FROM HEAD TO TOE
“medutainment”: Medicine + Education + Entertainment = #Me-
dutainment. 5 We are pressured to entertain as well as educate.
But “happy face marketing” by using only the best aesthetic
“before and after” results comes with a price. Have we unwitting-
ly raised patient expectations so high that more patients experi-
ence dissatisfaction with their results? This makes it more difficult
for all of us when patients only learn of the wonders of aesthetic
procedures, absent any complications or problems. This in turn
increases dissatisfaction which affects both patient and surgeon,
leading to a reduced feeling of professional achievement and pos-
sibly emotional burnout.
And nothing prevents today’s media savvy patients from post-
ing their own pictures and videos online which may or may not
portray their physician in a favorable light.
This is not to say that our online sites can’t also serve a valuable
service to counter non-evidence-based advertisements, debunk
sham science or share new scientific innovations along with con-
textual information. But can every doctor really be “internation-
ally renowned”?
4. Online reviews serve as endorsers of competency and are an
ingrained part of today’s world. Personal endorsement is a pow-
erful influencer of human behavior. Patients can be asked and
persuaded to post positive comments. There is also temptation to
incentivize patients to do so. This week I received an unsolicited
anonymous email asking me how many new reviews I would like
to purchase!
Excellent surgeons have traditionally been seen as having both
technical skills and sound judgment. We focus on emphasizing re-
alistic patient expectations, avoidance of overselling, truthful ad-
vertising, frank discussions about possible complications, present-
ing alternatives and a high value on proper training and use of ac-
credited facilities. And selecting patients for aesthetic procedures
requires many skills. For example, just because one can perform
an operation, which might or might not be medically indicated,
does not mean one should perform an operation. Patients do not
always have realistic expectations, yet there may be pressures on
the aesthetic surgeon to schedule a procedure, nevertheless.
From the surgeon’s standpoint, there are basically two reasons
for performing an aesthetic procedure. First, to try for a physical
improvement and second, more profound and complicated, is to
address their psychological needs. What if the patient requests a
‘fringe’ alteration not aligned with the norms of appearance: how
complicit do we want to be? 6
We are tasked with determining when patients have a “healthy”
concern regarding their appearance and avoid treating patients
with body dysmorphic disorder or those whose concerns out-
weigh their perceived deformity.
Many of my patients seeking aesthetic procedures just want to
feel better about themselves. For a myriad of reasons, they have
decided to explore medical or surgical options in order to bring
about a perceived improvement in not just how they look but
more importantly how they feel. Even if I think it might be frivo-
lous, might it be unethical to deny them their request, as long as
the risk-benefit ratio is acceptable?
According to the definition of Epstein and Hundert, profes-
sional competence is, “The habitual and judicious use of commu-
nication, knowledge, technical skills, clinical reasoning, emotions,
values, and reflection in daily practice for the benefit of the indi-
vidual and community being served.” 7
There exist conundrums in all of medicine and some of the
same ethical issues exist across all specialties. For example, how
can the primary care physician engaged with sick patients offer
them the best care possible, while being forced to manage the time
oppressive EMRs (do patients really benefit?) and simultaneous-
ly adhere to governmental, insurance and institutional employer
mandates, but not get burned out?
So, is aesthetic surgery a business ruled by market structures
and individual ambition aimed primarily at material gain and
profit? Or a specialty intended to benefit patients as an integral
part of the health care system? How do we ethically market/edu-
cate in a world where hype and perfection seem to be the norm?
How can we make use of the best of social media and leave the
worst of it behind? How can we help improve care for other pa-
tients, not just our own?
“In the final analysis honesty in all matters is the keystone in our
ethical arch. We must follow our instincts offering to those in our
care only the operations we would wish for our own wife or daughter
or mother, advising with the truthfulness and kindness we would
hope our own loved ones would encounter.” 8
References
1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 5th.
New York: Oxford University Press; 2001
2. California Medical Board, https://www.mbc.ca.gov/
3. Reza N, Navsaria H, Myers S, Frame J. Online Marketing Strategies
of Plastic Surgeons and Clinics: A Comparative Study of the Unit-
ed Kingdom and the United States. Aesthetic Surgery Journal 31(5)
566–571
4. Goodman JR. Best Practices or Advertising Hype? A Content Anal-
ysis of Cosmetic Surgery Websites’ Procedural, Risk, and Benefit In-
formation, Journal of Current Issues & Research in Advertising, 38:2,
146-164, DOI: 10.1080/10641734.2017.129138
5. Carley S. #Medutainment and emergency medicine. Part 1. What is it
and where did it come from? #FOAMed. October 11, 2015.
6. Amadio J. Are Cosmetic Surgeons Complicit in Promoting Suspect
Norms of Beauty? Virtual Mentor American Medical Association
Journal of Ethics May 2010, Volume 12, Number 5: 401-405.
7. https://journalofethics.ama-assn.org/article/competence-and-profes-
sionalism/2002-02
8. World Medical Association, Code of Medical Ethics, London 1949
Dr. Chatham is a practicing facial plastic surgeon at Chatham Facial Plastic Surgery
& Medical Skin Care.
APRIL 2020
15