Rural generalists are not the only group to raise concerns over AHPRA’s cosmetic surgery reforms.
Concerns are growing that mandatory referrals for cosmetic surgery have the potential to open GPs up to litigation, but the government pinky-promises it won’t happen.
As part of the ongoing attempt to clean up the cosmetic surgery industry, AHPRA and the Medical Board have designed a suite of reforms set to come into play from 1 July.
Rural generalists have already raised issues with the planned restriction of the “surgeon” title, arguing that it will adversely impact rural generalists with additional training in obstetrics and surgery. This puts them up against the AMA, which supports the strictest use of the title.
Now, the RACGP has written to the Medical Board requesting more information on the incoming requirement for all patients seeking cosmetic surgery to have a referral letter written by a GP.
The requirement only applies to cosmetic procedures which require cutting beneath the skin – non-surgical cosmetic procedures like botox, dermal fillers, varicose vein treatments and laser are exempted from a referral requirement.
In a letter to Medical Board chair Dr Anne Tonkin, the RACGP says that while there are instances in which having a GP referral is valuable for patients, it is outside the norm for GPs to write referrals unrelated to a particular health condition.
“A referral could be interpreted by the patient as an endorsement of the procedure, or of the clinician, which of course it is not,” the letter said.
The college requested further clarity on the reasoning behind the mandate, as well as a discussion on whether it could be amended.
Dr Tonkin and the Medical Board have not issued a reply at time of writing.
The Medical Board does have a frequently asked questions section relating to cosmetic surgery referrals, where it seeks to assure GPs that a referral is not an endorsement.
“Similar to any other referral, a referral will provide important medical information to the referred practitioner such as patient history, existing comorbidities, and medications,” the FAQs read.
“The GP can assess a patient’s physical and mental health and it is also an opportunity for a patient to discuss their motivation for cosmetic surgery with an independent practitioner.
“It is expected it will support continuity of care and patient safety.
“A referral from a GP is therefore not a recommendation of a surgery or a cosmetic practitioner.”
Of course, what’s not clear is whether the assurances of a government FAQ page will stand up in a court of law, should a dissatisfied patient or surgeon attempt to sue their GP.
MIGA senior manager of legal services Anthony Mennillo told The Medical Republic that the key medicolegal exposure for GPs writing these referrals likely lies in what they include on the patient’s mental health background.
“If it’s the usual treating general practitioner, which is what the Medical Board guidelines recommend, then that GP hopefully would have more information about that patient’s background, about that patient’s motivations, whether there’s any psychological history that might be relevant to … pass on to the practitioner before recommending or performing surgery,” he said.
“Or – and the guidelines are pretty clear – the referrer can decline to provide a referral in the circumstance [that] there is such a [significant] history.”
For example, if the GP was aware that the patient had a significant history of body dysmorphic disorder and likely wouldn’t be satisfied with the outcomes of any cosmetic procedure, the GP would be wise to either decline to write the referral or, at the very least, include that information for the surgeon to consider.
Prior to performing the surgery, cosmetic surgeons will now be required to screen patients for mental health conditions like body dysmorphic disorder and refer them back to a GP if anything is picked up.
“If there is a less severe psychological history, then the referrer [can] still provide the referral, but it’s important that they point that out to the cosmetic practitioner before recommending or performing the surgery,” Mr Mennillo said.
“And that’s where their exposure might be – if [the GP] didn’t provide that [information] and should have, that’s potentially an issue.”
As for the flip side, it’s not clear how the government will enforce the referral requirement, given that cosmetic surgery tends to be done fully privately, without going through MBS bean-counting.
“[AHPRA and the Medical Board] won’t necessarily know if it’s not happening, but it’s a huge risk for the cosmetic surgeon if they don’t [have a GP referral on file] and then there’s an adverse outcome that comes to AHPRA’s attention,” Mr Mennillo said.
“The Medical Board will, I expect, come down hard on them.”
Until the system is up and running though, Mr Mennillo said it was difficult to predict what would happen.
