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Are plastic surgeons required to do a psychological evaluation on pts prior to procedure?

Q:

Are plastic surgeons required to do a psychological evaluation on pts prior to procedure?

Are there Rules/laws governing practice?

A:

 

 No, psychological evaluation are not a requirement for plastic surgery. However, certain practitioners find them very useful in patients they consider may have psychological or psychiatric issues. Some examples would be a patient that appears to have an exaggerated concern over a minor or nonexistent problem or a patient that has undergone repeated surgical procedures by other surgeons/ physicians. The concern is over what is called Body Dysmorphic Syndrome (http://en.wikipedia.org/wiki/Body_dysmorphic_disorder). 

 Often the reason why these surgeons are performing these psychological evaluations is in the best interest of their patients. Body Dysmorphic Syndrome is most appropriately treated by medical treatment not surgical intervention. Best,

 

Gary R Culbertson, MD, FACS 

A:

No, plastic surgeons are not required to conduct a psychological evaluation. Plastic surgeons are required to ensure that a patient has the emotional and intellectual maturity/stability to be able to provide an informed consent. 

A:

Psychological Evaluations Before Plastic Surgery – I do not do routine psychological evaluations on my patients. Many patients, of course, have psychological diagnosis and are being treated by their psychiatrist or their physician with psychotropic or anxiolytic drugs which is fine. I feel that for cosmetic surgery, one needs to be reasonable, realistic and certainly needs to have a normal grasp of their pre and post operative risks and complications. The patient also needs to be realistic about their results. If I don’t feel that is the case, I don’t think that a psychological evaluation will help me and I personally would not do the operative procedure if I feel the patient has significant psychiatric problems or illness.

 

A:

Psychological evaluations prior to aesthetic plastic surgery is not required. However, it is important for a plastic surgeon and the staff of a plastic surgeon have the opportunity to get to know a patient before rushing into surgery.

The consultation process in my practice (and in the practice of many other plastic surgeons) goes as follows

1) First consultation with a surgical consultant to discuss general information about the plastic surgery procedure they are considering. A PA, RN, or NP will review health history and medications. 

2) Second consultation, generally takes place a week or more after the first consultation. During this consultation, I will meet with the prospective patient and discuss the particulars of their surgery including recovery.  This is an hour long consultation.

3) Patient will receive a quote for surgery and if the patient desires, surgery will be scheduled. Busy plastic surgeons have a schedule that requires a wait period of almost always at least a month and in some cases much longer

4) Pre-operative appointment. This is the final meeting with surgeon and patient prior to surgery to review surgery and recovery and answer any questions.

This process allows patients to get to know their plastic surgeon well and visa versa. If there is doubt about a patient being a good candidate for surgery for any reason, we have many opportunities to discover this. I have some wonderful patients who we insisted wait on surgery, sometimes people are in the very early healing process of a divorce or death of a spouse, others feel pressured by another person to have surgery. Still other people think that plastic surgery is an answer to all their problems. Sometimes it take a little time to get to know someone before some of these issues are revealed. 

Unfortunately, too many physicians practicing cosmetic surgery, many of whom are not board-certified plastic surgeons seem more interested in getting a patient pre-qualified for financing and scheduling surgery as quickly as possible. In fact, some physicians even offer reduced rates for scheduling and paying for surgery by a particular date, creating additional pressure for a prospective patient. In this scenario, there is a higher likelyhood that a person who is not psychologically prepared for surgery will end up on the operating table. 

Always search for a board certified plastic surgeon who is also a member of ASAPS

 

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