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 depressed
If you have no breasts
Because Dr X. …
Is better than the rest
In before breakfast
Out before lunch
Back to work in 3 days
Before 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?