Informed Consent Is Not a Form: What Prof Greg Goodman's Monash Lecture Teaches About Ethically Defensible Consent

Hi Facecoachers,

One of the most important messages in Prof Greg Goodman AM’s Monash lecture, “Total Patient Care and the Consenting Process,” is also one of the easiest to lose in a busy clinic:

Informed consent is not a form. It is a relationship.

A signed consent form matters. It creates an important record. But it is the starting point, not the finish line.

For practitioners working with cosmetic clients, consent is an ongoing process of communication, assessment and shared decision-making. It begins before treatment and continues through treatment planning, aftercare and follow-up.

This is interesting because cosmetic consultations often involve patients who are well, informed and highly motivated: but may also be vulnerable to social pressure, unrealistic expectations or emotional distress.

Our job is not simply to obtain a signature. Our job is to make sure the decision is voluntary, informed, clinically appropriate and able to withstand scrutiny.

What does ethically defensible consent look like?

Prof Goodman’s lecture places consent within the broader concept of total patient care:

• Initial consultation

• Patient suitability assessment

• Risk assessment

• Treatment planning

• Consent

• Treatment

• Follow-up and support

  
  

Consent sits across the entire care pathway.

For a cosmetic patient, that means discussing:

• What the treatment involves

• The expected range of outcomes

• Material risks and possible complications

• Alternatives, including doing nothing

• Recovery and aftercare

• The likely longevity of results

• Potential maintenance or revision

• Total costs and follow-up costs

• Who will perform each part of the treatment

• What to do if something goes wrong

  
  

We suggest avoiding a “form-first” workflow. Give the patient time to ask questions before presenting the consent document for signing.

A patient who signs quickly but cannot explain the proposed treatment, risks or alternatives has not necessarily given valid consent.

The AHPRA approach: shared decision-making and ongoing dialogue

The AHPRA Code of Conduct supports shared decision-making and recognises that informed consent is an ongoing dialogue.

This is particularly relevant in cosmetic medicine because the patient may not have a medical need for the procedure. The decision is discretionary. Advertising, social media and commercial pressure can all influence the patient before they enter your clinic.

That creates an additional professional responsibility.

The patient’s welfare must remain the primary consideration: not the clinic’s sales targets, appointment availability or treatment packages.

Good consent should give the patient space to:

• Ask questions

• Take information away

• Speak with a support person

• Seek a second opinion

• Reconsider the procedure

• Change their mind

  
  

A patient nodding along is not the same as a patient understanding.

As Prof Goodman highlights in the lecture, if a client appears confused, hesitant or overwhelmed, stop and check understanding. Use plain language. Ask the patient to explain the plan back to you in their own words.

sent is not merely evidence that a document was signed. It is evidence that the patient was supported to participate meaningfully in the decision.

When consent is not valid

The lecture identifies several situations where consent may not be valid.

Consent is not valid where the patient:

• Is intoxicated

• Is being coerced or pressured

• Does not have sufficient information

• Cannot understand the information provided

• Is underage without appropriate guardian involvement and capacity considerations

• Is agreeing without a genuine opportunity to consider the decision

A signature cannot correct a flawed process.

We suggest documenting not only that consent was obtained, but also the important elements of the discussion. Record the patient’s goals, concerns, questions and understanding.

When should you delay treatment?

Sometimes the most ethical clinical decision is to delay or decline treatment.

Consider the following scenarios from the lecture.

The rushed consultation

The client arrives late, is distracted and wants treatment immediately before an event.

That is not a reason to compress the consultation. If the consent process is rushed, postpone treatment.

The vulnerable client after a breakup

A client presents shortly after a relationship breakdown and describes the procedure as necessary to “fix” their life.

This is a point for careful exploration, not an automatic treatment indication. A temporary pause and appropriate support or referral may be clinically safer.

The influencer photograph

The client brings a heavily edited influencer image and insists on achieving exactly the same result.

We suggest acknowledging the patient’s goal while explaining the limits of anatomy, treatment and individual variation. Use clinical examples: not celebrity comparisons: and document the outcome limitations discussed.

A seven-day cooling-off period for new clients, as outlined in the lecture deck, can provide valuable space for reflection and a second opinion. Practitioners should also confirm how the applicable cooling-off requirements operate under their profession, patient age and procedure type.

For patients under 18, additional safeguards apply. Practitioners should refer to the relevant AHPRA cosmetic procedure guidelines and ensure that consent, capacity, guardian involvement and cooling-off requirements are properly addressed.

Consent and telehealth

Telehealth does not reduce the consent standard.

A cosmetic consultation conducted by video must still allow the practitioner to:

• Confirm the patient’s identity

• Take an adequate history

• Assess suitability

• Discuss risks, benefits and alternatives

• Explore expectations and vulnerability

• Answer questions

• Document the consultation

• Decide when an in-person assessment is needed

For cosmetic injectables, a visual, real-time consultation is particularly important. Questionnaire-only or asynchronous prescribing does not provide a sufficient basis for a practitioner-led suitability assessment.

The AHPRA telehealth guidance is a useful reference point.

Consent cannot be delegated to untrained staff

One of the lecture’s practical scenarios involves an untrained assistant obtaining consent.

The principle is straightforward:

Only qualified health practitioners can assess suitability. Consent must be practitioner-led.

Administrative staff may help provide information about appointments and clinic processes. They should not be responsible for assessing whether a patient is suitable for treatment, interpreting clinical risks or obtaining consent on behalf of the treating practitioner.

The practitioner who is responsible for the treatment must be satisfied that the patient understands the decision and is suitable to proceed.

Documentation: what should be in the record?

A defensible record should show the clinical reasoning behind the decision to treat: or not treat.

We suggest documenting:

• Patient history and relevant risk factors

• Treatment goals and expectations

• Assessment findings

• Material risks discussed

• Benefits and limitations

• Alternatives and the option not to proceed

• Costs and future maintenance

• Aftercare and escalation pathways

• Practitioner identity and role

• Patient questions and responses

• Written information supplied

• Patient acknowledgement

• Follow-up arrangements

• Pre- and post-treatment photographs where clinically indicated

  
  

Photographs must be clinically accurate. They should be taken consistently, without filters, retouching or deceptive lighting.

Cropping matters as well. Do not crop an image in a way that removes relevant anatomy, conceals bruising or makes the result appear more dramatic than it is. Before-and-after images should be comparable in lighting, angle, framing, background, posture, expression and exposure.

The most prominent image should not be the “after” result alone. The comparison should be presented responsibly, with a clear statement that results vary between individuals.

Never use images of anyone who appears to be under 18 in cosmetic procedure advertising.

Clinical photographs and marketing consent are different

Consent to take a clinical photograph is not the same as consent to use that photograph in marketing.

Marketing use requires separate, specific and fully informed consent. The patient should understand:

• Where the image will appear

• Whether it will be used on social media, websites or advertising

• Who may access or share it

• How long it is intended to be used

• Where the original image will be stored

• That the patient can refuse

• That consent may be withdrawn

Patients should have the opportunity to view the image before publication.

This is not a minor administrative detail. It is part of respecting privacy, dignity and autonomy.

BDD screening and referral pathways

The vulnerable patient scenario also connects with Module 3: Body Dysmorphia.

A cosmetic consultation is not a diagnostic assessment for BDD, but practitioners should be alert to red flags, including:

• Persistent preoccupation with a perceived defect

• Repeated procedures with ongoing dissatisfaction

• Excessive checking or camouflage

• Unrealistic expectations

• Significant distress or impairment

• A belief that treatment will solve broader emotional or social problems

  
  

Where psychological drivers dominate, referral to a GP or appropriately qualified mental health professional may be indicated.

The practical takeaway

Prof Greg Goodman AM’s lecture gives us a useful standard:

Voluntary. Informed. Practitioner-led. Documented. Ongoing.

That is the basis of ethically defensible patient consent in cosmetic medicine.

It is also why consent cannot be separated from governance, advertising, patient suitability and follow-up care.

Build your governance knowledge with Monash University

For practitioners looking to strengthen their approach to patient consent cosmetic, informed consent cosmetic injectables, AHPRA cosmetic guidelines and patient suitability assessment cosmetic services, the Monash University course provides a structured framework across eight modules.

The course covers:

• Advertising legislation

• AHPRA and National Board requirements

• Body dysmorphia assessment and referral

• Poisons and state legislation

• Patient consent

• Ethics

• National governance frameworks

• Basic assessment for lasers, Botulinum toxins and soft tissue fillers

The course is fully online and runs for 12 weeks, with 144 notional hours of learning.

There are ONLY 11 DAYS TO ENROL for the 1 September 2026 intake. Enrolments close on 23 August.

Use the code FIRST50STUDENTS at checkout for the available discount.

You can review the course details and enrol through the Monash University course page.

This is a worthwhile professional investment: not just for compliance, but for safer decisions, better documentation and better care for every patient who trusts us with their treatment.

( Mike Clague)