Questionable Ethics

Australian Society of Plastic Surgeons warns it is ‘ethically wrong to prioritise profits over patients’

Prominent Queensland plastic surgeon Dr Richard Theile has published a strongly worded warning to his profession, declaring bluntly: ‘Plastic surgery is a profession characterised by responsibilities. While we all expect to make a living from our skills, it is ethically wrong to prioritise pro ts or convenience over patient outcomes.

‘Patient interactions should be about the patient, not a business model. Every patient deserves our genuine respect—they trust us to do for them what we would want done for our own families.’

Under the heading ‘Ethical Practice in Plastic Surgery’, Dr Theile, chair of the Ethics Committee at the Australian Society of Plastic Surgeons (ASPS), wrote in the Australasian Journal of Plastic Surgery: ‘The growing influence of social media on marketing and self- promotion, and the inappropriate prioritisation of entrepreneurial business practices, means we are now experiencing a shift away from patient-centred decision-making to outcomes that favour surgeons.

‘Con icts of interest have always existed within our practice, but the most common and identifiable that often underpin dubious ethical behaviours relate to money. At best, unethical behaviour can be inadvertent, where a surgeon lacks reflective practice. At worst, it is driven by greed and ego where the patient becomes a commodity to be exploited.’

Explaining why this has become a major talking point, Dr Theile noted: ‘Once considered unseemly, unprofessional and unethical, the concept of marketing has more recently been accepted as tolerable, or a necessary evil, then normal and now, by some, as important.

‘But patients are not just buying products. They are making a conscious choice and relying on the professional integrity of surgeons. Advertising in medicine should be directed at educating patients and providing factually accurate information to ensure informed consent, not at presenting exaggerated or baseless claims of expertise or coercing patients into undergoing unnecessary or inappropriate procedures.’

Dr Theile emphasised that ‘in an era where advertising, self-promotion and ubiquitous social media can blur the lines of professional standards and decency, surgeons need to maintain their moral integrity… Our moral cues don’t come from Instagram, where clients may have a different sense of the seriousness and consequence of surgical procedures. In this environment, surgeons must refrain from social media commentary, regardless of prospective patients’ desiring casual and ‘cool’ interaction.’

In response to what Dr Theile described as ‘this worrying erosion of ethical standards’, ASPS will be including specific guidelines for social media in its revised Code of Conduct and ‘plans to monitor the content of members’ websites’.

ASPS hopes creating greater awareness of unacceptable behaviour ‘will ensure members act ethically, review and modify any unacceptable content and continue to be vigilant in this area in the future. If awareness alone is insufficient motivation then the ASPS will assist surgeons to understand their moral responsibilities.’

Under the new guidelines, ASPS members ‘are personally responsible for their social media content regardless of whether this may be outsourced to others within, or in association with, their practice— even if the content was originally generated and posted by patients and already in the public domain’.

Dr Theile added: ‘There are many examples of photographs or videos re-posted by surgeons that are demeaning, objectifying or present sexualised imagery. The re-posting of such images is unacceptable.

‘Nor should surgical procedures be trivialised. As the community is saturated with digital, electronic and print media stories about cosmetic procedures, there is an even greater responsibility for surgeons to reinforce the notion of serious decision-making about procedures.’
Under the headline ‘Instagram over ethics: ego-driven plastic surgeons put on notice’, The Sun-Herald followed up Dr Theile’s warnings with the summation: ‘Greed-driven plastic surgeons putting pro ts before patients are behaving more like social media influencers than doctors, their own colleagues warn.

‘The Australian Society of Plastic Surgeons (ASPS) has admonished self-aggrandising surgeons peddling misleading marketing over medical ethics, and damaging the reputation of the entire profession.’

In response, ASPS president Dr Gazi Hussein told the newspaper: ‘This is about taking a leadership role and setting boundaries about the way we believe members

should behave.’

The chief executive of the Consumers Health Forum, Leanne Wells, congratulated ASPS on its ethical framework, but warned that ‘self-regulation has never been enough’.

She commented: ‘There is, without doubt, the need for an ongoing, if not strengthened role, for medical boards and the government in regulating professional conduct. Patient safety deserves no less.’ AMP

CPCA Campaign highlights ‘Realistic expectations’

Meanwhile the Cosmetic Physicians College of Australasia (CPCA) has launched its ‘GET REAL’ campaign for public education about the importance of realistic expectations. ‘GET REAL’ emphasises that ‘Cosmetic Medicine is Real Medicine and both your care and treatment should be supervised, performed and coordinated by Real doctors who are trained and experienced. This is the best safeguard to protect yourself against unsafe practice.

‘Finding an experienced and trained doctor who puts patient safety rst and is able to manage realistic expectations is of paramount importance.’

CPCA President Dr Michael Molton emphasised that the campaign especially notes: ‘Real expectations are the most essential aspect to consider when deciding to proceed with treatment. You should have the expectation that your Cosmetic Physician will offer procedures that focus upon ‘better, not different’.’

He also explained that sometimes a doctor will advise against a procedure: ‘Like any face-to-face consultation, in Real medicine, your doctor will listen to what concerns you have and then ask questions about your concerns: such as how long you have observed the problem, and whether or not there might be underlying causes such as previous cosmetic procedures, surgery, trauma and/or illnesses you may have or had in the past?

‘Cosmetic Physicians commonly uncover health issues that are associated with your cosmetic concerns. During this consultation, your Cosmetic Physician will consider all these issues.

‘In some cases, just like requesting antibiotics when visiting your GP when you have a viral infection, some procedures just don’t suit some patients. Remember, your Cosmetic Physician puts your welfare rst, and this may include advising you that a particular procedure may be inappropriate for you as an individual.’