attributes other than appearance (for example, sense of humour; skill in a sport or hobby; social skills; success at work, etc), a lower reliance on the opinions of others for their sense of self-worth, and a pre-disposition to be ‘half-full’ (optimistic), rather than ‘half-empty’ (pessimistic) in their view of the world.
- Doesn't the gender surgery fall into this topic as well? ("I'd like to be someone else")
There are some similarities……the two areas can certainly share unrealistic expectations about the likely psychological & social gains after treatment…but more research is needed in both fields.
- To what extent does this pertain to Gender Dysphoria and those seeking Gender reassignment surgery?
See answer to previous question….
- Does body art (tatoos) fall into the same category as aesthetic medical or dental procedures as an indicator of self esteem and body image ?
Body art is often a statement of identity/individualism. Aesthetic medical/dental procedures are more often about achieving a perceived ‘norm’ of appearance (ie to look like other ‘desirable’ people.
- Working in forensic medicine - I am concerned about children and young people, even adults who are watching pornography and developing ideas about perfect genitals and seeking surgical changes. Many vulnerabilities and exposure to non-medical, backyard solutions etc any thoughts on this area?
Yes – absolutely – I share this concern. Access to pornography (via smart phones) etc, gives people very unrealistic ideas about norms of appearance of genitalia and other body parts (e.g. labia; breasts). Instead of understanding the enormous variety (& lack of symmetry) that exists in the broader population, viewers come to think they need a particular type to be acceptable.
- How do you differentiate between those patients seeking cosmetic surgery who have issues with self-esteem and psychological vulnerabilities and their suitability towards said procedure?
The Patient Assessment Tool (PAT) is designed as a first step in identifying different types of psychological vulnerability (including low self-esteem), highlighting potential risks for sub-optimal outcomes following aesthetic treatment and suggesting appropriate ways of managing these risks. In some areas of vulnerability, it is suggested that a fuller psychological assessment would be beneficial.
- A lot of female sales reps and those in the media who are getting older often have minor cosmetic procedures as find it helps their employability. What can be done about this as they are still judged by their appearance
Yes, there is more pressure for people in some professions. An education programme for employers and employees is needed to bust the myths about appearance on both sides of the equation and also to persuade employers that the skill/talent of the employees is going to be more closely related to their productivity than their appearance
The law differs between States and Territories but most prohibit recording of consultations without the specific consent of the patient.
Ensure you contact MIPS for 27-hour Support and Advice on 1800 061 113 in the event of an adverse event or where there is a threat of a claim or notification made against you.
Author: Dr Owen Bradfield
In a recent webinar, MIPS Chief Medical Officer, Dr Owen Bradfield addressed the most asked questions by our members regarding voluntary assisted dying (VAD).
While our panel of experts including Prof Ben White from the Australian Centre for Health Law Research, Melanie van Diemen, a care navigator at Peter MacCallum Cancer Centre, and Dr Andrew Bendrups from Royal Melbourne Hospital provided valuable insights during the webinar, there were additional member questions that could not be covered due to time limitations.
As a result, we have compiled answers to address the outstanding questions in three main categories: legal, clinical and employment.
Is Voluntary Assisted Dying (VAD) available for people with mental illness?
People with mental illness have the same rights as others in the community to access to VAD. However, having a mental illness alone is does not make a person eligible to access VAD. Therefore, people with a mental illness must also have an advanced disease or terminal condition likely to cause death within six months (or 12 months for neuro-degenerative diseases in Victoria). It is also a requirement that an individual must be capable of consenting to VAD. It is therefore important to ensure that an individual living with mental illness who wants to access VAD is capable of consenting to VAD. The capacity of everyone wishing to access VAD must be carefully assessed.
Can I raise VAD as part of a general advance care planning discussion?
This depends on the state in which your patient resides. Health practitioners may not raise VAD in Victoria and SA, even if it is part of advance care planning. However, in other states, medical practitioners can raise VAD as part of a discussion about other palliative care or end-of-life options. If it is not raised as part of a wider discussion about other care options, then it may amount to a breach of the legislation across all the states. It is permitted an Advance Care Directive cannot contain instructions for illegal activities, such as euthanasia, assisted suicide or assisted dying.
Can I conscientiously object to participating in VAD?
A conscientious objection is when a person declines to participate in a lawful process or procedure due to their personal beliefs, values, or moral concerns. In Victoria, SA and NSW, you are not under an obligation to be involved in any aspect of VAD if you conscientiously object. However, in Qld, WA and Tasmania, you must provide basic information or refer a patient to another practitioner, even if you conscientiously object.
As a general rule, an employee must follow any reasonable or lawful instruction given to them by their employer. However, the law allows for people to be conscientious objectors and while it is a lawful direction if you are a conscientious objector, then you can argue it wasn't a reasonable direction and you don't have to comply with it.
Can a guardian, family member or medical treatment decision-maker consent to VAD on behalf of an individual?
While guardians, family members and carers can support patients, only the patient can consent to VAD and there is no scope for a substitute decision-maker to decide. This is an important part of making sure the person’s decision is voluntary and not made on behalf of a carer, family, friend or other support person.
Can I assess or advise a patient about VAD using telehealth?
MIPS strongly recommends that members do NOT use telehealth to assess a patient’s eligibility for VAD or to discuss VAD with patients. This is because Commonwealth laws still make it an offence to insight suicide through the use of a carriage device. An excellent summary of these issues can be found here.
Do all patients have to receive a psychological or psychiatric evaluation prior to being able to access VAD?
No, but patients must be assessed by at least two medical practitioners to determine eligibility. The patient seeking VAD must be given information such as prognosis, treatment options, palliative care. If both practitioners assess the patient as being eligible, then the patient is able to make a written request called a Written Declaration. The third and final request is the administration - whether they want to self-administer or practitioner-administer. One of these medical practitioners may request a patient be assessed by a psychologist or psychiatrist to determine the patient’s capacity or to ensure that the patient’s judgment is not being clouded by a mental health condition, such as depression.
What counselling or support is available to doctors who choose to be involved?
The Voluntary Assisted Dying Care Navigator Service is available in each jurisdiction where VAD is currently lawful. Part of their important role is also a contact point for health practitioners seeking information about or assistance with VAD. Navigators can work closely with medical practitioners and healthcare teams to support the needs of the person.
The service may provide:
- general information about VAD
- individualised support and information, either in a face-to-face consultation or by post
- assistance in connecting people with appropriate medical practitioners and health services
- information about or access to VAD support packages
- holistic advice and follow-up on appropriate end-of-life care services
- education to health services and health practitioners.
How do we complete a death certificate if a patient dies after taking a VAD substance?
If a patient dies as a result of taking a VAD substance, the cause of death to be recorded on their death certificate should be the disease, illness or medical condition that was the basis for the person accessing VAD. In most jurisdictions, there is the option of ticking a box to confirm that the patient died following use of a VAD substance. That information will not be publicly available.
How do I become a VAD practitioner?
VAD practitioners need to have minimum qualifications and experience. Each state law also requires practitioners to do mandatory training before they can accept a request from a patient to assess their eligibility for VAD.
Visit your state’s health department website to find out more:
What should I do if I believe that a patient’s family is coercing them into accessing VAD?
It is an offense across all states to coerce or induce a person to access VAD. A patient's family cannot make decisions on behalf of the patient.
A decision to access (or refuse access to) VAD must be voluntary, and therefore free of coercion. If coercion is identified, it is important to discuss this with the patient and, to the extent possible, ascertain their thoughts and views of the patient without their family present if the patient allows this.
What happens if my patient cognitively declines after being approved for VAD?
A patient must be capable at all stages of the VAD process, including at the end of the process when a patient requests a VAD prescription. If a patient loses capacity at any time before a prescription for self-administration has been completed, then the patient is no longer eligible to access VAD.
Do we need family consent?
No, the decision to access VAD must be the patient’s decision. If you are assessing a patient’s eligibility for VAD, you must also ensure that their decision to access VAD is free from coercion, including coercion from family and carers. However, patients may request that their family or carers be involved in their decision-making.
Can my faith-based employer/health service prevent me from discussing VAD with a patient on religious grounds?
As stated above, in Victoria, SA and NSW, you are not under an obligation to be involved in any aspect of VAD if you conscientiously object. However, in Qld, WA and Tasmania, you must provide basic information or refer a patient to another practitioner, even if you conscientiously object.
The hospital cannot direct you to breach any legislative requirements. A faith-based hospital may lawfully decide not to support VAD and may make public statements that make this clear. However, their staff must abide by the legislative requirements in each jurisdiction. Therefore, in Qld, WA and Tasmania, staff must still provide basic information or refer a patient to another practitioner, even if the hospital does not support VAD.
If the doctor goes beyond the provision of information, such as by assessing patients at the hospital, then the hospital may be able to take steps to prevent you from doing that.
- MIPS on-demand webinar: Voluntary assisted dying
- VAD Care Navigator Service - (03) 8559 5823 or firstname.lastname@example.org
- Gippsland: email@example.com
- Grampians: firstname.lastname@example.org
- Hume: VADCareNavigator@nhw.org.au
- Loddon Mallee: email@example.com
- Barwon: VADEnquiries@barwonhealth.org.au
- QUT End of Life Law in Australia - https://end-of-life.qut.edu.au/assisteddying
- Victorian VAD training - https://vicvadlearninghub.com/
If a member has concerns about their involvement in VAD and require medico-legal assistance, contact us on 1800 061 113.
During a recent webinar on Risk Management for Oral Health Practitioners, we had the pleasure of hosting guest presenter Sinead Wright, an experienced Oral Health Therapist and clinical educator. Her valuable insights on scope of practice and informed consent proved to be highly informative.
Due to time constraints, some member questions couldn't be addressed during the live session. Therefore, we have compiled the following information that covers key themes relating to those outstanding questions.
If you require assistance or have questions about a specific circumstance, please don't hesitate to reach out to MIPS advisors at 1800 061 113.
Scope of Practice
Medicare provider numbers
Since 1 July 2022, dental hygienists, dental therapists, and oral health therapists can access Medicare provider numbers to directly claim for services under the Child Dental Benefits Schedule (CDBS), raising the question of OHTs working independently without dentists.
Practicing under your provider number is possible under Medicare, but the situation may differ with health funds due to their individual business rules. It is advisable for OHTs to verify with the relevant health funds in advance if their provider number and item number are accepted for claims. Failing to do so could lead to complications for both the practitioner and the patient.
Read more in the Australian Government Department of Health factsheet which explains how to apply for a Medicare provider number, the services that can be claimed, and where to find more information.
Business legalities for independent practice
When working as an independent practitioner, OHTs must consider the business legalities associated with performing certain procedures, such as taking radiographs and administering local anaesthesia (L.A.). It is crucial for OHTs to assess their scope of practice and ensure they possess the necessary qualifications, skills, and knowledge for the procedures they undertake. This self-assessment is vital as it enables them to substantiate their capabilities to regulators or in legal proceedings if ever required.
Additionally, OHTs operating their own practice or premises should consider whether they might benefit from obtaining public liability insurance. This covers liability for public liability incidents – for example, where a patient is injured from a hazard that you have negligently created in the workplace. More information can be obtained from a general insurers or brokers. This type of insurance package typically includes coverage for fire, contents, equipment, and public liability.
If you haven't practised a skill recently, you may wonder how to regain your competence. Ensuring you have the fundamental qualifications, skills, and knowledge is essential and should be kept up to date. Observing a colleague's performance or enrolling in a relevant course are both valuable options to consider. By doing so, you can refresh your understanding and proficiency. Ultimately, confidence in your abilities is vital, as it enables you to substantiate your appropriate scope of practice if ever challenged.
When it comes to advising on informed consent, MIPS relies on the Dental Board's code of conduct as a valuable resource. As your conduct will be evaluated against this code, incorporating its guidelines in your decision-making process will help uphold ethical standards and foster the highest level of care for your patients.
Guidelines for best practice
Informed consent is a crucial aspect of healthcare, representing a person's voluntary decision made with a comprehensive understanding of the associated benefits and risks. Practitioners seeking guidance on providing patients with the necessary information can refer to the National Health and Medical Research Council (NHMRC) publication titled "General Guidelines for Medical Practitioners in Providing Information to Patients". These guidelines cover essential areas such as detailing proposed management or approaches, especially where risks of harm are more substantial and offering advice on effective information presentation.
Adhering to good practice involves several key principles:
Communication with Clarity: Practitioners should present information in a manner that patients can easily comprehend before seeking their consent.
Informed Consent: Prior to conducting examinations, investigations, treatments, or involving patients in research or teaching, obtaining informed consent or valid authority is essential. However, in emergencies, this may not always be possible.
Transparent Cost Communication: When referring patients for further investigations or treatments, practitioners should inform them about the possibility of additional costs, allowing patients to seek clarification before proceeding.
Consent for Impaired Patients: When dealing with patients whose capacity to give consent may be limited or impaired, obtaining consent from individuals with legal authority to act on their behalf is crucial. Practitioners should also attempt to secure the patient's consent as much as practically possible.
Documenting Consent: Proper documentation of consent is vital, especially for procedures that carry a risk of serious injury or death. Consideration should be given to obtaining written consent in such cases.
Fees and financial consent
Establishing clear and transparent communication with patients is of paramount importance, and a crucial aspect of this communication is the disclosure of fees and obtaining financial consent from patients or clients. Prior to providing any health service, it is imperative to ensure that patients or clients are fully informed about all the fees and charges associated with their course of treatment, including out-of-pocket expenses where Medicare is billed.
Engaging in a professional discussion about fees is equally essential, as it ensures that patients understand the costs of all required services and enables a mutual agreement on the level of treatment to be provided. By adhering to these principles, healthcare practitioners can foster trust and facilitate a patient-centered and financially transparent healthcare experience.
Children and young people
Caring for children and young people entails additional responsibilities for practitioners, and adhering to good practice involves the following key principles:
Placing the interests and well-being of the child or young person as the top priority.
Considering the young person's capacity for decision-making and consent. In cases where practitioners ascertain that a person possesses sufficient age and mental and emotional capacity to give consent to a service, that individual should have the right to request and provide informed consent for receiving services without the involvement of a parent, guardian, or legal representative. However, where parents disagree about treatment and the practitioner believes the child is capable of consenting, it would be wise to seek a second opinion about the child’s capacity and the proposed treatment.
Ensuring respectful and effective communication with children and young individuals. Practitioners should treat them with respect, listen to their views, encourage questions, and provide information in a manner that they can easily comprehend. Additionally, acknowledging the role of parents and, when appropriate, encouraging the child or young person to involve their parents in decisions about care are vital aspects of good practice in paediatric healthcare.
When a child is not capable of consenting to treatment and parents disagree about treatment, it can be difficult to know how best to respond. In these situations, practitioners are strongly encouraged to seek legal advice and support, to ensure that they comply with your legal obligations.
By following these principles, healthcare practitioners can ensure the well-being and active involvement of children and young individuals in their healthcare decisions.
Dental Board AHPRA - Codes and guidelines
MIPS dental practitioner education - 1hr online modules
If a member has concerns regarding risk management and requires clinico-legal assistance, contact MIPS on 1800 061 113
What do I do if I am unsure if a patient has capacity to consent to cosmetic surgery? Who has responsibility for assessing the capacity of the patient?
Medical practitioners should specifically assess your patient’s capacity before discussing or offering cosmetic surgery, including through the use of a screening tool. If they are still unsure, then they should refer to a specialist for capacity assessment. Assessment of suitability starts with the referral.
The practitioner performing the surgery must:
- Discuss and assess the patient’s reasons and motivation for surgery.
- Assess the patient for underlying psychological conditions such as Body Dysmorphic Disorder (BDD).
- Discuss other options with the patient, including surgery, procedures or treatment offered by other health practitioners and the option of not having the surgery.
A medical practitioner must decline to perform the surgery if they believe that it is not in the best interests of the patient.
Are there any specific tools to assess if cosmetic surgery is appropriate?
There are currently no approved tools for screening for BDD, but many are available.
See guidelines for registered medical practitioners who perform cosmetic surgery and procedures. These include Patient assessment and body dysmorphic disorder (BDD) screening, MBA BDD-screening, and Australian Plastic surgery Foundation, APFS body-image-program.
What should I do if I don’t think the patient needs or should have the cosmetic procedure which they want the referral for?
If you don’t think cosmetic surgery is appropriate for your patient, based on your clinical assessment, then you are not under an obligation to refer them for surgery.
One reason for obtaining a referral is to provide information to the practitioner about the patient’s history. A discussion with the patient about their motivation does not require detailed knowledge of specific surgeries. The practitioner performing the surgery is responsible for providing information about the surgery.
The Board does not expect GPs to have detailed knowledge of every cosmetic surgery. It is not their role to provide information about the proposed procedure.
The referral should indicate the nature of the patient’s request, but the decision about which surgery is provided (if any) will be made by the patient and the practitioner performing the surgery. A referral is only required for cosmetic surgery, not for non-surgical cosmetic procedures.
Please note, the referrer cannot work in the same practice and cannot themselves perform cosmetic surgery or procedures.
Do cosmetic surgical procedures now have a “cooling off period”?
For cosmetic surgery, the cooling off period is 7 days for adults and 3 months for children under 18 years. For cosmetic procedures, there is no cooling off period for adults, but a 7-day cooling off period for children under 18 years.
Do these regulatory reforms apply to cosmetic procedures and cosmetic surgery?
The Cosmetic Surgery Guidelines apply to cosmetic surgery and non-surgical cosmetic procedures, although some requirements differ. The general Ahpra advertising guidelines apply to all regulated health services, including cosmetic surgery and non-cosmetic surgical procedures performed by medical practitioners. However, the new Advertising Guidelines for Cosmetic Surgery only apply to cosmetic surgery.
Are there resources for patients about the regulatory changes which outline best practice for cosmetic procedures?
Ahpra provides a comprehensive cosmetic surgery hub which includes “Information for the public” and “Information for practitioners”.
I am not sure whether the procedure is reconstructive or cosmetic? How should I approach this?
Ultimately this is your clinical judgement, but you need to be able to substantiate your decision if challenged. Generally, whether or not a procedure is reconstructive (as opposed to cosmetic) primarily depends on the intention, rather than the procedure itself. You should always ensure you comply with the MBS item descriptor for any procedure you seek to claim through Medicare. Please call MIPS if you are unsure about your obligations.
Do I need to assess a patient for BDD before using cosmetic injectables?
You should always exercise clinical discretion in deciding whether a psychological assessment would be in your patient’s best interests. The Cosmetic Surgery Guidelines require screening prior to cosmetic surgery for all patients, but only for patients under 18 years prior to non-surgical cosmetic procedures. The code of conduct Good Medical Practice provide further broader guidelines on which any healthcare provided can be judged.