On 1 June 2016 the GMC's newest supplementary guidance came into effect, this time for doctors undertaking cosmetic interventions. The guidance is applicable to doctors from many different specialties who undertake any intervention, invasive or non-invasive, with the primary purpose of altering the patient's appearance.
Read the new guidance here.
As well as advice for clinicians, there's also new GMC guidance aimed at patients who are considering cosmetic interventions. This suggests some questions they can ask their doctors before a procedure is carried out, and may give some extra insight into what patients might want to know.
The introduction of non-invasive techniques has led to an expansion of the cosmetic sector and means that more medical practitioners are becoming involved. The ease with which patients can gain access to treatments, which may have significant physical and psychological sequelae, has led to concerns about patient safety, though principally in respect of cosmetic procedures performed by unregistered practitioners.
The new guidance provides an ethical framework for doctors working in the cosmetic sector, covering the same four domains as those included in Good medical practice.
There is some reiteration of existing guidance but practitioners need to be aware that the GMC is setting out more specific requirements in some areas for those undertaking cosmetic interventions.
One area where the GMC has set out more detailed requirements for doctors undertaking cosmetic practice is that of obtaining patient consent.
In most clinical circumstances the ideal is that the doctor performing the procedure is the one taking consent, but the GMC's consent guidance recognises that this isn't always possible and accepts that the task may be delegated to someone who is appropriately trained.
However, the new guidance makes clear that if you're performing the cosmetic intervention, you must obtain the consent from the patient yourself, and this responsibility must not be delegated to another member of the team.
You must also ask the patient why they want to have the procedure and what outcome they are expecting, as well as discussing the potential physical and psychological impact of the procedure going wrong or the patient’s expectations not being realised.
The GMC also emphasises the importance of allowing the patient time to reflect on the information given to them before coming to their decision. Practitioners are reminded to consider vulnerable patients and those who may require additional psychological support, and where necessary doctors are advised to seek expert psychological assessment and/or support.
Practitioners need to be aware that the GMC is setting out more specific requirements in some areas for those undertaking cosmetic interventions.
The new guidance indicates that as well as providing information to patients, doctors must also consider communicating with the patient's GP, to allow a discussion on the relative risks and benefits of any proposed procedure.
Such communication will need the consent of the patient. If this isn't forthcoming, clearly document the fact in the records and consider how this affects the balance of risks, and if the procedure should go ahead.
The guidance also includes a section dedicated to continuity of patient care, which indicates that the patient should be provided with enough written information that another practitioner can take over their care.
Ideally this information should be shared with the patient's GP, again with the patient's consent. However, the guidance indicates that if the patient won't consent to this sharing of information, you must again record it in the patient's notes and you will then be responsible for patient follow-up.
In the event that the patient suffers a complication, you must also ensure that your patient knows how to contact you, or another named and suitably qualified individual, outside of your normal working hours.
Conflicts and compliance
The GMC's 'Good medical practice' makes it clear that doctors should not allow any interests they have to affect the way they prescribe, treat, refer or commission services for patients, but additional advice is included in the new guidance on advertising and communication standards concerning cosmetic practice.
In particular doctors are told that they must not provide their services as a prize, or use promotional tactics which might tempt an individual to make an ill-considered decision.
Finally the GMC has given a clear indication that it expects doctors to apply the same principles of audit, continual professional development and appraisal to their cosmetic practice as to any other clinical practice. There is a requirement that doctors will routinely monitor their patients' outcomes and audit their practice, producing a report at least once a year.
To demonstrate compliance with these new standards, we recommend that doctors document very clearly their communications with patients and, where relevant, medical colleagues. Pay particular attention to the explanation of risks offered to the patient and what the realistic expectations are of the procedure's outcome. If you're at all concerned about a patient's psychological needs, you can seek expert advice or support.
Ultimately, the GMC's new guidance is clear: 'If, after discussion, you still believe the intervention will not be of benefit to the patient, you must not provide it.'
Dr Nicola Lennard
MBChB MD FRCS(General Surgery) GDL
Nicola completed her post graduate training in general and vascular surgery before taking up post, initially as a senior medical officer, then Deputy Medical Director in the medical devices division of the MHRA. She joined the MDU as a medico-legal advisor in 2013 and completed her graduate diploma in law in 2014.
See more by Dr Nicola Lennard