Rules
issued by the Medical Board of Australia fail to close a loophole that allows
doctors to perform liposuction and facelifts
New
regulations for medical practitioners who perform cosmetic procedures fail to
close a loophole that allows GPs to perform invasive cosmetic surgeries such as
liposuction and facelifts.
On Monday
the Medical Board of Australia issued regulations for medical practitioners
following wide consultation with the industry and the public about how to protect
people undergoing cosmetic procedures.
The
cosmetic industry has been only lightly regulated. While plastic surgeons must undergo
extensive medical education and training to become accredited after obtaining
their medical degree, cosmetic surgeons need only to have completed a basic
medical degree to perform some surgeries.
The new
regulations, which will take effect from October, prescribe a seven-day cooling
off period for adults before major procedures. For anyone under 18 there will
be a three-month cooling-off period before major procedures, with a mandatory
evaluation by a registered psychologist, general practitioner or psychiatrist,
and a seven-day cooling off period before minor procedures.
Treating
medical practitioners will have to take “explicit responsibility for
postoperative care and for making sure there are emergency facilities when they
are using sedation, anaesthesia or analgesia”.
The vice
president of the Australian Society of Plastic Surgeons, Dr Gazi Hussain,
welcomed those requirements. But he said it did not change the fact that any
doctor with a basic medical qualification could perform some potentially
dangerous and invasive cosmetic operations.
“In our
submission to the Medical Board we specifically requested there be a
requirement for basic training in cosmetic surgery, and we would always
recommend someone has training from the Royal Australasian College of Surgeons
given the lack of regulation,” he said.
Medical
doctors might be capable of making incisions and performing some surgeries, he
said, but they might lack the training to respond if something went wrong. When
procedures were carried out in non-licensed medical facilities, there were no
specialists, such as anaesthetists or emergency doctors, on hand to respond. It
is not illegal to conduct surgical procedures in an unaccredited facility, such
as an office space, Hussain said.
“I’ve
seen patients who have had branches of their facial nerves cut and I have had
to try to repair or improve that; I’ve seen patients with breast implants who
then come to emergency departments with infections, and I’ve had patients with
tummy tucks falling apart,” Hussain said.
“Mostly
it had been done by non-plastic surgeons.”
There
have been calls for tougher regulations for plastic surgeons as well, and the
new regulations will also apply to them. When complications from both cosmetic
and plastic surgery occur, it can be difficult for patients to know if they are
suffering a statistically unfortunate but genuine complication, or are a victim
of malpractice.
Research
by Marie Bismark, a doctor and lawyer, found that of nearly 10,000 Australian
medico-legal cases resolved over a six-year period, 16% involved cosmetic
procedures. Plastic surgeons, orthopaedic surgeons, vascular surgeons and
dermatologists experienced disproportionately high rates of consent disputes,
with patients feeling they were not given enough information to give informed
consent, her study found.
As well
as the cooling-off period, the new regulations contain explicit guidance on
patient assessment and informed consent, and require doctors to provide clear
information to consumers about costs, risks and possible complications.
“Our
previous research found a large number of complaints each year from patients
who feel they were presured to undergo more extensive cosmetic and surgical
procedures than they wanted, and some made complaints they felt pushed into
making a decision rather than being given an opportunity to go away and think
about their options,” Bismark said.
“There
were some concerns that benefits of some procedures were being oversold and
that patients didn’t fully understand the risks or that it might not go as they
believed.”
The
chairwoman of the Medical Board of Australia, Dr Joanna Flynn, said cosmetic
surgery was very broad and difficult to define, which hampered regulation. It
included everything from non-surgical laser hair removal and Botox through to
breast augmentation and other invasive procedures.
“These
guidelines haven’t gone into the issue of specific qualifications, but not all
the harm is done by those with less training,” she said.
“There
was consideration about whether cosmetic surgery should be recognised as a
speciality in its own right which would require certain specialisation, and
that needs to happen before the Medical Board can implement a need for specific
qualifications. But it didn’t meet the test requirements for making it a
speciality, and that’s largely because it’s such a diverse field encompassing
relatively minor to major procedures.”
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