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.