Advertising cosmetic surgery: are doctors complying with ethical standards?

Over the past five years, there have been significant changes to the ways in which doctors are entitled to promote their services in Australia. State-by-State deregulation of advertising by doctors enables equal opportunity to all businesses in compliance with the National Competition Policy.

Dr Ring said there is concern about the risks to the medical profession from a shift to 'competitive principles', and the potential effects of this compromising traditional medical ethics.

The Australian Medical Association (AMA) has expressed such concerns for the medical profession over promoting strategies, which is reflected in its current position statement on advertising and endorsement:

"The promotion of a doctor's medical services as if the provision of such services were no more than a commercial product or activity is likely to undermine public confidence in the medical profession."

Dr Ring linked the continuing and potentially expanding use of such strategies to a possible decline in trust in the doctor-patient/client/consumer relationship.

"The AMA's concerns need to be taken seriously…Doctors have earned some of the credit for the fact that we are living in a society that is ageing healthily as our life expectancy continues to grow.

"It is therefore somewhat anomalous that the public face of cosmetic surgery includes promotions which play on the insecurities associated with the superficial consequences of ageing," Dr Ring said.

Currently, advertising and other promotional activity must comply with the rules of the Trade Practices Act 1974 - which prohibits a range of misleading, deceptive and unconscionable conduct and misrepresentations - and other relevant trading Acts.

An editorial in the same issue of the MJA, written by Dr Trevor Mudge, Chairman of the AMA's Ethics and Medico-legal Committee, and Dorothy Dashwood, Senior Policy Adviser, AMA, acknowledges cosmetic surgery is part of the global rise of the entrepreneurial approach to health care.

"Cosmetic surgery is in demand because of the changing culture and attitude of patients. It is initiated by the consumer, not medical need," Dr Mudge said.

"Cosmetic surgery does, however, provide a service for which consumers are prepared to pay."

In recognition of the need for a middle ground between the traditional ban on advertising and the current deregulated system, the Medical Practitioners Board of Victoria has produced draft guidelines which will provide clear guidance for doctors who wish to advertise their services.

A summary of the Medical Practitioners Board of Victoria's draft guidelines for medical advertising, includes:

Ban the use of "before and after" photography, which is common in advertisements for cosmetic surgery.

Limit advertising to a factual statement of services offered.

Warn against the creation of "unwarranted or unrealistic" patient expectations of treatment.

Continue the ban on the use of patient testimonials.

Prohibit advertising which encourages inappropriate use of medical services and contains information or language which could cause fear or distress or make people believe their health may suffer from not using a medical service.

Cosmetic surgery is not rebatable under Medicare, nor covered by health insurance, with relatively few referrals.

In concluding, Dr Mudge said whether or not we support doctors entering the free market of advertised services, or prefer the traditional culture, 'the one interwoven thread which must run unbroken through the fabric of medical practice is that of standards of ethical practice and the primacy of the patient'.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACTS: Dr Anne Ring (07) 3379 1505 (B/H)

(0419) 654 679 (A/H)

Dr Trevor Mudge (0413) 733 701 (B/H / A/H)

Sarah Crichton, AMA (0419) 440 076