Why doctors and hospitals shouldn’t advertise

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?

Why doctors and hospitals shouldnt advertise

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).

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.

“Skeptical Scalpel” is a surgeon blogs at his self-titled site, Skeptical Scalpel.

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  • John C. Key MD

    I’m not sure i agree but I would at least in part, Advertising should be factual, should not promise a result, probably should not include patient testimonials. Another item that you should have included is Direct-to-Consumer (DTC) ads by pharmaceutical companies. Granted, they aren’t doctors or hospitals but we all get tarred with the same brush. If I were legislating something DTC ads are the first things I would take off.

    • querywoman

      It’s very difficult to be factual in the medical world. Just give us your name, address, and phone number with a general list of the type of stuff you do.

  • Deceased MD

    And why it’s never going to happen…..
    but I can’t agree more. Include pharma, DME, the list is endless..

  • Lisa

    During the period between my first hip replacement and my second hip replacement, my local hospital opened a ‘Joint Replacement Center.’ The center was advertised – I saw ads in local papers for informational classes and I heard radio ads. The center was profiled in the hospital’s magazine and they had a big fancy brochure. They brochure touted the wonderful care patients would receive and outlined what to expect during the hospitalization. They even hired a nurse navigator. Yet all of this didn’t improve my care during my second hip replacement, when the surgical floor was severely understaffed. I think the money spent on advertising would have been better spent on actual patient services.

    I did write a letter of complaint to the hospital. Neither the hospital or the nurse navigator addressed my complaints.

  • Skeptical Scalpel

    Thanks for the thoughtful comments.

    In the interests of space, I didn’t address the pharmaceutical companies’ direct-to-consumer ads. I certainly agree they are a huge problem.

    Lisa, your story is right on the mark. Money for advertizing but not nurses.

    John, good points. There is no regulation of these ads. You can say anything you want.

  • Lisa

    Just curious…what form of advertising did you use when you were looking for doctor’s who performed the procedure you needed?

    When I was looking for a surgeon who used an anterior approach before my first hip replacement, I googled orthopedic surgeons in my area and looked at their websites. I found the information I wanted. While a website is a form of advertising, it is non-intrusive. Websites are not plastered on the back of buses, arenot cluttering up mailboxes and are not on the radio or TV. They are a form of adverstising that you don’t have to pay attention to unless you search it out. Websites can also provide a lot of information, more than conventional forms of advertising.

    I really think adverstising by the medical profession and drug companies (at least to consumers) should be limited.

  • SherryH

    I pay cash for my dental work, I don’t have insurance. While I appreciate the fact that pricing in dentristry is transparent and competitive, those without insurance do not get that adjusted rate, and therefore pay higher prices. My dentist charges too much, knows I have no insurance, and has never offered a lower rate (and yes, I have asked). They do more advertising than any office I know of. I am constantly seeing ads for them-full page ads in magazines, newspapers, billboards, radio ads, etc. I even saw ad an for their office on tv during the 6:00 news. Personally I think they should spend less on advertising and give their patients better pricing. I know I have started looking for a new dentist because of it.

    • querywoman

      In Texas, prepaid dental plans that negotiate fees down are the only way to get cheaper dental services for almost anyone above the Medicaid level, most of us!

  • Lisa

    Competition between hospitals does not lead to reduced cost to consumers; I think it leads to increased costs as each institution has to have the newest and ‘best’ technology. For example, robotic surgery is something that I often hear advertised. Yet I don’t think it is proven to necessarily improve outcomes.

    What doctors and hospitals believe benefits the public usually benefits their pocket books first before the public.

  • Patient Kit

    Hospital advertising has been relentless here in NYC. At the same time, 19 hospitals have closed here since 2000 and several more are on the brink of closing. Competition for patients seems to be fierce. It would be nice if the advertisements were — what’s the obscene word I’m looking for? — regulated (!?!!) to be truthful though. Healthcare should be held to a higher standard than perfume, car insurance, Pepsi and Walgreens (at the corner of Happy & Healthy) and even Hebrew National hot dogs. They do serve to remind me what a big business healthcare is in the US. I wonder what Don and Peggy of Mad Men would think of all the hospital ads.

  • http://drsethevans.com/ Dr. Seth Evans

    Thanks for the post, I found it quite interesting and thought provoking. I agree there’s a lot of problems in health care advertising, but I also think it can be used honestly and ethically to help patients and help generate business. I wrote a longer a response on my blog if anyone is interested.

  • querywoman

    All the ads for mammograms make me want to puke! The new mammogram parties with wine, cheese, and chocolates are even more nauseating!
    The medical profession tells us not to drink alcohol, eat fatty cheese or candy, until it’s convenient for them!
    Mammograms are controversial, yet most doctors and hospitals won’t admit it! It’s a steady stream of income.
    When the Yellow Pages rocked, I sometimes chose docs in my part of town.

    • Skeptical Scalpel

      Your comment is particularly true in light of the new study that shows mammograms do not save lives. Here’s the link http://www.bmj.com/content/348/bmj.g366

      • querywoman

        Wow! A doctor who agrees with me, Skeptical Scalpel!
        I have always questioned the breast cancer industry.
        Supposedly, 40,000 American women get breast cancer every year. There are many urban cities in the US with a population of one million people.
        Where is the math to support this lie: one in eight women will get breast cancer? I started asking for supporting documentation, the original study, years ago, from official government sources. I am still waiting for an answer.
        I can’t believe how people believe that silly statistic. I don’t see women around me dropping dead of breast cancer en masse.

        • Lisa

          Query women – you are confused about the numbers. Per ACS, it is estimated that there were 234,580 new cases of breast cancer in the US in 2013, with 40,030 deaths.

          The one in eight statistic is not a lie; it is the chance that a woman will develop breast cancer over her life, not that one in eight women will develop breast cancer in a year.

          • querywoman

            I am not confused about anything. I have read several times in the past few days that 40,000 US women per year get breast cancer.
            What I have been requesting for years is real documentation, real math studies that back up what we are told.
            I have never seen any solid evidence that one in eight women will develop breast cancer over their lifetimes.
            Most women, lie most men, if they live long enough, will die of heart disease.

          • Lisa

            More than 40,000 US women will be diagnosed with breast cancer this year. The number 40,000 represents the approximate number of US women who will die from breast cancer. There is a difference.

            Here is a link to the American Cancer Society estimated cancer statstics for 2013:

            http://www.cancer.org/research/cancerfactsfigures/cancerfactsfigures/cancer-facts-figures-2013

            This is a link from the National Health Institute that explains the 1 in 8 statistic and how it was estimated:

            http://www.cancer.gov/cancertopics/factsheet/detection/probability-breast-cancer

            And yes, more women die of heart disease. No argument there.

          • querywoman

            The math is very strange. If, at age 30, 1 in 227 gets dx’d with breast cancer, and, at age 70, 1 in 26 women gets dx’d with breast cancer, it’s really strange to assume 1 in 8 women will get breast cancer.
            It’s coming out that many breast cancers are being diagnosed that may never progress to killer cancer. Also that mammograms may cause cancer themselves.
            It is not surprising that some diseases are associated with aging, like breast and prostate cancer.
            Diabetes is also associated with aging and also with a drop in the blood sugar definition of diabetes from a 200 fasting blood sugar to 126 in the twentieth century.
            If you don’t die younger from an infectious disease or malnutrition, you will live longer and get more degenerative diseases.
            Lung cancer kills more women than breast cancer. Of course, heart disease is the biggest killer for us all, if we live long enough.
            After my brother, a noncompliant diabetic died, one of my mother’s favorite docs, a surgeon, told her that death certificates are usually vague and most people die of heart attacks.

          • Lisa

            The table that shows the age related statistics on the NHI link gives the chance that a woman at a given age will be diagnosed with breast cancer in the next ten years. If you add up the percentages for each ten year period of a woman’s life, you get 11,67% (or 1 in 8), i.e. the current estimate of the risk a woman will develop breast cancer in a lifetime. It is not strange, it is statistics.

            I won’t argue with you about your other assertions because I don’t disagree with you, In some cases I, agree with you. But I will argue with you about the statistics because it is important. Approximately 40,000 women die of breast cancer in the US each year. Last year about 235,000 women in the US developed breast cancer. That is why there is a breast cancer industry in the US. There are a lot of potential patients.

          • querywoman

            Stats can be jiggled. I just did my most comprehensive estimation of the issue. I just googled the population of the United States. The first thing I saw was from the US Census on our population in 2012.
            We had 319.3 million people. Women tend to outnumber men slightly, but half of that is 156.95 million people.
            The CDC estimates 3,958,000 babies were born in the US in 2012. Half of that is 1,979,000 girls, although more boy babies are born than girls, and die sooner in the first year of life.
            So 235,000 women in the US developed breast cancer in 2013. If the same number of baby girls were born in 2013 as 2012 and were taken as a segment of women, that would mean 11.875138959 of females get breast cancer at the current breast replenishment rate. So that is roughly one in eight to one in nine women who get breast cancer. But, I’m not sure that is a proper way to measure.
            However, if 156.95 million are currently alive in the US, and 235,000 got breast cancer in 2013, that’s .15% of the women alive in the US at anytime. That’s way less than one in one hundred women.
            So how do they come up with these stats?

          • Lisa

            The stats are based on disease incident data. I think the National Institute Health page has a link to the SEER Report:

            http://seer.cancer.gov/csr/1975_2009_pops09/

          • querywoman

            We are engaged in a meaningful conversation. It’s still bizarre to say that 1 in 8 women will get breast cancer over their lifetimes. And these stats show the risk increases over a lifetime, and by the time a women has reached 70 years old, she has just a 1 in 26 risk of breast cancer.
            I don’t understand how they can come to a conclusion that 1 in 8 women will get breast cancer.
            I downloaded some US government report on deaths in 2010 and am reading through it on and off. It’s complicated, but heart disease does cause most deaths. And I assume that’s among those of us who survive a while.
            I have to disregard, for my current purposes, the causes of infant death.

          • Lisa

            I don’t think it is bizzarre to say that one in eight women will get breast cancer over their life time: it is scary that the disease is so prevalent.

            Breast cancer is a disease of aging, the risk of developing increase as you get older. The table in the NHI link shows that a 70 year old women as a 1 in 26 risk of developing breast cancer in the next ten years. The one in eight life time risk comes from adding up the risks for each ten year period.

            :-) about the meaningful conversation.

  • querywoman

    I think listing the kind of providers you have, and services like home visits, is okay. I have been searching for a gynecologist who doesn’t do obstetrics, since I’m childless and don’t want to be in a waiting room with pregnant women. Proper advertising makes that easy.
    My dermatologist is a psoriasis specialist. Sure, he also does general dermatology. But, if he tastefully advertises “psoriasis specialist,” but makes not promises, I am okay with that.

  • Matthew Bowdish

    For once, I couldn’t disagree more with Skeptical Scalpel. Our clinic advertises on tv, radio and in newspapers. We have various specialized services (asthma center, cough center, high-quality, evidence-based allergy-immunology care) to offer to our patients and have no problem informing our community about what we do. We don’t make outrageous or false claims such as alluded to above. Because of our advertising, patients are able to find a provider to meet their needs. Other providers are also educated about the various services we provide and can direct their patients our way. But the advertising only gets patients in the door. It doesn’t bring them back for follow-ups. It doesn’t cause them to recommend us to their friends and family. And it doesn’t force patients to give positive feedback to their referring providers. Those actions are based on the care we provide and whether we do right by our patients and referring docs. Arguing against false advertising is fine. But there is absolutely nothing wrong with using outreach to help docs and patients find each other.