New GMC Guidelines
As of June 2016, new guidance from the GMC regarding doctors carrying out cosmetic procedures will come into force. The new guidelines will highlight the need for accountability from the doctors involved in the treatment, and consideration of patient safety at all times. Various cosmetic procedures have come under fire in the last few years, with the 2010 PiP implant scandal one of the industry’s better documented failings. Despite the bad press, the cosmetic sector is a rapidly emerging market which is now widely available, and prospective patients are faced with more options than ever before.
In the wake of recent problems, Professor Sir Bruce Keogh, National Medical Director of NHS England, has led an independent review of the cosmetic industry. This review was tasked with identifying the current risks associated with cosmetic interventions and how best to protect the public in this area. As a result of the review, the GMC’s new guidance for doctors carrying out cosmetic procedures will come into force in the summer. The guidelines apply to all cosmetic procedures, including both surgical and non-surgical treatments, with the aim of improving standards and making the ethical responsibilities of the industry clear to all doctors who work within it.
Thankfully, the majority of doctors in this field already practise ethically and to a high standard. However, the cosmetics sector is not without examples of unsafe practices, poor follow-up care and inappropriate marketing campaigns. The new guidelines are in place to protect patients from these more unsavoury elements, and to hold any unethical practitioners fully responsible for their actions. I will now take a look at some key areas in the new guidelines, and what they mean for practitioners.
Responsible Advertising and Marketing
One of the major changes coming in the summer will be the tighter regulation of advertisements. Though cosmetic surgery adverts will not be banned, as some campaigners have called for, they will have to obey certain rules. The adverts are no longer allowed to entice potential customers with cut-price deals, and marketing campaigns can no longer offer cosmetic surgery as a prize in a competition. These outlawed practices are designed to encourage people to make quick decisions without considering all of the implications – something that the new guidelines want to put an end to in the interest of patient safety. In addition, adverts are not allowed to make any unjustifiable claims. Patients must be presented with accurate information, and able to make their decision in their own time without feeling under any pressure to respond to outside influences.
Time for Reflection
Linked to the implications of the advertising guidelines is the rule that patients must be able to make fully informed decisions about prospective cosmetic procedures, and able to change their mind at any point. This means that patients cannot be rushed into their treatment; they must be able to reflect on their choice given all of the available information, including any associated risks. Under no circumstances should practitioners encourage patients to undergo these procedures lightly or without serious consideration.
It is often thought that a significant proportion of patients seeking cosmetic procedures may be appropriately regarded as vulnerable; from June, doctors will be required to consider the psychological needs of their patients, including whether the patient would benefit from a referral to another professional colleague. This is particularly important when it comes to the treatment of young people; their mental health in relation to the procedures will need to be fully evaluated, and sufficient time needs to be given to them to ensure that their treatment is right.
Practically, the amount of time given to a patient for their decision will depend on their specific circumstances. These include the invasiveness of the surgery, as well as its complexity, permanence, and risks. Above all, the patient needs to know that they can change their mind at any point; they should not feel pressured by advertising or by medical professionals themselves.
Fully Informed Consent
An integral part of the new guidelines is the requirement for the patient’s fully informed consent. It will be the responsibility of the doctor carrying out the cosmetic procedure to personally discuss the procedure with the patient and obtain their consent. This cannot, under any circumstances, be delegated to someone else. These is no longer any place for prescribing injectable cosmetic medicines over the telephone, via video link, online or at the request of others; the doctor may only prescribe treatment in person, and must carry out a physical examination of the patient first. In addition, the doctor must be satisfied that the patient’s request for cosmetic intervention is entirely voluntary, and not the result of any sort of external pressure.
Continuity of Care
As already mentioned, doctors must ensure that patients are fully informed as to the process and risks of the procedure, but the patient must be given information to help them beyond the treatment itself. This information includes contact details for the right person to get in touch with in the unfortunate scenario that something goes wrong with their procedure, to ensure that they are fully supported for as long as they need to be.
A couple of final points of note are that doctors will be required to make full and accurate records of all consultations with their patients, and that doctors must identify and immediately act on any patient safety concerns, including fully contributing to programmes designed to monitor quality and outcomes of the treatment. All of this is to make sure that there is never any lack of information regarding the procedure, meaning that any issues or complications can be acted upon quickly and correctly.
As I have said, many doctors already practising cosmetic procedures do so with good ethical standards and care for their patients, but there are also some who do not have the same considerations. These guidelines look to be a step forward for the industry, making it very difficult for those doctors who may have acted inappropriately in the past to continue to do so. The emphasis on patient care is important, and if the professionals working in the industry ensure that everything they do is with their patients’ interests at heart, then these guidelines will have gone a long way towards making cosmetic procedures safer for all involved.