Mr David Ward, a Council Member at the Royal College of Surgeons and consultant plastic surgeon in the NHS until last year, on why patients, providers and surgeons who carry out cosmetic surgery should take part in the GMC’s consultation on draft cosmetic practice guidance to improve standards and patient safety.
Many people are surprised when I explain that currently, the law is unclear about who can and cannot perform cosmetic surgery. Although guidance from the General Medical Council (GMC) states that doctors should not practise beyond their competencies, anyone who is on a specialty register, could, in theory, perform cosmetic surgery. This means any doctor, even if they are not a surgeon. Nearly all this work takes place in the private sector, and the Keogh review on the Regulation of Cosmetic Interventions [PDF], published in 2013, highlighted an urgent need for better regulation of the cosmetic industry.
Addressing the ethical issues
The Royal College of Surgeons (RCS) is working with the surgical specialties and the Department of Health to correct this by introducing a system of certification for surgeons who want to carry out cosmetic surgery.Under the new proposals, surgeons will apply to become certified by showing they have met RCS standards for cosmetic surgery training and practice. Patients will then be able to search online for a surgeon who is accredited in the procedure they want. The RCS is also working to provide independent information online for patients contemplating cosmetic surgery, a checklist which hospitals and clinics can use to make sure key questions have been answered before a patient consents to an operation, and a patient questionnaire so patients can feedback on the effectiveness of a surgical procedure.
The GMC has a key role to play in making sure there is a regulatory framework in place for doctors who provide cosmetic interventions and it is currently consulting on new guidance for doctors who perform surgical and non-surgical cosmetic procedures. These new standards are important because they make it clear what behaviour is expected of doctors and surgeons carrying out cosmetic procedures and they address some of the ethical issues around cosmetic surgery, such as responsible advertising and giving patients enough time and information before they consent to a procedure.
The vast majority of surgeons are highly trained, responsible doctors who want to provide the best care possible for their patients. This new GMC guidance will help stop those who are not working to the appropriate standards from practising. Doctors who do not follow the guidance may be brought before a fitness to practise hearing and have either conditions placed on their practice or their licence removed altogether.
The guidance will also help hospitals and clinics that offer cosmetic procedures to know what is, and is not, acceptable. Ultimately, they should help make this area of medicine safer for patients.
Information for patient safety
Before patients undergo cosmetic surgery, they need to understand clearly not only the likely outcome and benefits but also the potential risks. They must make sure they have chosen the right surgeon for them and that the surgeon explores all the available options: this may include not doing anything, having a non-surgical procedure such as Botox®, or having a less extensive or more specific procedure. For example, when I explained to patients that an operation to correct drooping of the breasts would result in extensive scarring, some decided not to go through with the procedure. In these cases, I felt I had done my job because I had informed my patients of the full risks and impacts of surgery and they had made an educated decision not to go through with it.
Patients should also understand what will happen after the operation – how long they will need to take off work and hobbies, and how long it will take to get the final result. A breast enlargement operation, for example, would take a few weeks for the swelling to go down and six to eight weeks before the patient can do sport. Far from what people may think, this is not a simple procedure: it is a serious operation which involves a general anaesthetic, scarring, bruising and takes some weeks to recover from.
It is also important that patients understand the full costs of an operation and any potential after care. Most operations go smoothly but occasionally patients need further surgery, such as bleeding or if the final result is not as good as expected – for example if after a rhinoplasty (nose reshaping) – the bridgeline is not as smooth as expected.
‘Cooling off’ period
The RCS believes the GMC’s guidance should specify that patients undergoing cosmetic procedures requiring surgery should be offered a minimum two week “cooling off” period before consenting to an operation. This would give the patient time to reflect and let the full implications sink in. We will make this clear in our own guidance, specifically for cosmetic surgery which will supplement the GMC’s guidance and will be published alongside it. However, it is important that patients, providers and surgeons who carry out cosmetic surgery give their views too, so that we can work together to improve standards in cosmetic surgery.
Please take part in the GMC’s consultation on draft cosmetic practice guidance, which is open until 4th September.
Mr David Ward is a Council Member at the Royal College of Surgeons. He has first-hand experience of performing surgery for both medical and cosmetic reasons, and of working in the NHS and the private sector. He was a consultant plastic surgeon in the NHS for over 23 years until last year, specialising firstly in head and neck reconstruction and later in skin cancer. Part of his work involved carrying out cosmetic surgery such as tummy tucks, breast augmentation and breast reduction for private patients.