An extensive update to the Medical Board of Australia’s (Medical Board) Guidelines for Registered Medical Practitioners Who Perform Cosmetic Surgery and Procedures (Guidelines) will be officially published and come into effect on 1 July 2023, in the wake of growing public concern over problematic conduct within the cosmetic procedure sector. We have viewed an advance copy of the Guidelines and discuss the key changes below.
Background
The amendments to the Guidelines, which emerged from the recommendations of an external review into patient safety issues in the sector, aim to clarify the Medical Board’s expectations of good practice. The Independent Review of the Regulation of Medical Practitioners Who Perform Cosmetic Surgery was commissioned by the Medical Board and the Australian Health Practitioner Regulation Agency (AHPRA) in November 2021 and included targeted consultation with a Technical Advisory Group and a Consumer Reference and Advisory Group in addition to public consultation. One of the recommendations of the review was to update the Guidelines, particularly in relation to the improvement of patient assessment and the standards of the premises where cosmetic surgical and non-surgical procedures involving injecting, piercing of the skin or incisions are performed.
Key points
- The new version of the Guidelines is divided into a section on surgical cosmetic procedures and a section on non-surgical cosmetic procedures.
- Medical practitioners must incorporate stronger psychological screening in their consultations, particularly for body dysmorphic disorder.
- There are now stronger restrictions on access to cosmetic procedures for patients under the age of 18.
- Medical practitioners must obtain a higher level of consent from patients, particularly regarding the use of patients’ pictures.
- Medical practitioners must undergo regular continuing professional development relevant to their scope of practice to maintain and enhance their knowledge and skills, including reviewing their performance and measuring their outcomes. Additionally, practitioners must ensure that the facilities where they undertake certain invasive procedures are accredited.
- Patients seeking cosmetic surgery must have an independent referral from a general practitioner or specialist medical practitioner.
- There are now increased cooling off periods between the consultation at which consent is obtained and the surgical procedure, with even longer periods (3 months) for patients under the age of 18. Underage patients also have a cooling-off period of seven days for non-surgical procedures.
- Medical practitioners offering cosmetic surgery must adhere to stricter post-operative care requirements.
New dichotomy: surgical and non-surgical cosmetic procedures
Unlike the 2016 Guidelines, the updated version divides cosmetic procedures into surgical and non-surgical. Cosmetic surgery involves any cutting beneath the skin, such as breast augmentation, facelifts and liposuction, and non-surgical cosmetic procedures may involve procedures piercing the skin but not cutting underneath, such as injectables, thread lifts and laser treatments. The section below details changes made to the Guidelines for both surgical and non-surgical cosmetic procedures.
Patient assessment
The patient assessment section of the new guidelines has been bolstered with stronger required psychological screening measures and restrictions on access for under 18 year olds. The medical practitioner who will perform the procedure must assess their patient for psychological conditions which may make them unsuitable for the procedure, particularly for body dysmorphic disorder (BDD). Additionally, the Medical Board considers that cosmetic injectables, such as botulinum toxin and dermal fillers, should not be prescribed for patients under the age of 18. Patients under the age of 18 must also have a cooling off period of 7 days, at a minimum, between the date informed consent was given and the date the procedure is performed. During this period, no money may be paid (except money paid for the initial consultation) and the underage patient should be encouraged to discuss the procedure with their general practitioner before going ahead.
Consent, complaints and NDAs
The Guidelines also impose stricter informed consent requirements, especially for the use of pictures of patients. Written consent should be given for the use of images in any capacity, along with detailed information regarding the storage, access, purpose, and use of the images. This consent should be obtained separately from consent to undergo the procedure. The patient must also have the right to refuse or withdraw consent, at any stage, to the use of their pictures. The Guidelines also include an obligation for the medical practitioner to take all practical steps to ensure information regarding the consent is provided in a language the patient can understand. Additionally, information must be given during the consent stage about the medical practitioner’s relevant registration, and details about other practitioners who will also be involved in the procedure. The patient must also be given information regarding their right to make a complaint and the required steps to do so. Practitioners who also ask patients to sign a non-disclosure agreement must ensure the patient understands that the agreement does not preclude them from making a complaint to any relevant body.
Training and accreditation
The Guidelines provide for higher training and accreditation standards for practitioners and their facilities. Regular continuing professional development relevant to their scope of practice is prescribed for all medical practitioners who engage in cosmetic procedures. In addition, the Guidelines require that procedures be performed in facilities appropriate for the level of risk associated with that specific procedure. As such, medical practitioners who are performing procedures which require injection, the piercing of the skin or incisions are encouraged to do so in facilities that are accredited by an agency approved by the Australian Commission on Safety and Quality in Health Care’s (ACSQHC) National Safety and Quality Primary and Community Healthcare Standards (Primary and Community Healthcare Standards).
Separate from ACSQHC’s National Safety and Quality Health Service Standards, which apply for surgical cosmetic procedures, the Primary and Community Healthcare Standards apply on a voluntary basis to services such as pharmacies, outpatient facilities and community care clinics, the kinds of settings in which non-surgical procedures are typically performed. To be accredited under the Primary and Community Healthcare Standards, a healthcare provider needs to comply with three standards. The Clinical Governance Standard and the Partnering with Consumers Standard ensure that healthcare providers have healthy community relationships, clearly defined and effective responsibilities for their staff and leadership and patient-centred services. To be compliant with the Clinical Safety Standard, healthcare providers must ensure they have systems in place to effectively prevent and control infections; safely administer medications; offer comprehensive care plans; communicate constructively with other healthcare professionals and patients; and be able to recognise and respond to serious deteriorations in their patients’ health.
More changes for surgical procedures
Medical practitioners providing cosmetic surgery (that is all cosmetic procedures which involve cutting beneath the skin) must be aware of, and comply with, the following additional changes to the Guidelines:
- All patients seeking cosmetic surgery must have an independent referral from a general practitioner or specialist medical practitioner.
- The patient must have had at least two consultations before the operation and at least one of the two consultations must be in person.
- During their psychological screening, the medical practitioner must use a validated psychological screening tool for BDD.
- The patient is not able to consent to cosmetic surgery until they have had an in-person consultation with the medical practitioner who will perform the surgery.
- A cooling-off period must be instituted between the second consultation and the day the surgery can be booked and paid for. For under 18s, the cooling-off period must be at least three months between the date of consent and the date the surgery is performed.
- Should a medical practitioner perform a fly in/fly out procedure, they must remain at the location for at least 24 hours after the operation and only delegate post-operative care after this time. The practitioner must have admitting rights to an appropriate hospital in the area or make alternative arrangements for post-operative admission.
- Cosmetic surgery must be performed at a facility accredited in accordance with ACSQHC’s National Safety and Quality Health Services Standards, which are more stringent in matters of infections, blood management, communication, acute deterioration and comprehensive care than the Primary and Community Healthcare Standards highlighted above.
- Prospective patients must not be offered free or discounted surgery for the purpose of promotion.
- Prospective patients must not be encouraged to take on debt or access superannuation for the purposes of accessing cosmetic surgery.
Key reforms beyond the Guidelines
The updated Guidelines are just one of a number of new reforms brought about by the independent review. Other measures include the release of the new Guidelines for Registered Medical Practitioners Who Advertise Cosmetic Surgery, which will also come into effect on 1 July 2023, and addresses issues with advertising on social media and online generally.
The review has also encouraged the introduction of cosmetic practice endorsement, by which medical practitioners can gain endorsement from the Australian Medical Council and the Medical Board and be listed on a public register of qualified practitioners once they complete minimum requirements of education and training. These reforms are aimed at assisting consumers to make informed decisions about whether and how to access cosmetic procedures.
Separately from the endorsement scheme, the Queensland government has introduced national laws aimed at regulating the use of the title ‘surgeon’ and imposing penalties of up to three years imprisonment and a $60,000 fine for the incorrect use of the title. Queensland ‘hosts’ the Health Practitioner Regulation National Law and is introducing the reforms on behalf of all states and territories. These reforms are targeted at reducing misinformation and the misleading promotion of services within the cosmetic procedure industry.
Should you require further advice regarding the regulation of surgical and non-surgical cosmetic procedures, please do not hesitate to contact us.
This article was written by Geoff Bloom, Partner, Angela Pale, Senior Associate, and Olivia Savage, Law Graduate.