In April this year, the GMC published further guidance for doctors who offer cosmetic interventions. This piece considers whether the practice of consenting patients for cosmetic procedures has changed as a result.
In 2013, the Royal College of Surgeons’ Cosmetic Surgical Practice Working Party produced a document entitled “Professional Standards for Cosmetic Practice”. In turn, those Professional Standards referred on the issue of consent to earlier applicable guidance produced by the General Medical Council in June 2008, entitled “Consent – patients and doctors making decisions together”. The 2008 GMC guidance clearly recognised the possibility of consent being taken by someone other than the practitioner performing a procedure and covered the potential for delegation.
The 2013 Professional Standards went on to state that:
“Consent is a process that begins at the first consultation. The practitioner should check for consent at every stage of the pre-procedure processes.
…in general, the practitioner performing the procedure should obtain consent from the patient at least once in person and a signature indicating consent must be obtained at least once on the day of the procedure.
… cosmetic practice is a special case where both the practitioner and the patient need to have a common understanding of the expected and likely outcome.”
Within the 2013 Professional Standards, it is recommended that for invasive procedures consent ought to be a two-stage process, with at least two weeks between the stages to allow the patient to reflect on his or her decision. It is also recommended that the operating surgeon should see the patient personally immediately before the procedure, in order to re-emphasise the consent, and should take consent at least once “even if consent has been obtained previously from another practitioner”.
Subject to certain safeguards, the 2013 Professional Standards still allowed for the pre-operative consultation to take place with someone other than the operating surgeon, provided the operating surgeon “re-emphasised” the consent immediately before the procedure.
Bringing things up to date, the General Medical Council published a document on 12 April 2016 entitled “Guidance for doctors who offer cosmetic interventions”. This came into effect on 1 June 2016. That guidance contains the following passage on consent:
“If you are the doctor who will be carrying out the intervention, it is your responsibility to discuss it with the patient and seek their consent – you must not delegate this responsibility. It is essential to a shared understanding of expectations and limitations that consent to a cosmetic intervention is sought by the doctor who will perform it, or supervise its performance by another practitioner.” (emphasis added)
Hence the 2016 GMC guidance adopts a more stringent approach to consent than that set out in previous guidance. The practice of a patient meeting their surgeon for the first time on the day of surgery is now unlikely to satisfy current requirements.
Ultimately of course, this is one of the outcomes that Sir Bruce Keogh set out to achieve when he published his report on the industry back in 2013 – a tightening of standards across the industry. Clinics and practitioners who fail to embrace these new standards may, along with their indemnifiers, find themselves facing an increase in claims from dissatisfied patients.
Written by Greg McEwen, healthcare partner