THE 4 ‘R’S OF REFERRAL
– WHEN SAYING ‘NO’ IS IN YOUR PATIENT’S BEST INTEREST BDD is on the rise; here’s how to safely refer a patient that’s unfit for treatment to a psychologist, says Dr Toni Pikoos.
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ave you ever come across a patient in your practice, who continues to feel dissatisfied or unhappy with the treatment outcomes, even when you thought that the treatment was a success? Every injector will face this scenario at some point in their career. One possible reason for this dissatisfaction could be body dysmorphic disorder (BDD), a psychiatric condition where individuals hold a distorted perception of their physical appearance, becoming preoccupied with flaws that appear minor or non-existent to others.1 BDD is a condition that’s on the rise, and disproportionately affects people seeking both surgical and non-surgical cosmetic procedures. While only 2.9% of the general population have BDD, this number skyrockets to between 15-20% of patients seeking cosmetic treatment.2 While most people seeking cosmetic procedures experience positive results, such as improvements in body image, self-esteem and confidence, individuals with BDD are at greater risk of dissatisfaction or adverse events. In up to 91% of cases, people with BDD don’t experience any change in their symptoms, and in 16% of cases, their symptoms actually worsen following cosmetic treatment.3 Patients with BDD are not only more likely to be dissatisfied, but may also make complaints, leave negative reviews or take legal action against the practitioner.4 Beyond BDD, other mental health issues can also increase the risk of poor outcomes from cosmetic treatment, including personality 58 | SPA+CLINIC
disorders, severe anxiety or depression, obsessive-compulsive disorder and eating disorders. 5 For this reason, the Medical Board Guidelines (2016) and the Australian Health Practitioner Regulation Agency (AHPRA) recommend routine mental health screening prior to undertaking both surgical and non-surgical cosmetic procedures. By completing a mental health screen during your consultation, it can help you identify who is most likely to benefit from cosmetic treatment, and who may be at risk of dissatisfaction. Using my clinical and research experience, I started ReadyMind, an organisation which develops screening tools to help cosmetic practitioners assess the psychological needs of their patients (visit www.readymind.com.au to access these tools). We recommend implementing these questionnaires prior to or during your consultation to protect yourself, your practice and your patients. But one of the biggest challenges comes after the initial screening stage – you’ve identified that your patient may have BDD or another mental health concern, now what? The research suggests that in these cases, referral to a mental health professional is the most appropriate next step, before proceeding with cosmetic treatment. The mental health professional would further assess the patient’s emotional wellbeing, goals and expectations for cosmetic treatment and facilitate a discussion of whether the procedure is likely to resolve their concerns or if alternative options such as psychological treatment may help. This can support