Question and Answer with ReadyMind Co-Founder, Dr Toni Pikoos.
I’ve been fielding lots of questions from cosmetic practitioners about how the AHPRA guidelines will effect them, and how to implement them. I’ve consulted with AHPRA and wanted to summaries some of the most common questions i’ve been hearing:
QUESTION: Are the ReadyMind screening questionnaires validated?
Yes, every screening questionnaire on the ReadyMind platform has undergone a research-based development and validation process. Each questionnaire includes details regarding the validation process and psychometric properties of the questionnaire. Click here for more information about the validation of the Cosmetic Readiness Questionnaire.
QUESTION: Can the patient complete the questionnaire before their consultation?
Yes, they can! We have clarified this with AHPRA and received the below response:
“The Medical Board Cosmetic Guidelines state that the medical practitioner providing the surgery must assess the patient, and they must use a validated screening tool. The patient assessment cannot be delegated to another practitioner, nor can the patient complete their own BDD assessment. A patient can complete a questionnaire before the consultation but the practitioner must still discuss with the patient to assess for underlying conditions and to determine a patient’s suitability for cosmetic surgery.”
So, the practitioner can send patients the link to the Cosmetic Readiness Questionnaire to complete before the consultation, and then discuss this information with the patient during the consultation to make their assessment regarding suitability for cosmetic treatment.
QUESTION: Do I still need to assess my patient’s mental health, motivations and expectations during my consultation if I use the CRQ?
The CRQ is designed to aid your consultation, allowing you to gather a large amount of information in a short period of time. However, it is not a replacement for clinical judgement and you are encouraged to use the CRQ along with your routine consultation and assessment process to determine the patient’s suitability for treatment.
QUESTION: Do I need to screen my patients for Body Dysmorphic Disorder (BDD) for non-surgical cosmetic procedures?
AHPRA has addressed this question on their FAQ, and have stated:
“The Guidelines require that all patients seeking cosmetic surgery or non-surgical cosmetic procedures be assessed for suitability and underlying psychological conditions such as body dysmorphic disorder (BDD). The Guidelines specify that a validated psychological screening tool must be used to screen for BDD for patients seeking cosmetic surgery. A screening tool is not required for patients seeking non-surgical cosmetic procedures.”
QUESTION: How does the screening process work at ReadyMind?
ANSWER: ReadyMind offers a streamlined process for meeting the requirements under new AHPRA guidelines for cosmetic treatments. ReadyMind provides a software platform where practitioners can send patients a link to complete a screening questionnaire. The questionnaire is completed by the patient on their personal device either at home or at the clinic. The results are instantly scored and interpreted, generating a report that is emailed to the practitioner. The report includes an overall rating of the patient’s cosmetic readiness, reasons for the rating, and, if applicable, recommendations for further assessment or treatment.
QUESTION: What does the report from ReadyMind’s screening process look like?
ANSWER: The Cosmetic Readiness Questionnaire report provides an overall rating of the patient’s cosmetic readiness, categorized into green, yellow, or red zones. It breaks down the reasons for the rating, such as identifying factors like body dysmorphia or perfectionism. The report also offers recommendations for the practitioner, including referrals for further assessment by a mental health professional and prompts for discussing sensitive topics during the consultation.
QUESTION: What percentage of patients are expected to be in each readiness zone?
ANSWER: Based on pilot studies using the Cosmetic Readiness Questionnaire, approximately 70% of patients were in the green zone, 22% were in the yellow zone, and 8% were in the red zone. The red zone represents patients who are flagged for further referral and are considered to be at the highest risk. Standard Body Dysmorphic Disorder (BDD) screening tools tend to only have 47% of individuals in the green zone. That means that If you’re only assessing for BDD, about half of people might screen positive. This is why the CRQ takes a more nuanced approach that can better predict patient satisfaction.
QUESTION: How should practitioners handle conversations if a patient screens positive on the questionnaire?
ANSWER: ReadyMind suggests a four-step framework for referring patients to a mental health professional: relate, reassure, refuse, and refer. Practitioners should first empathize with the patient’s disappointment, then reassure them that their well-being is the top priority. Next, the practitioner should explain that they are unable to proceed with the treatment based on the screening results and guidelines. Finally, they should refer the patient to a specific mental health professional, normalizing the process and emphasizing that it is a common practice to ensure the best outcomes.
QUESTION: What is the role of a psychologist after a referral?
ANSWER: After the referral, the psychologist will conduct an assessment following guidelines set by the Australian Psychological Society. They will evaluate various domains to determine the patient’s readiness for a cosmetic procedure. The psychologist will then provide a report to the referring practitioner, highlighting the patient’s risk assessment and making recommendations. These recommendations may include psychological treatment instead of a cosmetic procedure, support before and after the treatment, or proceeding with the procedure if the patient is in the low-risk zone.
QUESTION: How do patients generally respond to the psychological screening process?
ANSWER: In focus groups conducted with patients seeking cosmetic treatments, eight out of ten participants had a positive response to the idea of a psychological screening questionnaire. They valued practitioners who could manage their expectations and make decisions in their best interests. Two participants had neutral views but mentioned that routine implementation of the questionnaire would prevent them from feeling targeted.
QUESTION: What resources does ReadyMind offer to implement the guidelines?
ANSWER: ReadyMind provides a screening and assessment platform, including the Cosmetic Readiness Questionnaire, as well as scripts, training videos, referral letter templates, and information handouts. We also offer a one-month free trial of the software.
QUESTION: How can practitioners administer the questionnaire during consultations?
ANSWER: The questionnaire can be administered in person, through a generated link, by email, or by scheduling it. It can be done face-to-face or remotely, depending on the practitioner’s preference and the circumstances of the consultation.
QUESTION: Do practitioners need to administer the questionnaire at every consultation?
ANSWER: The guidelines do not specify the frequency of screening, but a recommended approach would be to administer the questionnaire to every new patient and possibly every 12 months afterward. Regular screening helps ensure up-to-date information and ongoing assessment of treatment outcomes.
QUESTION: What does a “validated” BDD assessment mean?
A validated screening tool in this context means one that has been:
a) developed for use in the cosmetic industry so it is fit for purpose
b) has demonstrated evidence that it can identify patients who have the condition that it is designed to detect – so it is evidence-based.
There are many different research methods to demonstrate validity but usually the strongest method is to have a screening tool validated against the gold standard diagnostic assessment.
So a BDD screening tool should have been tested against a clinical interview using the BDD Diagnostic Module and BDD-YBOCS as these are the gold standards, and show that it has high sensitivity and specificity.
The reason for the mention of ‘validated screening tool’ in the AHPRA guidelines is to prevent people from coming up with their own questionnaires with limited knowledge on the subject matter e.g., asking someone ‘have you been diagnosed with body dysmorphic disorder?’ is likely to be ineffective. For example, some clinics that have been asking questions like ‘How many times a day do you check your appearance in the mirror?’ which is getting to the main issue, but is problematic as patients with BDD may only check 3 times a day but be there for hours.
AHPRA has advised that they will not be recommending or endorsing any specific tools so it is up to the individual practitioner to find an appropriate measure.
For a recording of a live Q and A session, see here.