Medical Board releases draft Guidelines for cosmetic procedures
The Medical Board of Australia has released a Consultation Paper that includes draft Guidelines for medical practitioners who provide cosmetic medical and surgical procedures. The Board is seeking feedback regarding the effectiveness of current regulation of cosmetic procedures, whether further regulation is required to protect patient safety, and the form of any further regulation required.
Specific guidance for cosmetic procedures
The Consultation Paper states that cosmetic procedures are promoted to and viewed by the community in different ways: as medical procedures, beauty treatments or consumer products. The Consultation Paper also outlines various differences between cosmetic procedures and other medical or surgical procedures, including that cosmetic procedures are almost always requested by the consumer, usually do not relate to a medical need, and are usually paid for completely by the consumer. The Board views these factors as contributing to a number of problems with the current regulation of cosmetic procedures.
Options for further regulation of cosmetic procedures
To address the concerns listed above the Board has identified four options for future regulation of cosmetic medical and surgical procedures:
- No additional regulation, but continuing the current approach of providing non-specific guidance via the Board-approved Good Medical Practice: A Code of Conduct for Doctors in Australia;
- Develop and provide Board-approved consumer education material regarding the provision of cosmetic procedures by medical practitioners;
- Strengthen current guidance through new, practice-specific guidelines regarding the Board’s expectations of medical practitioners who provide cosmetic medical and surgical procedures; and
- Create new, practice-specific guidelines (as in option 3) but with less-explicit guidance to medical practitioners.
The Board’s preferred option is Option 3 because specific guidelines would provide “clear, nationally consistent guidance about the Board’s expectations”, as well as having what the Paper describes as "minimal regulatory impost". Option 2 was not preferred due to concerns about the costs of developing consumer education material and because information should not be “a substitute for a comprehensive discussion between medical practitioner and patient”.
Draft Guidelines for Cosmetic Procedures
A number of procedural steps included in the draft Guidelines have the potential to substantially alter the provision of cosmetic procedures by medical practitioners.
Significant inclusions in the draft Guidelines include:
- A “cooling-off” period of at least 7 days between an adult patient giving informed consent and undergoing a cosmetic procedure. The cooling-off period is targeted at major cosmetic surgical procedures and would not apply to minor procedures that do not involve cutting beneath the skin (injections, laser procedures, etc).
- For patients under 18 years of age, mandatory referral for psychological assessment prior to any cosmetic procedure and a minimum 3 month cooling off period between informed consent and the procedure.
- Written discharge instructions to patients that include the practitioner’s contact details, instructions for emergency care, medication and self-care instructions, and arrangements for post-procedure follow-up.
- Restrictions on prescribing Schedule 4 injectable cosmetic medications unless the patient has attended a face-to-face consultation with the prescribing practitioner. The draft Guideline specifically states that remote prescribing following a telephone, email or video-conference consultation would not be appropriate.
- Requirements for detailed information to be provided to patients regarding costs of procedures, and prohibition on payment of deposits for procedures until after any cooling-off period.
- Prohibition on practitioners offering loans or additional products or services that could act as incentives to undergo cosmetic procedures. For example, patients could not be offered a ‘package deal’ involving free or discounted flights or accommodation.
Other than the introduction of mandatory cooling-off periods, many of the measures outlined above would represent good medical practice and are covered by existing guidance in the Board’s existing Good Medical Practice publication.
The draft Guidelines include a number of terms that are not defined, which may cause difficulties for practitioners and associated providers to understand their obligations and place them at risk of disciplinary proceedings. For example:
- Guideline 7 requires a face to face consultation between practitioner and patient prior to each “course of treatment” with injectable Schedule 4 medications, but does not define “course of treatment”;
- Guideline 8 does not define or describe what would be considered “appropriate” or “necessary” training; and
- Guideline 10 does not indicate what would be considered advertising that would “glamorise” a cosmetic procedure.
The apparent prohibition on any form of remote prescribing for Schedule 4 injectable medications appears to impose a standard that is more restrictive than under existing drugs and poisons legislation in some jurisdictions.
Potential effect of Guidelines
If implemented, the Guidelines would provide evidence of what constitutes appropriate professional conduct for a medical practitioner providing cosmetic procedures. Non-compliance with the Guidelines could be used by the Board to support disciplinary proceedings against medical practitioners where the investigation relates to a cosmetic procedure. Practitioners would need to have detailed knowledge of the Guidelines and ensure that their practice satisfies (or exceeds) the requirements set out in the Guidelines.
Given the substantial corporatisation of cosmetic medical and surgical procedures, operators of cosmetic clinics, day surgeries and operators of hospitals where cosmetic procedures are performed would also need to be aware of and meet the requirements in the Guidelines. Providers will also need to consider the practical implication of the financial disclosure and restriction on financial offerings set out in section 12 of the draft Guidelines.
Submissions to Medical Board can be made until 29 May 2015. For further details see: http://www.medicalboard.gov.au/News/2015-03-17-media-release.aspx.
Draft Guidelines for Cosmetic Procedures
Contact our Health team for further details regarding the draft Guidelines, Medical Board regulation or other medical practice related queries.
Cindy Tucker, Partner