Whenever a doctor provides or arranges treatment for a patient, they must do so on the basis of what would be of overall benefit to the patient. While the vast majority of treatment decisions will be medically indicated, the potential benefits stretch beyond strictly medical interests to include, for example, psychological factors. This is the case with much cosmetic surgery - the doctor decides that the risks of surgery are outweighed by the potential improvement in a patient's mental health and general wellbeing that a positive outcome could achieve.
Having said that, while a patient's requests for treatment must play a part in care, they should not override a doctor's professional judgement. In this case study, if Dr Yannis considers that the second face-lift is unlikely to deliver the desired outcome or to be of overall benefit to Mrs Melville, he must discuss this with her and explain his reasoning. If, after discussion, he still believes the face-lift will not be of benefit to Mrs Melville he must not provide it. Mr Yannis should discuss other options available to Mrs Melville and respect her right to seek a second opinion.
Although the structure of healthcare is constantly changing, most people in the UK still have a GP who is first point of contact for concerns about their health. If referral to a specialist is necessary, then the GP makes the referral and discloses relevant information to the specialist. The specialist sees the patient, then communicates with the GP as well as with the patient about the treatment required and follow up care.
However, patients will probably approach doctors who provide cosmetic procedures directly, rather than through their GP. In these circumstances, the doctor must consider whether it is necessary to consult the patient's GP to inform the discussion about benefits and risks. If so, a doctor must seek the patient's permission and, if they refuse, discuss their reasons for doing so. If the patient is determined not to involve their GP, the doctor must record this in their notes and consider how this affects the balance of risk and benefit and whether they should go ahead with the procedure. If the doctor decides to go ahead with the procedure and the patient refuses consent to send information about the intervention to their GP, then the treating doctor must record this in the patient's notes, and will be responsible for providing the patient's follow-up care. Mrs Melville eventually agrees to Dr Yannis contacting her GP but, if she hadn't, Dr Yannis would need to consider whether he was prepared to go ahead with the procedure. If he did, without contacting the GP, then he'd be responsible for her follow-up care.
Doctors used to be banned from advertising their services directly to the public. However, Good Medical Practice has never prohibited doctors from advertising their services provided that the information is honest, factual and doesn't exploit patients' lack of medical knowledge. Our cosmetic interventions guidance requires doctors to ensure that marketing of their services is responsible and follows the regulatory codes set by the Committee of Advertising Practice. Doctors must also ensure that they don't mislead about the results they are likely to achieve and not falsely claim or imply that certain results are guaranteed. The title of the advert that Jenny has written for Dr Yannis ("We will make you beautiful") strays outside these requirements because it makes a broad claim about the quality or outcome of the service that would be difficult to verify.
Doctors must be careful when using information about patients - in this case study Mr Yannis uses photographs of his patients for advertising. IT is important that the patient has given consent for the doctor to use their information in this way, whether or not the doctor believes that the patient can be identified from the information. Our guidance on Confidentiality and the supplementary statements expand on the advice in Good Medical Practice. Even if the intended use is teaching, rather than something more easily accessible to the public, the doctor must take care to ensure that the patient is not identifiable from the information.