Involving other professionals

Background

Ellen is 32 and gave birth to her second child six months ago. She lost weight easily after the birth of her first child but hasn’t this time and has excess skin and pockets of fat. 

Ellen’s tried managing her diet and exercising more but she doesn’t feel that anything is happening.  And the way she looks is affecting her confidence and she feels very low and is reluctant to leave the house.  She’s come to see consultant cosmetic surgeon Ms Hyde to discuss an abdominoplasty

Scenario 

Ms Hyde explains that it can take well over a year for a woman’s body to recover from pregnancy and is likely to still see further changes in her figure. 

She asks Ellen a few more questions and explains the potential impact on her family life. Having surgery will mean a 24 hour hospital stay and not lifting her baby for several weeks. Ellen becomes tearful and tells Ms Hyde that she just can’t see how things will improve when she feels disgusted every time she looks in the mirror.

Ms Hyde is concerned that Ellen’s low mood and lack of energy may be caused by an underlying psychological condition, such as depression or anxiety. 

She tells Ellen that she isn’t happy booking her in for surgery without first addressing her psychological wellbeing. She would like to refer her to a psychiatrist for assessment and she also wants to speak to her GP. 

Ellen is surprised and reluctant for Ms Hyde to discuss any possible cosmetic surgery with her GP.

What the doctor did

Ms Hyde says she won’t speak to Ellen’s GP without her consent, but explains that she won’t proceed until she has a clearer picture of her medical history including an assessment with a psychiatrist.

Ellen’s annoyed and says she’s paying for this service but Ms Hyde stands by her advice. Ellen then agrees to see a private psychiatrist and also gives Ms Hyde her consent to contact her GP.

The psychiatrist confirms that Ellen is suffering from depression, but not postnatal depression. He recommends cognitive behavioural therapy (CBT) and suggests discussing with her GP whether she should be on antidepressants.

Two months later, Ellen returns to see Ms Hyde. She is feeling better, the CBT has helped her to manage her negative feelings and she’s joined a local depression support group.

She still hasn’t seen much change in her figure and would like to go ahead with the tummy tuck in a few months when her oldest child starts nursery and it will have less impact on her family.

What the doctor had to consider

• A patient’s psychological needs, realising that  there may be underlying mental health issues affecting the decision to request surgery.  (paragraph 19).

• Recognising the limits of your competence and working with an experienced colleague to make the patient’s psychological needs are assessed (paragraphs 43, 44, 45).

• Respecting a patient’s right to confidentiality when there is no public interest in sharing the information and it is not required by law and making sure decisions are recorded in the patient ‘s records (paragraph 27). 

• The patient should be given written information after the surgery explaining everything in enough detail to enable another doctor to take over their care if necessary. And if the patient consents coping this to the GP to help the GP more accurately assess the patient’s health care needs in the future.

• The doctor carrying out the procedure would be responsible for all aspects of after-care, if the patient refuses to have the information shared, (paragraph 39).