Edit Consenting to Cosmetic Surgery

<p>It is not surgery to alleviate pain or disability or to prevent death. Predominantly it is designed to meet what the patient considers to be desirable.  </p> <p>In some cases, it might be argued, cosmetic surgery may alleviate psychiatric or psychological suffering, but in every case the patient's desire to have the surgery will have a psychological and/or social motivation.</p> <p>Thus the process of obtaining informed consent to cosmetic surgery will be different in character from the process of obtaining consent to, say, bowel surgery for diverticulitis. The surgery is always elective and in most cases the patient will not suffer pain or disability as a result of chosing not to have the surgery.</p> <p>In nearly every case the patient's choice to proceed will come at a financial cost - cosmetic surgery is rarely performed by the NHS.</p> <p> </p> <p><strong>Psychological Assessment</strong></p> <p><br />Given the motivations to seek cosmetic surgery, it would seem sensible to have some form of psychological assessment of all patients. It has been suggested that a significant proportion of patients seeking cosmetic surgery have an identifiable psychological disorder. Some will have body dysmorphic disorder.</p> <p>Many will seek surgery at or following very difficult life events such as divorce. Their mental state can affect their motivation to have surgery and the likelihood of the surgery satisfying their perceived desires. In order properly to advise a patient of the potential risks and benefits to them of the proposed surgery, surely the surgeon needs to know something of their psychological history and condition.</p> <p>The National Minimum Standards which apply to the regulation of private hospitals offering cosmetic surgery,  insist that referral to appropriate psychological counselling is available <u>if clinically indicated</u> prior to surgery [A26.4] but who decides if it is clinically indicated if there is no routine psychological screening or assessment? The <a title="NCEPOD Report 2010" href="http://www.ncepod.org.uk/2010report2/downloads/CS_report.pdf" target="_blank" rel="nofollow noopener">NCEPOD Report 2010</a> found that routine psychological assessment was performed in only 35% of those clinics which took part in the survey (only 32% of clinics responded and, as the report authors noted,  they might be amongst the most conscientious clinics).</p> <p> </p> <p><strong>Medical History</strong></p> <p><br />A significant number of patients self-refer to cosmetic surgery and some do not even consent to their GP being informed. If so, how does the surgeon find out whether the patient has any significant medical history? Is it reasonable to rely on the patient's own account (particularly if given to a patient coordinator on a Pro-forma questionnaire)? Might the patient who is particularly motivated to undergo cosmetic surgery be willing to mislead the surgeon? Cosmetic surgery is purely elective, there is no urgency or emergency. There will always be time to take a full history and carry out a full pre-operative assessment and any tests that may be necessary.</p> <p> </p> <p><strong>The Patient's Desires</strong></p> <p><br />The surgery is designed to meet the wishes of the patient, not to do what the surgeon thinks would be best for them. So it is incumbent on the surgeon to elicit those wishes. There is no such thing as an ideal nose which will suit every patient.  However, if what the patient seeks would have ramifications (for example very large breast implants might give rise to physical problems) then the patient needs to know of the consequences of what they are seeking. In particular, in future years might further surgery be required and what will that surgery cost?</p> <p> </p> <p><strong>Options</strong></p> <p><br />The GMC, amongst detailed guidance on consent, advises that doctors should "identify which investigations or treatments are likely to result in overall benefit for the patient. The doctor explains the options to the patient, setting out the potential benefits, risks, burdens and side effects of each option, including the option to have no treatment. The doctor may recommend a particular option which they believe to be best for the patient, but they must not put pressure on the patient to accept their advice."</p>

Selected: Text Block Text Block Full Width Image Banner Image Side By Side Images Left Aligned Image Right Aligned Image Quote Video

No Background Colour CR Purple Medium Purple Light Purple Dark Pink Light Pink Light Grey Dark Grey No Background Colour