Mind the Gap - There must be psychological screening for cosmetic surgery patients

Posted on the 10 December 2012 at 13:46

As aesthetic surgery becomes increasingly popular, proper patient selection becomes even more important to the entire surgery process. Aesthetic surgery is unique because, unlike any other surgical procedure, it is initiated by the patient and not the physician. In addition, this surgery elicits a more acute reaction from its patients than any other type of surgery.

Before agreeing to operate, a surgeon must evaluate the psychological condition of a patient. Whilst some surgeons (a small minority) in the UK will have pathways in place to address the psychological stance of an elective cosmetic surgery patient. Many others clearly do not.  Is there evidence to back my claim?

Well let’s commence with my personal experience, as a patient of cosmetic surgery myself having undergone five elective procedures, I can safely say I was not properly psychologically assessed for any of my procedures. In three of my 5 operations the ‘subject’ was barely touched upon, whilst for the other two procedures there was no mention at all.

Was I ever asked by my cosmetic surgeon ‘why’ I wanted to undergo liposuction, or rhinoplasty or breast augmentation? NO, I was not. Was I ever asked if I would like counselling pre surgery or post surgery? NO I was not, was I ever prepared for how I would ‘feel’ before or after surgery? NO I was not, I think you’re starting to see a pattern emerge here right?

In 2011, Cosmetic Surgery Times ran a news item stating that UK surgeons were backing a psychological test for patients and that some private clinics in the United Kingdom had begun using new assessment forms aimed at stopping people from having cosmetic surgery they may later regret, you can imagine my genuine enthusiasm at reading this development when it emerged.

The news clipping further stated that Psychologists who developed the test said ‘patients are being put at risk by some facilities that do little or no checking’, the tests were backed by the British Association of Aesthetic Plastic Surgeons, and some member clinics were reported to have ‘already started using the form.

The forms consisting of a mere 10 questions were to be answered by a patient before their first consultation with a surgeon. A separate guide was in place to ‘help surgeons identify patients who may be unsuitable for surgery and who perhaps need counselling instead’, this is the part where my enthusiasm quickly turned into scepticism, forgive me but 10 questions on a tick form and a ‘guide’ to ‘help’ a surgeon ‘assess’ a patient hardly constitutes proper screening, does it?

May I also hasten to add that at this point no surgeon whether a BAAPS member or not is actually obligated by any regulation to carry out psychological screening.

I personally have had two consultations with BAAPS surgeons this year and whilst they talk a good ‘game plan’ and I am sure they have the best intentions ‘at heart’ the reality translates into something quite the opposite.

It is a non arguable topic in my case. When I woke up from a routine breast augmentation procedure two years ago, something that many thousands of women have done before me and probably thousands more have done since, nothing prepared me for the feelings that hit me as I exited the surgical theatre and was wheeled away nauseously to my post surgical recovery room.

I remember breaking down into floods of tears shortly after coming round and feeling rather ‘fragile’, it wasn’t  the pain of the actual surgery that was troubling me, (as I was in ‘pain killer’ territory to address that aspect) but more an inner turmoil and anxiety that I couldn’t quite explain. I remember thinking, ‘nobody tells you about this bit’.

It was the same feeling that had hit me in the pre operative room before my breast surgery, as surgical staff worked busily around me preparing me for the scalpel, the memories of laying on a hospital bed staring at a stark white ceiling still haunt me, overcome by muddled feelings of excitement, fear, anxiety and guilt, I asked myself at the time, Was ‘this feeling normal’? I never had time to ponder the question much as seconds later I was deep asleep in anaesthetic slumber.

As a Cosmetic Surgery and Beauty Coach, I see dozens of women (and men) monthly who consult with me for information, guidance and referral to the safest ways to shop for image enhancement services, be they doctors, nurses, clinics, or aestheticians, I always aim to inform my clients on the best way to make the right decisions and my ultimate objective is to arm a client with the essential knowledge and skills to empower them as individuals to make the right choices ‘themselves’. As a person who has ‘safety’ at the helm of my core message this stance sits more comfortably with me in terms of ethics, rather than simply reel of a few randomly picked names of medical experts.

However no matter how well informed you are, no matter how well prepared you are physically there is clearly insufficient preparation within the industry when it comes to ‘psychologically’ preparing a patient for cosmetic surgery pre and post operatively ’.

My experiences and those of many hundreds of patients that I have dealt with over the years have led me to seriously question this aspect of Cosmetic Surgery, a subject I feel is too easily over looked or brushed aside.

A report by the National Confidential Enquiry into Patient Outcome and Death found many centres in the UK offering cosmetic surgery were failing to assess and care for patients properly, including psychological evaluations.

It was for this reason I set up an e-petition earlier this year calling upon the government to implement mandatory psychological screening for invasive elective aesthetic surgery procedures.

If a surgeon can’t be ‘bothered’ to handle the psychological aspects of surgery as they’re far too busy dealing with the ‘practical stuff’ then may I suggest they refer patients to independent counsellors and experts who now offer pre and post cosmetic surgery counselling such as http://thewrightinitiative.com/  this way the patients journey is a much more positive and safer experience and realistic outcomes will have a far better success rate all round, after all no matter how skilled a surgeon may be, a scalpel may be able to fix an imperfect body but it doesn’t quite cut it when it comes to healing the mind.  

Please sign my petition: http://epetitions.direct.gov.uk/petitions/34217

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