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07 Apr 2015

Patients who want face lifts, breast implants, liposuction, botox injections and other cosmetic procedures will face a mandatory cooling off period under guidelines being considered by the medical profession watchdog.

Horror stories of botched operations, life-threatening post-operative infections and unexpected complications have sparked concern about the level of accountability and consumer protection in the burgeoning cosmetic surgery industry, estimated to be worth around $1 billion a year.

The Medical Board of Australia, which regulates the medical profession, has released draft proposals to improve public safety, including a seven-day cooling off period for adults, a three-month cooling off period and mandatory psychological assessment for patients younger than 18 years, explicit treating practitioner responsibility for post-operative care, and mandatory face-to-face consultations before the prescription of botox and other schedule 4 cosmetic substances.

Medical Board Chair Dr Joanna Flynn said the proposals, which are open for public comment, have been drafted in acknowledgement that cosmetic surgery differs from other medical procedures because it is entirely elective, is usually initiated by the patient, is undertaken to improve appearance rather than address a medical need, is performed outside the public hospital system, and usually paid for directly by the patient.

Its move is in response to a report from the Australian Health Ministers’ Advisory Council, which warned that consumers were taking an increasingly casual attitude to cosmetic surgery despite the fact that it was a significant intervention that carried risks and complications.

“If the cosmetic procedure is performed by a medical practitioner without the appropriate training, or in a facility that does not have the appropriate staff or equipment, or the post-operative care is inadequate, the outcome can be far more devastating than unmet expectations,” the Board warned. “The outcome may be a serious complication resulting in disfigurement or death.”

Concerns about the standard of care have been underlined by recent inquests in Victoria and South Australia which found that two young women died of complications arising from liposuction surgery following inadequate post-operative care.

In addition, state regulators have received numerous complaints about problems including bleeding, pain and infection through to scarring, nerve damage, gross deformity and psychological distress.

Even where cosmetic procedures were carried out skilfully and safely, the nature of the undertaking made it more prone to patient dissatisfaction than many other specialties, according to a report from the-then Health Quality and Complaints Commission in Queensland.

The Commission reported that plastic surgeons were twice as likely to be embroiled in disputes about informed consent as any other specialty, and speculated that this might be due to the “elective nature of cosmetic procedures and the costs associated [which] may contribute to higher patient expectations and lower tolerance for poor outcomes”.

The Medical Board cited data from medical indemnity insurers showing practitioners who perform cosmetic procedures are subject to higher number of claims than other practitioners, and noted that MDA National ranked cosmetic surgery just below obstetrics and neurosurgery in terms of risk.

The Medical Board said there were several shortcomings to current arrangements which exacerbated these problems and exposed consumers to increased risk.

It said the fact that patients could directly request cosmetic surgery rather than seek a referral from a GP meant they missed out on an important source of advice on possible risks and benefits, as well as alternatives.

The Board voiced concern that the quality of patient assessment in the sector was variable, and was at risk of being compromised by commercial considerations.

“Given the information asymmetry [between doctor and patient], the sometimes unrealistic expectations of consumers, and the commercial relationship between the medical practitioner and the patient, it may be difficult for the medical practitioners to objectively determine the appropriateness of a cosmetic procedure, and whether it is in the best interests of the patient,” the Board said.

It said that informed consent was a critical step before a patient decided to proceed with cosmetic surgery, underlining the need for a cooling off period.

While noting that the Australian Society of Plastic Surgeons has specified a minimum 10-day cooling off period for cosmetic procedures in its code of conduct, the Board bemoaned the lack of a consistent nationwide guide for consumers or practitioners.

“This means that a consumer can proceed with a major, irreversible elective procedure without fully appreciating the risks, the likelihood of complications, the variable outcomes and the cost,” the Board said.

It said complaints data supported the view that some consumers went ahead without fully appreciating the risks involved, suggesting informed consent processes in these instances were inadequate or poorly done.

“It is critical that the consumer who seeks a cosmetic procedure…is fully informed and has time to consider all the factors before deciding to give consent,” the Board said.

“Available data and evidence suggest that there are consumers who are making rushed decisions to have major, irreversible elective cosmetic procedures without fully understanding all the factors.”

The Board’s discussion paper ca be viewed at http://www.medicalboard.gov.au/News/Current-Consultations.aspx

The closing date for submissions is 29 May, 2015.

Adrian Rollins

 


Published: 07 Apr 2015