submitted by Deborah Sandler
In response to your Call for Evidence re Cosmetic Surgery I propose the following recommendations:
- Pre- and post-operative counselling should be strongly recommended as a necessary component of cosmetic surgery.
- Counsellors should be specially trained and approved.
As noted by Sir Liam Donaldson in 2005 (1), there is a lack of balanced information about the risks and benefits of cosmetic surgery. Prospective patients can too often be the victims of unscrupulous clinics which offer pressurizing sales promotion. Sometimes this is even disguised as ‘counselling’ or ‘patient support’. Such practices provide a misleading sense of reassurance to vulnerable people subject to manipulative advertising.
Patients need opportunities to talk about their motivation, expectation and fears with unbiased and trained counsellors wholly independent of commercial pressures.
The PIP scandal has prompted the formation of many new patient support groups with a focus on justice for patients adversely affected.
PIP patients will benefit from counselling which offers an opportunity to recover from the post-traumatic mental trauma caused. Many lives have been turned upside down and many are still struggling with the damaging consequences of their experience.
All patients benefit from counselling before and after life-changing and irreversible surgery.
‘Cooling-off’ periods that include counselling sessions are more productive
‘Cooling-off’ periods allow patients to consider their choice of surgeon
Surgeons benefit by having calmer, more relaxed, better-informed patients
Patients will have access to counsellors as advocates where necessary
Counsellors can organize patient meetings with permission. This encourages realistic expectations. Promotional static photos shown during information-laden consultations are inadequate
Online patient support groups reveal high levels of confusion and anxiety through misleading adverting, causing poor decisions on the part of the patient. Specially trained cosmetic surgery counsellors kept up-to-date with current policies will help clarify the information patients need.
After-hours online counselling reduces post-operative stress, helping recovery. Patients feel safer knowing there is unbiased emotional support and information a few clicks away.
Creating well-informed patients requires collaboration from all parties involved in cosmetic surgery, especially surgeons and nurses The support of BAAPS and BAPRAS, both as organizations and as individual surgeons, would enhance emotional patient safety. Disappointingly, I have repeatedly been met with reluctance on their part when seeking support for this additional safety net, despite their claim to ‘tirelessly educate the public’2. I have asked BAAPS’ permission to allow me to reproduce their surgical information fact sheets on my website only to be met with ‘our surgeons are sensitive about who uses their information’ and ‘if you use our information sheets, everyone else will want to’ and ‘if you reprint this information, it is plagiarism’. This kind of information protection puts the safety and education of patients at risk.
My experience has shown that a patient who claims to have done some ‘research’ on their plastic surgery procedure will be able to talk about prices and distances and whether or not the plastic surgery clinic they are going to will drive them home. Crucially, most of their research will revolve around the photos they have of the clinic and the glossy pictures of the results that clinic is showing. Patients also generally know about a clinic’s ‘special offers’. In other words, the patients ‘research’ is often little more than reading an advertising brochure.
I understand that the current call for the ban on advertising cosmetic surgery may stop this type of ‘patient research’ but there will still be a need for patient education, information and support, even without the advertising.
Clear information and psychological support creates well-informed patients who are able to:
Understand their motivations physically and emotionally
Manage their expectations
Make informed decisions
Know how to access psychological support pre- and post-surgically
Know how to access emotional support after hours and at weekends
Understand the difference between advertising and information
Not succumb to pressurized sales techniques.
Declaration of Interest
I have a training in psychotherapy and a specialist interest in body image, with personal experience of both good and bad cosmetic surgery, as well as body dysmorphic disorder. I am a member of the All Party Parliamentary Steering Group for Body Image. I have run a voluntary, independent and non-profit cosmetic surgery patient website for 13 years (Cosmeticsupport.com) offering information and psychological support, including moderated discussion forums and videos. The latter cover such questions as:
How Do I Become a Well-Informed Patient?
What Makes A Good Consultation?
What Are Realistic Expectations from Cosmetic Surgery? Will I Need Further Surgery?
The site covers all surgeries and other cosmetic procedures and receives no commercial funding. I would welcome the opportunity to work with BAAPS/ BAPRAS more closely in offering this type of information to all cosmetic surgery patients.
2. www.baaps.org.uk/about-us/press-releases/1029-surgeons-put-forward-regulation proposal