SAFEGUARDING IN AESTHETICS

Eddie Hooker discusses the issue of safeguarding women undergoing intimate health procedures in aesthetic clinics

Ever since the Kate Muir and Davina McCall documentary Sex, Myths and the Menopause aired in 2021, the menopause conversation in the UK has become louder and louder.1

Having been a taboo for so long, women are now taking charge and speaking out about the impact menopause has on them across every area of their lives. As Mariella Frostrup wrote, “Menopause is no longer a dirty word”.2 

From the hashtag #makemenopausematter created by campaigner Diane Danzebrink3 to the Menopause Mandate4 and the recently published article in The Lancet5 on “An empowerment model for managing menopause”, menopause has become one of the biggest women’s health issues of our time. 

Employers are becoming more conscious of their obligations in the workplace6 , and in terms of our sector, healthcare professionals have been moving to the front in terms of providing care for patients who may be struggling to access help through their GPs.7 

The surge in treatments specifically aimed at alleviating menopausal symptoms marks a significant trend in the rapidly evolving sector of aesthetic medicine, so it’s vital that both practitioners and patients understand the associated insurance risks.8 

As an insurance provider, it is important that we, too, keep on top of current industry trends and practices, and with the aesthetics industry moving more and more into the women’s health space, we have been partnering with Menopause in Aesthetics (MiA)9 to work towards supporting women in getting the right advice through the clinics they are accessing. One of the key motivations behind this is to make sure that menopause care is provided safely and ethically, especially when it comes to intimate health treatments. 

Safeguarding is key to this, especially when considering providing intimate treatments that involve examining and treating a woman’s vulva and/or vagina internally and externally. 

WHY SAFEGUARDING MATTERS

 Safeguarding involves “protecting a person’s health, wellbeing and rights to enable a life free from harm, abuse and neglect.”10

As aesthetic practitioners, you may come into contact with vulnerable patients, especially when working in the menopause space. Yet, in The Journal of Aesthetic Nursing11 nurse practitioner Cheryl Barton described what she believes is a “safeguarding gap in plain sight” and argued that the “whole landscape on safeguarding the public within the cosmetic sector and beauty industry must now be urgently addressed.” 

This is particularly true when it comes to intimate health procedures where there is not only a need to safeguard vulnerable patients from the potential risks of sexual assault but also to make sure that aesthetic practitioners are being vigilant about their own practices to minimise the risk of any allegations being made against them (unfounded or otherwise). 

Whether this is making sure anyone performing such treatments has an enhanced Disclosure and Barring Service (DBS) check (not mandated unless you are working in a CQC-registered practice) or putting chaperoning policies in place within the clinic, safeguarding is a topic that needs to be on the agenda.

Here are my key safeguarding tips if you are providing intimate treatments.

1. Make sure you have the right cover

Our job as an insurance provider is to protect the practitioner and, in turn, the patient because without insurance, there’s no recourse for them if something goes wrong.

Once you start treating the more intimate areas of the body, cover is NOT provided as standard. The reason for this is that the risks, unfortunately, are a lot higher. We are picking up phone calls every day now about these types of treatments, and while we can extend insurance to cover these areas, practitioners need to ask us.

The internet doesn’t help because you can get quotes and policies online. Practitioners are being thrown a lot of information and don’t read all of the conditions of their policy or know what evidence they are supposed to provide.

So my advice is that whenever you are thinking of introducing any treatment into your clinic, you should get on the phone to your insurer.

2. Prioritise clear and concise communication with the patient

Good communication with your patient is of the highest importance. Take your time when discussing any treatments of intimate areas of the body. Something may come out in that discussion that means the patient may need more of a medical [or specialist] referral. They also may not be suitable for treatment within the clinic that you are actually operating in.

When you are on a one-to-one basis with a patient, and you are performing some of these intimate procedures, then there is always that opportunity someone could end up making an unfounded or founded allegation against you. This is the difficulty of these sorts of discussions; your word against theirs. That’s where your notes and your continual communication with them comes in. Get them to confirm that your notes are accurate and sign them if possible. Consider a chaperone or at least offer them the opportunity, especially if there is a need for the removal of clothing in those areas.

If the patient is starting to feel uncomfortable, you need to stop and have another chat about things, really explain the procedure and give them an opportunity to go away and think about it rather than just jumping in.

3. Ethical use and storage of before and after images

Under most malpractice policies and indemnity policies, you are required under the terms of the policy to take before and after photos. If a claim or allegation is made against you, and you don’t have those photos, that puts you in breach of your policy condition. So you’ve got to make sure you have before and after photos.

But then there’s the discussion about how you do that. How do you make the patient comfortable when you are taking those photos? Again, offer the opportunity for a chaperone, or do they want to bring someone in with them if they feel more comfortable, perhaps a close partner or family member? If you are offering a chaperone, make sure they are suitable and ask permission from the patient. And then, what do you do with the storage of all of those photos? I hope no one would dream of putting them on their website or social media, but you must be very, very careful about what you do with these images, who can access them and how you keep them.

4. A malpractice policy does not cover you if you are criminally negligent

If sexual allegations are made against you, how do you deal with that? It is important to be aware that a malpractice policy will not pick up any claim if you are criminally negligent or if there is a criminal issue.

But, if an allegation is made that you’ve done something, that’s when your insurance policy can help you. These sorts of allegations are awful. They’re awful for you, they’re awful for the patient, and you need some professional help there. I’ve dealt with claims exactly like this, and they are traumatic for everyone involved.

5. Why we need regulation to safeguard patients

A lot of people are going on training courses run by unqualified practitioners. It’s a minefield, there are no common training standards and a lack of practical after-course support. That’s why we work closely with the Joint Council of Cosmetic Practitioners (JCCP) and I am proud to sit on their trustee board to advise on these sorts of issues.

Iam calling for heavier regulation in the sector, so that we can deal with the real issues. We need to get some form of recognised qualifications across all of the treatments that we are doing and educate the public, because it’s important that, when they go into a clinic or salon, they’re asking the right questions. Are you qualified? Where can Ifind out if you are insured? Have you ever done this? Can I bring someone with me? Can I go away and think about this? That’s what we also need to be shouting about and pushing for as a community.

IN CONCLUSION

Insurers, manufacturers and practitioners all have a role to play in safeguarding vulnerable patients, not just when bringing intimate health or menopause treatments into the clinic but across the board in our aesthetic practices. In the absence of regulation, the medical aesthetics industry has a duty of care to uphold the commitment to “do no harm” and to make sure all patients are safe when they walk through your door.

EDDIE HOOKER

Founder and chief executive of Hamilton Fraser, Eddie Hooker is an expert in the cosmetic insurance sector with over 26 years of experience. Hamilton Fraser was the first company to offer medical malpractice insurance specific to the cosmetic industry in 1996 and Hooker is passionate about continuing to raise standards in the sector. Hooker is an accomplished speaker who regularly provides support, advice and education to practitioners as an industry commentator on key topics such as aesthetics regulation, legislation, insurance and business growth. By working closely with the industry’s leading practitioners, training courses and distributors, Hooker has built up a detailed and unique understanding of the aesthetic market ensuring that Hamilton Fraser’s customer experience is founded on expert knowledge and support.