Friday, January 31, 2014

Is advertising by doctors and hospitals worthwhile?

The decline of medicine as a profession began when it became legal for doctors and hospitals to advertise.

Apparently it all started when an Arizona lawyer sued for his first amendment right to advertise his services. In 1977, the US Supreme Court ruled that states could not prohibit advertising by lawyers.

This opened the floodgates for all professionals. Soon advertising by doctors and hospitals became common.

I don't know what it's like where you are, but I can't listen to the radio without being bombarded by doctors advertising their wares like car dealers and ads for bogus "university" hospitals.

Outrageous claims are made. The best, the most advanced, the newest, the latest, the most experienced, the most talented, and many, many more.

Just like car dealers, every hospital in my area is "#1" in something or other. Often more than one hospital is #1 in the same specialty.

Here's a sobering number. In the first half of 2011, hospitals in the US spent $717 million on advertising. This is despite the consensus that hospital advertising has not been shown to be effective at generating business. In fact, hospital CEOs admit that much of their advertising is aimed at stroking the egos of their doctors or boosting staff morale.

Regarding advertising by doctors, I don't know if that works either.

When I was in private practice in the late 1970s and early 1980s, advertising by physicians was mostly limited to the telephone book's Yellow Pages [younger readers may be excused for a minute to google the term].

Every patient who ever came to me via the Yellow Pages either didn't pay his bill, was non-compliant or both. Apparently, only a certain type of individual chooses his surgeon via the Yellow Pages.

I eventually stopped listing myself in the Yellow Pages.

In addition to wasting a lot of money, hospital and physician advertising is harmful because it creates unrealistic expectations among patients. A case in point is the ongoing debate about the supposed, but yet unproven benefits of robotic surgery. The ad below appeared in an airline in-flight magazine. Do you think it is effective? Do you believe it?

Although there is no proof that robotic surgery results in better outcomes than traditional laparoscopic techniques, hospitals have marketed robotic surgery by having potential customers play with the robot in such places as shopping malls and minor league baseball stadiums. [For a comprehensive look at robotic surgery advertising by hospitals, check out the Health News Review blog here and here.]

The public is flooded with advertisements promising miracles that often cannot be delivered. Disappointment surely follows

Is this the only reason for the medical profession's fall from grace? Of course not, but it certainly hasn't helped.

If advertising by hospitals and doctors disappeared tomorrow, we would all be better off.


artiger said...

It is for the most part disgusting. It's kind of a vicious cycle, robotic surgery has to be advertised to get the patients to bring in the revenue to pay for the robot. The heart programs seem to be big on advertising these days as well.

I can almost understand the cosmetic folks advertising (plastics, dentists, etc.), as I don't even count that as health care anymore. The one that really disgusts me is the real time ads for ER wait times. These guys want to bring more patients to a place where stays are already way too long? I know, the CEO's think it leads to an increase in admissions, and it probably does, but it also makes the ER the least favorite place in the hospital for some of us.

Libby said...

I question a doctor having to advertise "discrete and private in-office consultations"...that is something that is expected, a given. Soooo if a doctor doesn't advertise this particular offering they don't adhere to standard ethical behaviour? As a patient...(who also knows what the Yellow Pages are), I question the skills of a specialist who needs to advertise...can't get patients via referrals? What is wrong? Advertising here (Alberta) generally is wanted by patients for family doctors who are taking new patients. That is usually locally, outside the building or in neighbourhood newsletters. Word of mouth is fast too.

Alberta Health Services have 'real time' emergency wait times for all local hospital/Urgent Care Centre posted on their website and in the EDs. I think it only helps to soften the blow of waiting when the hospital you're at has the lowest wait times--at least you're not at the Foothills Medical Centre with an usual wait time of 6+ hours (a slow day) to see a doctor (it's our regional trauma & stroke centre). Some people actually check before leaving home! (maybe they should think that a walk-in or their family doctor would be the better place to go for the barely-there cough they've had for 3 weeks).

Skeptical Scalpel said...

Artiger, as usual, we agree. Except as you can see, Libby feels the wait time ads can be helpful. They are a form of advertising, but at least the information is useful to some people. I don't think an ad that brags about a chef making gourmet meals is of any value. If a patient can eat a gourmet meal, he doesn't belong in the hospital.

Anonymous said...

Fortunately, except for the the cosmetic practitioners, egregious TV and print advertising ("I am the best!) is still rare. Most of the ones I see basically say that they are available, they really, really care about patients, and they hike and travel.

Some are more subtle. An OB/GYN group in my locale (very good docs) has a regular spot on NPR stating nothing but their sponsorship. The unspoken message is that they are liberal, well-to-do, environmentally friendly, just like you, NPR listener.

The more egregious practice is the fluffy PR pieces that many practitioners now have on their websites. Caring! Expert! Spent a research year at MGH! Likes food! And hiking!

Basically, most docs are now advertising thru their websites.

artiger said...

Libby's point is well taken, although her last sentence makes my point for me better than I did, i.e., if it's truly an emergency, who has time to get on the internet? The guy with the shotgun wound to the lower abdomen that I finished up today around 5am certainly didn't have the chance to check. I don't think he cared though.

Now that I think about it, advertising wait time might be the solution to overcrowded ER's, but it would mean taking the opposite tack. To discourage patients with bogus, I mean nonemergent issues, wait times of 4-6 hours should be posted. Things like "We're busy! We have patients with true emergencies here, we don't have time for your 3 week old headache right now. You can come here but you'll be here until tomorrow and you'll have thousands of dollars in bills and lots of tests you really didn't need. Have you checked with a walk-in clinic near you?"

What are the chances that my anti-advertising scheme will catch on?

Skeptical Scalpel said...

Anon, where I live the radio is full of ads for prostate cancer surgeons, radiation therapists, cyberknife, hospitals with all sorts of outrageous claims etc. Most doctor and hospital websites are full of canned syndicated content that is not very interesting. I do like the NPR approach though.

Artiger, there's no chance that your plan will catch on.

Unknown said...

I spent 25 years or so at the Mayo Clinic and they held out on advertising for a very long time. Then they went in with both feet -- it was odd to watch.

"Although there is no proof that robotic surgery results in better outcomes than traditional laparoscopic techniques, . . " Heh -- laparoscopy is now traditional. I wonder if brand-new surgeons are good enough to convert to open procedures when needed, the really traditional kind.

Skeptical Scalpel said...

Christopher, I wondered about brand new surgeons and their ability to convert a case to open too. Here's what I said in my post on Physician's Weekly ( The comments are worth reading too.

Anonymous said...


I read your link. Very interesting, and scary.

I didn't realize how few open cases a new grad have done. And those are the averages; so quite a few prob. did even less.

Libby said...

Artiger, maybe that is AHS's plan posting ED wait times, to dissuade the non-emergent cases to seek help elsewhere...hmmm. They really do want people to use the appropriate level of care. A sprained pinky can be dealt with at the family doctor. But then, there are too many people without a primary care physician and wait times at walk-in clinics rival our ED. Our problem is that the patient doesn't pay out of pocket for their care unless they are from a different province or from another country. And no, I don't want to go back to the pre-medicare days and pay at every visit. (I had to visit an ED in Phoenix a few years ago and it cost $3000.00 just to rehydrate me).

Unknown said...

Nice essay at Physician's Weekly. I suppose the low numbers are a combination of less open cases done overall and decreased resident training/duty hours available in which to do them.

I'm not a surgeon but I took a bunch of surgery electives because I like it. It looks to me as if I assisted at more open cases in the course of 6 months or so than today's senior surgery resident has even seen. That's sobering.

This is not a problem unique to surgery, though -- today's residents just see and do less owing to duty hour restrictions. Yet no one wants to opening considering lengthening residency.

Skeptical Scalpel said...

Thanks. Making training longer would be tough, especially because so many med school grads have such enormous debt.

Caro said...

I think the decline of medicine began when the profit motive entered the picture in the 80s and 90s. The profit motive came first, then came the ads.

Anonymous said...

Great article. The money involved is obscene and jacks up the cost of care on so many levels.

Anonymous said...

I felt the medical profession was dirtying itself by getting into the ad market. Ads are not known to be honest, so being associated with ads brought doctors down in the world. When it comes to health, ads should be forced to present all the downsides of everything, but they aren't. And some poor fools believe them. As far as I'm concerned, the medical profession has sullied itself with ads, as well as betrayed its patients.

Anonymous said...

I consider websites to be a form of advertising, and they are the norm now for most non-hospital based specialists..

For many sophiscated patients, elective medical care is just another consumer good for which they shop.

How would you find the best doc to take out your cataract? It is basically a fungible service. Why not take into account advertisements? Since insurance is paying anyways, why not hire the doc who runs, has the same dogs as you, and likes to cook?

Skeptical Scalpel said...

Caro, yes money is a big part of the problem.

Anon1, thanks.
Anon2, I agree.
Anon3, websites are a form of advertising. The fact that you might have something in common with a doctor does not tell you if she's any good, which is much more important.

Peter J. Stanton, DC, MS, DABCO said...

Sounds like sour grapes. There is nothing wrong with advertising if it educates the patient as to the abilities of the Doc. Sure much of it is fluff and some can be misleading but it's better than the old school, "good ol boy network" that covered up incompetent Docs, didn't give patients their medical records and withheld information.

KAC RN said...

Advertising outs incompetent physicians? Seriously. I am all for imparting useful information to the public, but I don't see much of that in advertisements by physicians/hospitals (or attorneys). I avoid the radio ads by listening to NPR and Sirius. For TV, there's the mute button.

DD said...

Maybe what hospitals should advertise is their nurse to patient ratios! A meta-analysis of 90 studies found that increased registered nurse (RN) staffing was associated with lower mortality on intensive care, medical, and surgical units; reduced risk of hospital-acquired pneumonia, unplanned extubation, respiratory failure, cardiac arrest, and failure to rescue; and shorter lengths of stay for surgical (31 percent) and intensive care unit (ICU) patients (24 percent).

But I guess (hospitals) should not advertise what they do not provide. Even the most skilled surgeon's patient can develop a post-op complication if the bedside care is less than optimal.

Kane RL, Shamliyan TA, Mueller C, et al. The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis. Med Care. 2007 Dec;45(12):1195-204.

artiger said...

Peter Stanton, I suppose you're right. While we're at it, why should we stop with advertising? We should follow you chiros' lead and go purchase police reports for motor vehicle accidents, and call the victims to tell them that it is crucial for them to come in for a visit and exam. I had seven such calls after I was hit by another driver, all unsolicited. Imagine the embarrassment of the secretaries who placed those calls when I told them I was fine, and was certainly more qualified than their bosses to determine that, being a surgeon who takes care of trauma patients.

DD, I think nursing staff ratios, having all private rooms, and describing what services are available are things I'd like to know.

Skeptical Scalpel said...

Thanks to all for the comments.

Advertising the abilities of the docs might be ok if the ads were truthful, but how could one possibly determine that?

I agree that nurse staffing ratios would be interesting, but again, how does one know if the ads are telling the truth?

Henry Woo said...

Great piece. Agree with all that you have to say on the matter. We are now seeing the type of advertising that I thought was only seen in the cosmetic surgery arena now entering into the advertising of robotic surgery services. The cropped image that you use in this piece is from a picture I took of an Emirates inflight magazine advertisement (very happy for you to use it as an example by the way) - if readers wish to see the full advert, it is here.
What's SMART got to do with it? - Google it in the context of robotic prostatectomy and then groan and roll your eyes.

Skeptical Scalpel said...

Henry, thanks for comments and for tweeting the ad that I used as an illustration. Your post is spot on as far as a critique of the robotic surgeon's ad goes. The video of the SMART procedure is over the top. 3600 robotic prostatectomies without a major complication? (Groan. Eye roll.)

Anonymous said...

The damn robot!

The hospital at which I work came into a very, very large sum of money. Rather than spend it on things that are quite needed, like mental health or other unsexy-yet-necessary things, they bought a damn robot with it.

Money down the tubes.

Skeptical Scalpel said...

That's too bad. Maybe they can take it to shopping malls and ballparks to entice more patients. It's like the Cold War. Hospital A buys a robot. Hospital B buys two.

Amy McCloskey Tobin said...

I am not a medical professional - I just work in your world for clients, and I AM a marketer. I think there is a difference between individual doctors marketing themselves and their skills, vs. hospitals and organizations marketing themselves.

I think about the dwindling numbers in private practice; if one is dedicated to remaining there, you'll find that you have to market. I don't think it's dirty - I think there is a BIG difference between getting your name out there and being unethical.

To write off all marketing, especially in this world we live in, as somehow 'beneath' a profession is, frankly, Utopian, and unrealistic.

Skeptical Scalpel said...

Amy, I appreciate the comments. There's no doubt that marketing of docs and hospitals is here to stay. I was just lamenting the fact that it exists.

What I don't like is the hyperbole and downright lies that are disseminated in the name of marketing. The waste of money is appalling too.

Dorothy Decimal said...

Not the point you're making, of course, but I'd find it difficult if not impossible to entrust my prostate to a physician/facility that couldn't parse the difference between "discrete" and "discreet". If I had a prostate, that is!

Skeptical Scalpel said...

Dorothy, thanks. Good comment. I missed that.

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