ACP: Medicine up in the air inflates patient expectations



A guest column by the American College of Physicians, exclusive to

Medicine is big business. If you don’t believe me, the next time that you travel by plane, pick up the airline magazine in the seat pocket and read the ads. If the advertising is a reflection of the air traveling public, the typical flyer is bald, tired, and has back pain and low testosterone; is interested in a home health care franchise; and wants to stop the aging process. At 39,000 feet, there is no shortage of clinics, experts, and pharmacies that will fix what is wrong with you, what you think is wrong with you, or what you’re afraid will be wrong with you.

It’s not just the snake oil merchants either. Some of our most prestigious academic medical centers want you to hop on the SuperShuttle and let them meet all of your health care needs. Physicians advertise as well. Alongside the listings of the best seafood joints, steak houses, and  Italian restaurants in America you’ll find the “best” plastic surgeons, LASIK surgeons, and other specialists (I’ve yet to find a primary care physician on any of these lists – I guess we can’t afford to advertise at high altitudes).

You’ve probably gathered by now that I view most of this with a degree of disdain, but I bring it to your attention as another illustration of why the utilization of health care services is so high in the United States. For example, one ad has a list of nonspecific symptoms and states that if you have five or more, you might have undiagnosed hypothyroidism. The symptoms include fatigue, difficulty losing weight, feeling tired when you awaken, hair loss, and afternoon fatigue (which I guess is different from just plain old fatigue, since it is listed separately).

Hmmm, do I have hypothyroidism? Or am I going to bed too late and have bald ancestors? Perhaps I’m spending too much time not sleeping on airplanes and eating at airport food courts. If you’re sitting in coach on the flight from Chicago to Burbank, by the time that you are over the Continental Divide, those ads for non-surgical rejuvenation of your knees or same-day back surgery with a Band-Aid sized incision look very tempting.

I have to believe that air travelers respond to these ads, otherwise, why would these companies shell out big bucks to advertise in airline magazines? Even if people don’t call the toll free number or visit the website, how does this marketing shape expectations and perceptions of what the health care system can or should do for them? Do these ads also create doubt about the care that travelers get from their usual physicians? Does it make them wonder why their doctor didn’t tell them about the non-surgical treatment to cure arthritis, or the regimen that makes you young again? Does it make them think that in order to get the “best” medical care, they need to travel long distances because the doctors at home are way behind the cutting edge?

It’s easy to blame all of this on corporations looking to make a profit (and that includes some not-for-profit institutions, by the way). But who is providing the medical care for these businesses that market to the flying public? It’s not the venture capitalists who are bankrolling the operation or the MBAs who are running the clinics. It is physicians. Some of them are providing evidence-based care but promoting it alongside casinos and dating services, while others are selling unproven treatments to the vulnerable and gullible.

Before the indignant comments start flying about my criticism of colleagues who are simply trying to make a living, let me state that I have no problem with the entrepreneurial spirit in the practice of medicine. Delivering high quality care that utilizes the best medical knowledge is compatible with building and growing a successful business. I would like to believe that my own medical group is such an example. However, at a time when we are trying to make a case for shortages in the physician workforce and defending against external forces that question our professional commitment to our patients and science, these ads and the existence of some of these providers of medical services contribute to unrealistic patient expectations, making the practice of evidence-based medicine that much more difficult.

Yul Ejnes practices internal medicine in Cranston, Rhode Island, and is the Immediate Past Chair, Board of Regents, American College of Physicians. His statements do not necessarily reflect official policies of ACP.

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