Melbourne School of Population Health, University of Melbourne, 207 Bouverie Street, Carlton, 3053 VIC, Australia.
J Plast Reconstr Aesthet Surg. 2012 Nov;65(11):1506-12. doi: 10.1016/j.bjps.2012.05.004. Epub 2012 May 30.
Plastic surgeons and other doctors who perform cosmetic procedures face relatively high risks of malpractice claims and complaints. In particular, alleged problems with the consent process abound in this area, but little is known about the clinical circumstances of these cases.
We reviewed 481 malpractice claims and serious health care complaints resolved in Australia between 2002 and 2008 that alleged failures in the informed consent process for cosmetic and other procedures. We identified all "cases" involving cosmetic procedures and reviewed them in-depth. We calculated their frequency, and described the treatments, allegations, and outcomes involved.
A total of 16% (77/481) of the legal disputes over informed consent involved cosmetic procedures. In 70% (54/77) of these cases, patients alleged that the doctor failed to disclose risks of a particular complication, in 39% patients claimed that potential lack of benefit was not explained, and in 26% patients allegations centred on the process by which consent was sought. Five treatment types-liposuction, breast augmentation, face/neck lifts, eye/brow lifts, and rhinoplasty/septoplasty-featured in 70% (54/77) of the cases. Scarring (30/77) and the need for reoperation (18/77) were among the most prevalent adverse health outcomes at issue.
A mix of factors "supercharges" the informed consent process for cosmetic procedures. Doctors who deliver these procedures should take special care to canvas the risks and possible outcomes that matter most to patients.
进行美容手术的整形外科医生和其他医生面临相对较高的医疗事故索赔和投诉风险。特别是，在这个领域中，大量声称存在同意过程方面的问题，但对于这些案例的临床情况却知之甚少。
我们回顾了 2002 年至 2008 年间在澳大利亚解决的 481 起医疗事故索赔和严重医疗保健投诉，这些投诉指控美容和其他程序的知情同意过程存在失误。我们确定了所有涉及美容手术的“案例”，并对其进行了深入审查。我们计算了它们的频率，并描述了所涉及的治疗、指控和结果。
共有 16%（77/481）的与知情同意有关的法律纠纷涉及美容程序。在这些案例中，有 70%（54/77）的患者声称医生未能披露特定并发症的风险，39%的患者声称没有解释潜在的益处缺失，26%的患者指控集中在寻求同意的过程上。五种治疗类型——吸脂术、隆胸术、面部/颈部提升术、眼部/眉毛提升术和隆鼻术/鼻中隔成形术——在 70%（54/77）的案例中出现。最常见的不良健康后果包括疤痕（30/77）和需要再次手术（18/77）。
各种因素“加剧”了美容手术的知情同意过程。提供这些手术的医生应特别注意评估对患者最重要的风险和可能的结果。
