Should doctors be allowed to advertise?

“Today’s reality is that medical care is often provided on a fragmented piecemeal basis by numerous specialists, and the patient needs to learn to get the best medical care for himself”
Dr Aniruddha Malpani

The Code of Ethics of the Medical Council of India does not allow doctors to advertise and most senior doctors in India look upon advertising with suspicion. After all, doctors are professionals - why should they behave like shopkeepers in order to attract customers?

However, the truth is that times have changed, and we need to change with them. Gone are the days when patients had a family doctor whom they could blindly trust, and who would provide medical care for them from cradle to grave. Today’s reality is that medical care is often provided on a fragmented piecemeal basis by numerous specialists, and the patient needs to learn to get the best medical care for himself.

This is why it is so important that he has access to information on available doctors, so that he can select the best one for himself. Most doctors feel that advertising is unethical, but we need to look at the reality more carefully. How are young doctors who have just started practice going to get patients? How will patients know of their skills and their expertise? Many young professionals, who have spent long years to qualify and taken loans to start practice, simply cannot afford to sit back and starve till patients arrive on their doorstep. This is why new doctors have to resort to unethical practices like cuts and kick-backs today - many of which have been institutionalised by their seniors. I think it is far more honest to allow them to attract patients by allowing them to advertise - at least this is open and transparent !

The fact is that preventing advertising favours senior doctors - those who have an established reputation, with many hospital attachments, and lots of patients. They will do their best to maintain the status quo by prohibiting advertising - not to protect patients as they claim, but to prevent new doctors from competing with them, thus safeguarding their own interests !

Since senior doctors form the “medical establishment,” which sets the rules for all doctors, the Medical Council of India code on ethics still prohibits advertising by doctors. However, this code was developed many years ago, and needs to be updated so that it is responsive to the needs of today’s patients and doctors.

It is worth remembering that doctors were not allowed to advertise by the powerful American Medical Association (AMA) in the US as well, many years ago. The reason this has changed, is because some courageous doctors took the AMA to court, and the Supreme Court ruled in their favour, declaring that not allowing doctors to advertise was unfair on them - and also unfair to patients, who need access to information on doctors, so they can select the best for themselves!

Today, the AMA has promulgated guidelines for ethical advertising by physicians, and these guidelines permit physician advertising, provided it is not false, deceptive or fraudulent. Maybe we should learn from them!

To keep readers abreast of new medical guidelines worldwide, here is what the Council of the College of Physicians and Surgeons of Alberta has to say about physician advertising in its Code of Ethics. “The Council...believes that clear and accurate information about physician services benefits all parties in the health care system. Advertising falls within the definition of “freedom of expression,” and any constraints to this freedom should be minimal and reasonable.” They clearly specify what is acceptable, and state that “Advertising is just one of the professional activities subject to the Code of Ethics”.

It is true that advertising has a downside. For one, advertising may cause doctors to start treating their patients as clients or customers, rather than as patients - and this is a shame. For another, some ads will be dishonest, but at least they will be in black and white, where they can be refuted and debated - and a doctor making false claims taken to task.

This is far better than making tall claims privately within the four walls of a clinic and taking the patient for a ride. What about the risk that patients would be lured to the doctors with the fanciest ads, rather than the “best doctors”? To answer this objection, think about how patients select doctors in India today. Usually they do so either by reputation or referral, and neither of these are reliable criteria! Allowing reputed and reliable doctors to advertise will help to enlighten and educate patients - and an excellent example of such educational advertisements are the ads placed by the Cleveland Clinic, USA in the Times of India.

We live in a fast changing global village, and we can no longer afford to cut ourselves off from the rest of the world! Since India has an abundance of qualified and skilled doctors who can provide state of the art medical care at a fraction of the cost which doctors in the West charge, there is tremendous scope to export our medical services. If we learn to advertise Indian medical services worldwide effectively, we will be able to attract patients from all over the world, and medical services can become a big foreign exchange earner for India.

(The author is a Mumbai-based infertility specialist. This article was originally written for www.housecallsindia.com)

Medical professionals are welcome to send their articles for the ORACLE column. Oracle is an open platform for doctors and professionals concerned with the healthcare industry to express their views on different issues that are significant in the present healthcare delivery system. Contributions can be sent at ehm@rediffmail.com