Ethics and Plastic Surgery - ASAPS Position
NEW YORK, NY (July 20, 2000) — Many doctors engage in advertising and public relations, but when do such activities cross the line that separates ethical from unethical? A recent article in The New York Times ("Doctors Who Love Publicity," July 2, 2000) brought to light what many "insiders" in cosmetic surgery already knew - that some doctors trade professional services for media coverage, offering journalists everything from complimentary laser hair removal to free surgical procedures. "This type of unprofessional behavior is an embarrassment to members of the American Society for Aesthetic Plastic Surgery," says the organization's president, Daniel C. Morello, MD, of White Plains, NY, "and it is in direct violation of the professional Code of Ethics that we have pledged to maintain."
The problem is that not all doctors - particularly in the competitive field of cosmetic surgery -- hold to the same high standards. In fact, only a relative handful of plastic surgeons - fewer than 1500 - have qualified for election into the elite membership of the American Society for Aesthetic Plastic Surgery (ASAPS), which requires not only certification by the American Board of Plastic Surgery (ABPS) but also substantial cosmetic surgical experience. Application for membership in ASAPS also requires surgeons to subject their advertising and marketing activities to close scrutiny by their peers, who look for evidence of any ethical breaches.
"ASAPS members are expressly prohibited from giving anything of value to a representative of the media in anticipation of, or in return for, professional publicity," said Dr. Morello in a Letter to the Editor that was published in The New York Times (July 9, 2000).
Some of the other unethical practices identified and prohibited by ASAPS include:
- Payment or acceptance of referral fees from any person in exchange for the referral of patients
- Promotional use of before and after photographs that use different lighting, poses or photographic techniques to misrepresent results
- Exaggerated claims intended to create false or unjustified expectations of favorable surgical results
- Participation in a charity raffle, fund raiser or contest in which the prize is any surgical procedure
For surgeons who already are ASAPS members, the penalty for failing to follow these and other specific guidelines can be loss of membership status.
Misrepresentation of Credentials
Ads promoting cosmetic surgery often may mislead prospective patients about the doctor's training and board certification. "A doctor may represent that he or she is a 'cosmetic' or 'plastic' surgeon, and also 'board-certified.' The public assumes this means the doctor is certified by the American Board of Plastic Surgery," says Dr. Morello. "In reality, the doctor may be certified in another specialty, with little or no surgical training."
In 1999, California and Florida passed laws requiring a doctor who advertises that he or she is "board-certified" to identify the certifying board. Florida requires that the advertised board must be one of the 24 boards recognized by the American Board of Medical Specialties (ABMS). California requires any board named in a physician's advertisement to be an ABMS board or a board recognized by the state as "equivalent." This means that doctors certified by, for example, the American Board of Cosmetic Surgery, which is unrecognized, cannot advertise this certification in either state.
"The members of ASAPS would like to see more states adopt this type of regulation," says Dr. Morello. "This is one way to help protect the public from being misled about a doctor's qualifications to perform plastic surgery."
The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.
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