As a consumer/patient and psychotherapist with a specialist interest in body image issues and cosmetic surgery counselling, I have been very concerned about the trivialization of cosmetic surgery and how this affects patients’ expectations. Regulation will offer greater physical and mental protection by reducing some of the greater anxieties suffered by patients.
The review addresses two main areas:
- Physical protection
- Emotional welfare
It is easy to see from a selection of the recommendations below how much more protection will be afforded to patients who have been vulnerable in an unregulated industry:
- A register for all medical devices including breast implants
- Surgeons must be on the GMC Specialist Register and practicing in that field
- Fly-in/Fly-out surgeons subject to UK standards
- Patients can review meaningful data
- Legislation to classify fillers/botox as prescription only
- Ban on incentive/special offers
- Patients must see the surgeon and not a sales person
- Fund to help patients when companies go bust
- Ombudsman for private health (including cosmetic surgery)
- Compulsory insurance
The Keogh Review acknowledges the vulnerability of patients. Every elective beauty enhancement surgery contains a vast emotional component. Psychological questionnaires may create better-informed surgeons but, with the best of intentions, do not create well-informed, integrated (mind/body) patients.
It is easy to think that counsellors should only be involved when cosmetic surgery goes wrong or if a surgeon believes a patient to be unsuitable for surgery. This dated concept of counselling creates a lost opportunity to increase patient safety and negate surgical risks. Specifically trained cosmetic surgery counsellors would make a valuable addition to the forthcoming patient safety regulations resulting from the Keogh Review.
The counselling conversation is a unique experience where patients can feel safe enough to explore their issues. This is not the same as talking to a friend, although the best counselling sessions will feel that way.
Counselling (as part of the consent process) pre-operatively creates a preventative measure against rogue traders in the industry. A cool-off period is more productive when patients are referred to counsellors who understand what constitutes a well-informed patient according to new regulation.
Mind and body in cosmetic surgery have become alienated from one another and must be re-united if safety is to remain centre stage. The person-centred relationship built up in pre- and post-operative counselling becomes the intermediary between beauty shopping and medical procedures. Patients benefit from the opportunity to safely reintegrate internal (mind) and external (body) aspects of their needs. This delivers a more relaxed, realistically-grounded patient to the surgeon.
Every fibre of my being believes that counselling should be an integral part of the consent process: even more so in the cases of patients who wish to keep their surgery secret. At the very least patient support sites and support groups would benefit from the professional skills a cosmetic surgery counsellor brings to the experience.
The quest for beauty is equally a quest for health, happiness and well-being. As consumers/patients, the false belief has been that the path to beauty, health and well-being is always safe and pretty. Regulation from the Keogh Review will go a longer way toward making this a reality if the path to well-being is clearly integrated.
The disjunction between pressurizing commercial interests of the surgery industry and the self-critical anxieties of credulous patients is where insight through counselling creates well-informed patients.
Patients who once were insecure about their looks as well as ill-informed about their choices can take pride in joining a cultural shift towards better knowledge and better outcomes both practically and emotionally.
Consultations with a surgeon are a time to concentrate on what can and cannot be done through surgery. It is not the time or the place to discuss personal psychological issues.
Consultations can create confusion in patients. Many patients may need more than one consultation with a surgeon. We are not easily able to look objectively at our bodies the way a surgeon can. Often, we are unable to picture how the discussed changes will really look. Some surgeons offer 3-D imaging but even with that it is not always easy to imagine the predicted reality. Additionally, we may think we need one thing and a surgeon may suggest something else. Sometimes we may need more than one surgery to achieve our goals. Patients may feel anxious about asking for a second consultation.
Patients need time and freedom from pressure to consider everything after a consultation. Patients may say they do not need counselling but experience shows that they spend countless hours online searching for support groups to talk about their needs and experience. Whilst these online relationships are helpful for patients, they often compound mis-information and cannot replace the benefit of conversation with someone suitably qualified to understand the sensitive issues involved. This need to talk has been exploited by sharp operators online who take referral fees or have other exploitative agendas that they keep concealed. Genuine, non-exploitative counselling sessions online through specifically tailored support groups keep patients safe in many ways.
Physical patient safety will benefit from the Keogh review. A specifically trained independent cosmetic surgery counsellor will help a patient shield themselves against the twin arrows of hype and dismissal. A safe conversation has no exploitative agenda. A more frivolous conversation about beauty and fashion can be helpful to while away the hours before and after surgery but will not enhance patient safety. Where advertising in medical procedures exists, so too remains the need for demystification.