After years of pleading with the authorities about the dangers of an unregulated cosmetic medical industry, Professor Anand Deva, Plastic Surgeon and ASAPS Member, welcomed the news from the Council of Australian Government Health Ministers meeting in Canberra last week that they would crackdown on the cosmetic surgery industry.
Led by NSW Health Minister Brad Hazzard, who has witnessed first-hand the suffering and death of a patient at the hands of a “fly in doctor” from China, there was unanimous agreement that the term “cosmetic surgeon” needs to be better regulated for the sake of protecting vulnerable patients.
The cosmetic medical industry is one of the fastest growing in medicine, fuelled by a rapacious demand which is in turn fuelled by a heady mix of media, celebrity, reality television and more recently, social media.
The increasing need for recognition and attention perhaps reflects that we are becoming more narcissistic as a society but that is a whole different debate.
I have written before about the consequences of rising demand matched with medical entrepreneurs and why this is dangerous when you add desperate patients who seek “affordable” treatments with those that seek to increase profit margins by disregarding standards of safety and quality in health.
With this background in mind, let us examine more closely the rise of the “cosmetic surgeon” in recent years and why our health ministers have now deemed that this term is potentially misleading and dangerous.
Surgery is a profession that is rooted deep in history.
In the middle ages, surgery was actually performed by barbers who assisted monks who were prevented by the bible from spilling blood.
It was not unusual to have a barber cut your hair and also drain an infection or remove a skin tumour.
In the 1500s, Henry VII in England formed the Guild of Surgeons who split from the barbers, as procedures became more complex and required formal training.
In the 1800s, in response to a growing number of charlatans and quacks, the physicians, surgeons and apothecaries (later to become chemists) approached the government in England to introduce formal medical registration.
Parallel to this was the growth of medical schools that provided the framework for training and apprenticeship so that candidates could apply to be registered backed by a recognised degree indicating a minimum standard of skill and knowledge.
The process of ensuring that an individual has the necessary skills to perform procedures on the general public is thus a mixture of recognised medical training, selection into surgical apprenticeship and a final certification by a recognised training body as a specialist surgeon.
This infrastructure is duplicated in each country around the world and remains the gold standard in protecting the public by ensuring those that carry the title of “surgeon” have successfully come through several checkpoints and are safe to practice.
In Australia, the Royal Australian College of Surgeons oversees and certifies trainees in all aspects of surgical practice. Once a doctor is successful and receives a fellowship of the RACS, they are then eligible to apply to the Australian Health Practitioner Regulation Agency to be listed as a specialist surgeon.
The specialisation of surgical practice goes further to subcategorise surgical expertise into various branches e.g. orthopaedic surgery, ear nose and throat surgery, neurosurgery and plastic and reconstructive surgery.
Fellows of the RACS in the main, stick with their area of expertise so you won’t find a cardiothoracic surgeon starting a practice in neurosurgery, for example.
I went through this process myself and it took a fun but gruelling eight years after a basic medical school degree gaining a competitive spot in the training scheme and then being certified by my peers through examination and performing procedures under supervision by my mentors to finally earn my right to practice as a surgeon in Australia.
I now actively train and mentor candidates in order to pass on my skills and experience to the next generation of surgeons — constantly seeking to uphold and improve the highest standards of practice. I do think that most of society would therefore equate the term surgeon with this level of expertise.
The term “cosmetic surgeon” and the practice of “cosmetic surgery” are still not recognised by AHPRA as a specific specialised area of surgery. Herein lies the problem. There is, unfortunately, no guaranteed link to a degree of scrutiny, training and certification and yet, the term is trying to cloak itself with the perception of a high degree of expertise.
To go further, we have seen this title now increasingly used by doctors who have clearly no specialised training and/or certification to perform invasive procedures on patients but who are willing to bend the rules to further their own commercial gains.
This has ended badly for an increasing number of patients who now are seeking redress through the courts and who are facing difficult multistage reconstructive surgery at a considerable emotional and financial cost.
It’s actually a cost that we all, as Australians, will bear, as our tax dollars ultimately will be spent to treat patients in both the public and private sector.
My practice in Sydney is now spent in the main, performing reparative surgery to many women who have fallen victim to these circumstances. It is hard work, but I feel compelled to provide help (often at little or no out of pocket cost), as it is part of my remit of being a caring doctor.
What then is the way forward? I applaud the decision by our health ministers and custodians of our great healthcare engine in Australia to push for tightening of the usage “cosmetic surgeon”. I would go one step further to propose a ban of the term altogether.
In this area of medicine where there is a dangerous mix of commercialism with professionalism, the best way to protect patients is to ensure that quality, safety, standards of care and transparency with respect to risks and benefits are placed ahead of the needs of the business.
The best doctors always put the needs of the patient ahead of all else — it’s really quite simple.
Professor Deva (@saferimplants) is a leading Australian clinician, academic, translational researcher and healthcare innovator. He is founder and director of the integrated specialist healthcare education and research foundation and Head of Plastic and Reconstructive Surgery at Macquarie University.