As published on Health + Hospital Wednesday, 14 June, 2023
For registered specialist plastic surgeons, looking for signs of mental health issues has always been an important part of training.
Anything that may negatively impact a patient’s ability to make a good decision regarding cosmetic surgery must be carefully assessed to ensure the patient is making the right decision for the right reasons.
Learning about conditions such as body dysmorphia has long been an integral part of the plastic surgery training curriculum.
The news that this once-informal process will now be mandated and formalised through a validated screening tool is a major win for patient safety.
From 1 July, the medical regulator is bringing in new regulations around which vulnerable patients may need to be referred for psychological or psychiatric assessment before surgery.
The Australasian Society of Aesthetic Plastic Surgeons (ASAPS) has been working in collaboration with the Australian Foundation for Plastic Surgery for five years to develop a tool alongside leading psychological experts — including renowned psychologists Emeritus Professor Nichola Rumsey and Dr Alex Clarke — to help clinicians screen patients for these complex, multi-layered issues.
The tool is set to be released exclusively to ASAPS members prior to 1 July with an aim to help improve patient safety while also enabling members to comply with the medical regulator’s new guidelines.
Only available to clinicians, the online tool contains 13 questions covering factors that influence people’s expectations of surgery, including mental health, social media, intimate partner relations, eating disorders, personality disorders and body image. The tool has been designed to help to reduce patient dissatisfaction as a result of unrealistic expectations and determine whether patients are psychologically well enough to undergo cosmetic surgery.
The online tool will help surgeons make accurate, real-time decisions on who to refer for psychological or psychiatric assessment before surgery is further considered. It will also help to identify people who should not pursue surgery at all, using an easy-to-use traffic light system.
A lot of time has been spent ensuring the questions are designed in a way that maximises the chances of valid and authentic answers. They are both comprehensive and practical enough to identify all red flags, but not so detailed and specific that they lose objectivity and practicality.
Research from the Australasian Foundation for Plastic Surgery found 30% of people would benefit from further assessment or education prior to considering surgery. These people might suffer from anxiety, depression, an eating disorder or body image issues exacerbated by social media. A much smaller group could have vulnerabilities that should altogether exclude them from surgery, such as body dysmorphic disorder.
No matter how well versed a clinician may be in assessing a patient’s red flags in a more informal way, the tool can help catch those patients who may once have slipped through the net.
It’s important to note that this isn’t a ‘test’ designed to intimidate patients or reduce the number of patients receiving surgery. It’s a tool to encourage and facilitate more relaxed, realistic conversations between patients and their practitioners and ensure the highest possible psychological safety for the patient. It’s also a great way to build stronger relationships with patients, in order for them to feel seen and heard.
In extreme cases of patient dissatisfaction, litigation can be the unfortunate next step. In Australia, around 16% of all healthcare disputes related to cosmetic surgery. Of these, 39% of patients claimed the surgeon failed to explain the potential lack of benefit, and 26% alleged they were improperly informed before consent.
ASAPS’ new tool is designed to help stem these issues at the source and screen out patients who are at risk of extreme dissatisfaction with their surgical outcome, irrespective of how well the procedure has been performed. The tool will help mitigate the extreme psychological harm of patient dissatisfaction and the ligation that can sometimes come along with it.
The new change isn’t about reducing the number of patients who receive surgery. In fact, we expect that between 85% and 90% of patients will receive the green light when using this tool. The tool is more about looking at a patient as a whole person and paving the way for a successful surgery that the patient feels completely satisfied with.
By screening for unrealistic expectations and the psychological issues that can sometimes go along with those expectations, we can ensure that every patient is getting the right surgery for the right reasons..
Dr Tim Edwards, MBBS MS FRACS FAICD.
(MED0000968339) Registered medical practitioner, specialist plastic surgeon (specialist registration in surgery – plastic surgery)