From July, patients must see a GP before facing a scalpel – but there’s no need to assess the patient or know anything about the procedure.
Mandating GP referrals for cosmetic surgery without including a requirement to screen for mental and physical suitability amounts to nothing more than an administrative hurdle, according to RACGP sources.
Associate Professor Magdalena Simonis, who chairs the college’s Women in General Practice Group, told The Medical Republic that she was surprised to see the referral requirement included in AHPRA’s latest update on cosmetic surgery reforms.
In its monthly newsletter, sent earlier this week, the regulator mentioned that it had published its revised guidelines for doctors who perform cosmetic surgeries and that it had included a requirement for patients seeking cosmetic surgery to get a referral from their regular GP.
According to the Medical Board, this measure will add a layer of protection for patients because they will be “able to discuss their motivation for cosmetic surgery with their GP”.
However, unless the patient is under 18 there is no requirement for the GP to screen for physical suitability for surgery or for mental health conditions like body dysmorphic disorder – this duty still falls to the treating surgeon.
Soon people will need to see their GP before they get a tattoo. The final stage of control will be needing assessment prior to extreme hair cuts and out there colouring.
— Donald Rose (@twitbug500) April 5, 2023
Dr Timothy Edwards, president of the Australasian Society of Aesthetic Plastic Surgeons, said the society values the input of GPs, but was also unsure whether a referral requirement would end up becoming a burden on the system.
“We are … conscious of the great demands placed on GP services at the present time, and so we hope that the Government will consult with the RACGP to ensure this measure does not become a further burden on a vital service that is already under considerable stress,” he told TMR.
Professor Simonis, who helped inform the RACGP’s submissions to AHPRA’s inquiry into the regulation of the cosmetic surgery industry, said her advice had been the exact opposite of what AHPRA had gone with.
“In fact, I said it would overload us and that we’re not equipped, really, to make a decision on every form of surgery,” she said.
For example, she said, patients might take it as a signal to ask advice on different breast implant types or facelift procedures.
The rule will apply to all cosmetic surgery procedures that involve cutting beneath the skin, but not non-surgical procedures like injectables.
“We could certainly … assess their suitability for surgery in terms of their health, in terms of their chronic disease background, in terms of their mental health and their psychological state,” said Professor Simonis.
“But that’s not what I understood [AHPRA’s] announcement to mean.”
The RACGP’s submissions to AHPRA on cosmetic surgery reforms don’t explicitly state that it would be opposed to mandated referrals, but it recommended that patients consult with an independent, appropriately trained health professional prior to undergoing a significant cosmetic procedure.
In a submission made in December last year, the college requested that AHPRA more clearly articulate what role the GP referral would take.
“The purpose of referral from a GP is to provide important medical information to the referred clinician such as patient history, existing comorbidities, and medications,” the RACGP said.
“An appointment with the GP also provides an important opportunity to counsel patients (particularly those under the age of 18) and to assess the patient for underlying psychological conditions, such as body dysmorphic disorder, which may make them an unsuitable candidate for the procedure.”
In its announcement, the Medical Board clarified that it does not expect GPs to have “detailed knowledge” of cosmetic procedures, just to provide a referral.
If GPs aren’t required to know the ins and outs of cosmetic surgeries, and there’s no requirement to screen the patient in any way, then why require a referral at all?
“Most cosmetic surgical procedures at this point in time happen outside of the MBS system,” Professor Simonis said.
“Is this really a means of capturing the amount of cosmetic surgery that’s taking place?”
Professor Simonis pointed out that even AHPRA likely has no firm estimate for the number of cosmetic surgeries that take place each year.
Even the requirement for GPs to write a referral in itself wouldn’t give the numbers directly – the regulator would have to introduce a specific item number if it wanted to measure the volume of patients going under the knife for beauty.
