Communication, partnership and teamwork
You must communicate clearly and respectfully with patients, listening to their questions and concerns and considering any needs they may have for support to participate effectively in decision making.8
Seeking patients' consent
You must be familiar with the guidance in Decision making and consent. In the following paragraphs, we’ve highlighted key points from the guidance, which are important to protecting patients’ interests in relation to cosmetic interventions.
Responsibility for seeking consent for cosmetic interventions
If you are the doctor who will be carrying out the intervention, it is your responsibility to discuss it with the patient and seek their consent – you must not delegate this responsibility. It is essential to a shared understanding of expectations and limitations that consent to a cosmetic intervention is sought by the doctor who will perform it, or supervise its performance by another practitioner.
Responding to requests for cosmetic interventions
If a patient requests an intervention, you must follow the guidance in Decision making and consent, including consideration of the patient’s medical history. You must ask the patient why they would like to have the intervention and the outcome they hope for, before assessing whether the intervention is appropriate and likely to meet their needs.
If you believe the intervention is unlikely to deliver the desired outcome or to be of overall benefit to the patient, you must discuss this with the patient and explain your reasoning. If, after discussion, you still believe the intervention will not be of benefit to the patient, you must not provide it. You should discuss other options available to the patient and respect their right to seek a second opinion.
When you discuss interventions and options with a patient, you must consider their vulnerabilities and psychological needs. You must satisfy yourself that the patient’s request for the cosmetic intervention is voluntary.
You must explain any monitoring or follow-up care requirements at the outset. You must tell patients if implanted medical devices may need to be removed or replaced and after how long.
You must tell prospective patients if alternative interventions are available that could meet their needs with less risk, including from other practitioners.
Discussing side effects, complications and other risks
You must give patients clear, accurate information about the risks of the proposed intervention and any associated procedures, including anaesthesia and sedation,9 following the guidance in Decision making and consent (paragraphs 11-12, 17-24, 27-30, 58f and 66-67).
See the Royal College of Anaesthetists’ Safe sedation practice for healthcare procedures (accessed 7 March 2016).
You must talk to the patient about any adverse outcomes that may result from the proposed intervention, paying particular attention to those the patient is most concerned about.10 You must talk about the potential adverse physical and psychological impact of the intervention going wrong or failing to meet the patient’s expectations.
Medical research involving children (pdf) (Medical Research Council, 2004), Guidelines for the ethical conduct of medical research involving children (Royal College of Paediatrics and Child Health: Ethics Advisory Committee, 2000), Guidelines on the practice of ethics committees in medical research with human participants (Royal College of Physicians, 2007).
Giving patients time for reflection
You must give the patient the time and information they need to reach a voluntary and informed decision about whether to go ahead with an intervention.
The amount of time patients need for reflection and the amount and type of information they will need depend on several factors. These include the invasiveness, complexity, permanence and risks of the intervention, how many intervention options the patient is considering and how much information they have already considered about a proposed intervention.
You must tell the patient they can change their mind at any point.
You must consider whether it is necessary to consult the patient’s GP to inform the discussion about benefits and risks. If so, you must seek the patient’s permission and, if they refuse, discuss their reasons for doing so and encourage them to allow you to contact their GP. If the patient is determined not to involve their GP, you must record this in their notes and consider how this affects the balance of risk and benefit and whether you should go ahead with the intervention.
Being clear about fees and charges
You must explain your charges clearly, so patients know the financial implications of any decision to proceed to the next stage or to withdraw.
You must be clear about what is included in quoted prices and what other charges might be payable, including possible charges for revision or routine follow up.
Treating adult patients who lack capacity
If you consider providing an intervention for an adult who lacks capacity to make the decision about whether to go ahead with the intervention, you must follow the advice in paragraphs 87-93 of our Decision making and consent guidance. The advice in these paragraphs takes account of the legal requirements across the UK that govern decision-making with adults who lack capacity.
You must seek and take account of the views of people close to the patient, as well as any information you and the healthcare team may have about the patient’s wishes, feelings, beliefs and values. Your approach to consulting with those close to the patient should follow the advice on sharing information set out in paragraphs 8-30 of our Decision making and consent guidance.
Treating children and young people
If providing treatment to children, you should be familiar with the detailed advice in 0–18 years: guidance for all doctors, which includes the key points set out in this section of guidance. You should take particular care if you consider providing cosmetic interventions for children or young people – you should make sure the environment for practice is appropriate to paediatric care, and work with multidisciplinary teams that provide expertise in treating children and young people where necessary.
You must only provide interventions that are in the best interests12 of the child or young person. If a young person has capacity to decide whether to undergo an intervention, you should still encourage them to involve their parents in making their decision.
A parent13 can consent to an intervention for a child or young person who does not have the maturity and capacity to make the decision, but you should involve the child in the decision as much as possible. If you judge that the child does not want to have the cosmetic intervention, then you must not perform it.
‘Parents’ are people with parental responsibility.
Your marketing activities must not target children or young people, through either their content or placement.
Providing continuity of care
You should consider whether you or a colleague will need to review the patient’s response to the intervention and make sure the patient understands whether you recommend a follow-up appointment.
You must make sure the patient has the medicines or equipment they need to care for themselves after an intervention.
You must make sure that your patients know how to contact you or another named14 suitably-qualified person if they experience complications outside your normal working hours.
See our Guidance for doctors acting as responsible consultants or clinicians
You should give patients written information that explains the intervention they have received in enough detail to enable another doctor to take over the patient’s care. This should include relevant information about the medicines or devices used. You should also send this information, with the patient’s consent, to their GP, and any other doctors treating them, if it is likely to affect their future healthcare. If the patient objects to the information being sent to their doctor, you must record this in their notes and you will be responsible for providing the patient’s follow-up care.
You should organise your records in a way that allows identification of patients who have been treated with a particular device or medicine in the event of product safety concerns or regulatory enquiries.
You must keep records that contain personal information about patients securely and in line with:
- any data protection law requirements
- our Confidentiality: good practice in handling patient information guidance guidance
- guidance published by the UK health departments, even when the interventions are provided outside the National Health Service.
Working with colleagues
You must make sure that anyone you delegate15 16 care to has the necessary knowledge, skills and training and is appropriately supervised.
'Colleagues' include anyone a doctor works with, in and outside their team, whether or not they are also doctors.
You must work effectively with healthcare professionals and others involved in providing care. You must respect the skills of colleagues within multidisciplinary teams and support them to deliver good patient care.
You must ask for advice from colleagues if the patient has a health condition that lies outside your field of expertise and that may be relevant to the intervention or the patient’s request.
You must make sure you build a support network of experienced professional colleagues who can support and advise you. You should ask for advice when you treat patients who may need psychological or other expert assessment or support.