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Jan-Mar2003-11(1)
LETTER FROM AMERICA
He's ethical but has bad
taste…
Bashir
Mamdani
In a previous issue of IME (January-March
2001), I supported the right of physicians to advertise. That discussion came to
mind last August when I decided to consult a dermatologist for a painful rash.
On calling up a colleague from my old place of work, I discovered that he, too,
had retired. He gave a glowing recommendation for his son, also a dermatologist,
saying "I am not saying so because he is my son ..." On calling the office for
an appointment, a recorded voice greeted me with "Welcome to the world-renowned
Dr X's office …"
The office was located in a shopping mall. The
street door opened into a large posh waiting room with a glass fronted office
area at the back. The walls of the office were plastered with Dr X's
qualifications: one of only a handful of triple boarded physicians in the
country; studied laser surgery at Harvard University Medical School; board
certified by the American Board of Laser Surgery, American Board of Dermatology,
American Board of Cosmetic Surgery, Fellow of International Society of Cosmetic
Laser Surgery, etc. One wall was plastered with 'before' and 'after' photographs
of various cosmetic procedures: thighs, facelifts, tummy tucks, and so on.
There was a photocopy of an article about his clinic and its patients from
Newsweek magazine along with photographs of Dr X performing various cosmetic
procedures live on the major network TVs. A prominent sign welcomed you saying,
"For your waiting pleasure, we offer complimentary deluxe treats: Coffee, Hot
Chocolate, Cappuccino, Café Latte…"
Next to the receptionist hung a jingle:Don't be depressedIf you have no breastsBecause Dr X. …Is better than the restIn before breakfastOut before lunchBack to work in 3 daysBefore anybody has a hunch
Dismayed at the blatant self promotion, my wife
fiercely whispered: "Let's get out of here." But just then the nurse called out
my name. She escorted me to the exam room, checked my blood pressure and pulse,
and verified details of the history I had provided on a questionnaire I had to
fill in when registering. Soon the "world famous doctor", short, balding,
swarthy, accompanied by two young attractive females, walked into the room. One
of the young ladies carried a recorder that captured everything uttered in the
room. Another was writing down all that was being said. Doctor X
went over the history and carried out a thorough physical examination. He then
advised me that my particular ailment was new to him and that he would need to
read more before he could advise me. I set up a follow-up appointment with his
receptionist.
My wife fumed in the car on the way back predicting
that I would regret the visit to this show-biz doctor.
At about 7:30 the next morning, the phone rang. To
my surprise it was Dr X. He had researched the skin manifestations of my illness
and advised a confirmatory biopsy. He promised to have the articles for me at my
next visit. Subsequently he did the biopsy which indeed confirmed the diagnosis.
He mentioned a medication that could be of help but was up-front telling me that
he was unfamiliar with it and that I should check it out with another
specialist.
This encounter raises interesting questions about
professional ethics and advertising by physicians. Professional ethics demand
that a physician should only perform what he has been trained to do; he should
explain the pros and cons of the procedure; he should not amplify his abilities
by false testimonies; he should be working primarily for the patient's benefit.
Advertising too needs to be ethical. If the advertisement makes false claims
then it is not only unethical but also actionable.
As a dermatologist, Dr X was ethical and
professional. He readily admitted his unfamiliarity with my particular problem,
he promptly and meticulously got to the bottom of it and after establishing the
diagnosis, appropriately advised me to consult a more knowledgeable physician.
As his office setup indicated, Dr X's main professional activity was an
invasive, somewhat riskier form of cosmetic enhancement. Assuming that all the
claims about enlarging breasts, flattening tummies and removing wrinkles were
accurate, then he was not being unethical.
Advertising or self-promotion is fairly common
among doctors. Many doctors hang large name plates with various degrees outside
their offices and most have their board certifications on the walls of their
consulting rooms. Many readers of IME may have encountered their seniors
dropping names of their famous patients during casual conversation, 'pushing'
the medical books they have authored on hapless medical students, and so on.
Hospitals routinely advertise the wondrous qualities of the staff of their
various "Centres for …." Perhaps Dr X's self-promotion crossed the
boundaries of good taste. But good taste is very subjective and impossible to
legislate. What may seem garish to one is perfectly acceptable to another. If
cosmetic industry giants like Max Factor can promote their wares with little
regard to taste, why shouldn't Dr X do so?
Bashir Mamdani, retired
internist and nephrologist, Oak Park IL USA Emailbmamdani@attbi.com