Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Friday, April 13, 2007

DTC Double Standard

Apologies to David Williams at the Health Business Blog, (Edit: apologies; it was Dr. RW) where I believe I first saw this mentioned:

Does everyone remember what DTC actually stands for? And that the "D" is not for "drugs."

Why is is that "direct to consumer" pharma advertising is universally vilified (except by Pharma itself, of course) whereas the ubiquitous ads on radio, TV and all variety of print media for hospitals, "health systems" and assorted doctor groups are considered legitimate marketing? That is to say, why is medical marketing kosher at all?

At one time, wasn't self-promotion the height of unethical behavior for professionals? Isn't this why billboard lawyers are deemed to have sunk so low? When did the medical profession join in? Aren't doctors supposed to limit their "advertising" to location, hours and perhaps insurance plan participation? Doesn't anyone else find this kind of self-promotion crass and unprofessional? Just because more and more people are doing it -- offering the excuse that one must join in in order to remain competetive -- doesn't make it right. See the Twelfth Law of the Dinosaur:
A bad idea held by many people for a long time is still a bad idea.
In this case, it's more on the order of everyone else is jumping off a bridge. Going along with the crowd doesn't make it less stupid.

Last week I wanted to write a letter. Not an email; not a phone call; an honest to goodness, pen and paper letter. (Yes, I even wanted to handwrite it. Another post later on the stereotyping of doctors and their handwriting.) I couldn't find any nice stationery anywhere around the house, so I popped out to the mall to find some. Hanging from the magnificent vaulted, stained glass Romanov Egg ceilings were advertising banners. The one outside Nordstrom's flaunted a larger-than-lifesize portrait of a smiling Ryan Howard, the Phillies' slugger. But hanging above the escalator down from the upper level food court was a similar banner touting the Orthopedists at Thomas Jefferson University Hospital. Five Jefferson orthopods stood there, posed and smiling, watching over the shoppers and browsers with the same glint in their eye as Ryan Howard. Each column along the promenade had a smaller poster with one or another of the doctors, all smiling as if they wanted to be your best friend while simultaneously slicing your knee open.

Never mind that if you actually called for an appointment today you'd be told the first one available was in July. Never mind that if your appointment was for 10:00 you'd have to leave your home in the suburbs a good 1-2 hours before that to allow time for rush hour traffic and finding a place to park. Never mind that once you got there (at 10:00) you wouldn't be seen for up to another four hours (true stories from patients of mine braving Jefferson) and then for two minutes by an abrupt ortho resident. Never mind that the exact same "highly specialized and advanced" services are readily available twenty minutes from home at your perfectly good neighborhood hospital, where your perfectly competent orthopedist (who's been doing this for twenty years) sees you within five minutes of your appointment time, and does your surgery himself; no trainees. And never mind that the University of Pennsylvania, Temple University, Lankenau Hospital and any number of other teriary care centers in the same area code all provide essentially identical care.

Medical marketing is bullshit; even more so than direct-to-consumer pharma advertising. Although I am under absolutely no illusions about the extent of my influence, I would like to see it stop.


At Fri Apr 13, 07:21:00 PM, Anonymous Anonymous said...

You're talking about the Rothman Institute, no? They certainly have slick ad campaigns, on TV, in the newspapers, on their website, and apparently now in malls, just in case people haven't yet heard of them.

I had outpatient surgery there a year ago. At my first visit, on the patient info form, they asked how I had heard about Rothman. I had to check yes for 'newspaper, TV, Internet, doctor, friend, and yellow pages.'

I had an uncommon surgery which the surgeon I had specialized in, so I don't regret going there. But for more routine orthopedic surgery, I wouldn't consider going to the place. Their main center is run like a zoo. The clerks are clueless. They lose essential paperwork, like referrals. It is absolutely true - both times there, I waited 1.5-2 hours for a 5 minute rushed appt with the surgeon, during which he made it quite clear he was not there to answer questions.

Rothman has a good reputation, but I think it is based mostly on their slick ads, and not on the actual care that patients receive. I give kudos to their ad agency.

Lest I forget, the staff at the Jefferson Outpatient Surgery Center were very professional, and I have nothing but good to say about them.

At Fri Apr 13, 11:54:00 PM, Blogger Midwife with a Knife said...

I agree. DTC advertising by physicians seems almost like seeking out illness or something. I don't know, it just seems smarmy, maybe only a step above promoting well reimbursing but possibly unnecesary procedures. I'll never do it.

And the drug companies... argh! If I have one more patient come in and ask for Lunesta or Ambien CR or Rozerem, I may scream.

At Sat Apr 14, 01:04:00 AM, Blogger Bardiac said...

One of the local hospitals in town advertises based on affiliation with a hospital in another state; the idea is that if you're really sick, they can get you to a good hospital. (If you get sick here, you evidently want to get to another state asap.)

At Sat Apr 14, 10:21:00 AM, Blogger #1 Dinosaur said...

Anon: No; I am not talking about Rothman. I'm talking about downtown Jeff, in competition with Rothman.

Adding the word "Institute" to your name is another tactic. In addition to Rothman, several of the ophtho guys have done this. They've generated high-volume LASIK and cataract practices this way.

At Sat Apr 14, 06:49:00 PM, Blogger Dr Dork said...

I resigned from my AMA about not taking a stance against indirect advertising by medicos. Docs can't promote themselves but some of the moneygrubbing 'cosmetic' surgeons and opthho's who jus do LASIK at several $K a pop have been advertising the "centre" or "institute" which is often just a day surgery office in a shopping centre.

Does your AMA take a stand on this behaviour ?

At Tue May 08, 01:25:00 PM, Anonymous Anonymous said...

After I moved to another state I began receiving brochures from local hospitals touting their services. Frankly, it was ghoulish. Am I to think they HOPE I'll get ill enough to need their services? I now have a primary care physician here and I just assumed he'll use a good hospital if I ever need one. Rethinking this, now. How does one check out area hospitals? Have to start googling that.

At Wed May 09, 11:31:00 AM, Anonymous Anonymous said...

Side note: when you write your post on stereotypical doctor handwriting, be sure to mention how hard it is to read the nursing notes.

I am always getting comments on how nice my writing is. Why?'s legible! But...I'd say 75% of the nurses I have ever worked with write worse than any doc I've ever seen.


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