On the heels of a study suggesting plastic surgeons need to increase their visibility on social media, comes a paper spotlighting the need for guidelines to help keep plastic surgeons’ video posts professional and respectful.
Tactful educational video posts showing cosmetic surgery procedures can be good for patients, the doctors posting them as well as the specialty. But videos of surgeons dancing or singing in the operating room, or holding a patient’s tissue post-surgery, with a super-imposed baby face emoji on the image (true story), may harm patients and the profession, according to study author Clark Schierle, M.D., Ph.D., a plastic surgeon and faculty member of Northwestern University Feinberg School of Medicine and director of aesthetic surgery for Northwestern Specialists in Plastic Surgery, in Chicago.
“I think there are a number of areas where some of the more egregious posts cross the line into something that we would argue is in conflict with the principles of medical ethics that date back to Hippocrates,” Dr. Schierle says.
Plastic surgeons behind the controversial posts realize a social media irony: The more outrageous and edgy the video content, the more likely it is to go viral; the more likely they’ll get good and bad comments and coveted shares and followers.
But the social media attention comes at a price to patients — even the specialty and medicine — Dr. Schierle argues.
Sometimes, physicians have a responsibility to protect patients against themselves.
“Twenty-year-old you may see this as a really fun, playful way to express yourself on social media by having your surgery broadcast for the world to see, but 40-year-old you, who is trying to get a job someday might not be too happy when it shows up as the number one search result, when your name is Googled by your future employer,” Dr. Schierle says.
Beverly Hills, Calif.-based cosmetic dentist Matt Nejad, D.D.S., says he posts practice photos and videos to social media and his website.
“I post them to show examples of the quality of my work and also to educate patients on available high-quality treatment options. I especially like to post videos and pictures of the veneer treatment process including planning, 3D-evaluation, fabrication of temporaries and final results achieved,” he tells The Aesthetic Channel.
But Dr. Nejad agrees it’s unethical to use photos and videos without patient permission. It’s also wrong to repost another doctor’s work and pass it off as one’s own, or edit photographs to make results look better than they are.
Today’s “instant gratification society” has created a dynamic and ever changing set of challenges for any professional organization including the medical profession, according to Michael S. Kluska, D.O., president of the American Academy of Cosmetic Surgery.
“One of my positions this past year was to help our members ‘compete’ in this crazy, dynamic environment,” says Dr. Kluska, who is a dual board-certified plastic and reconstructive surgeon and cosmetic Surgeon. “Competition is good as long as it is ethical and within the rules or guidelines of what is fair to all involved. All physicians should practice medicine based on their commitment to the profession, to the patient and the acceptance of the foundation of the Hippocratic Oath including ‘do no harm’ and respect the patient and respect the authority and privilege that has been given to the physician with their medical degree.”
Do No Harm
Doing harm is another concern.
“It’s when you physically stop the operation and step away from the table to do a dance, or sing a song, or perform inappropriate activities with body parts, making inappropriate jokes. Those cross the line into something that is potentially degrading the level of care. And you’re delaying the progress of the case and increasing the length of time that patients are under general anesthesia,” Dr. Schierle says.
Videos—the good kind
Dr. Schierle says he and his coauthors are all for entertaining, engaging content.
“We understand that’s how you have to communicate to get likes and shares,” Dr. Schierle says. “But the physician-patient relationship is something special and deserves respect and decorum. And when a patient is under general anesthesia undergoing a procedure, your first and foremost responsibility should be the care of that patient.”
That’s not to mention that the physician is in a position of power when the patient having surgery is potentially unable to object at all because of general anesthesia or vulnerable because of the circumstances, he says.
Beverly Hills facial plastic and reconstructive surgeon Ben Talei, M.D., often posts clinical photos and videos. Among his postings: videos of surgical and nonsurgical procedures, as well as before and after photos. He says the posts give people watching a realistic view of what to expect.
But before posting, Dr. Talei says he takes a few things into consideration.
“The practical issue is whether or not graphic images would offend or traumatize unsuspecting followers or possibly deter them from doing a procedure because of the imagery involved,” Dr. Talei says. “Ethically, I always ensure the patient has given complete permission to publicize them and the procedure on social media whether or not their identity is revealed. Posting photos of patients without their consent is … unforgivable, even if the patient’s face is not shown.”
Dr. Kluska’s advice to physicians considering social media and other marketing: “Do to the patient what you as a physician would be comfortable having done to you or your immediate family.”
Guidelines for Posting Content on Social Media
Cosmetic specialty societies might already have general guidelines in place about how member physicians should handle marketing and promotions involving patients. That’s a good place for many to cosmetic medicine physicians go, first, for guidance when posting social media content. The American Academy of Cosmetic Surgery offers members social media guidelines, and the American Society of Plastic Surgeons’ (ASPS’) code of ethics addresses how plastic surgeons should treat patients with respect with their words and images.
“The ethics committee of the ASPS has said they will use this paper as guidance for how to enforce those guidelines,” Dr. Schierle says:
· Clearly ask patients how they feel about having their procedures videotaped and broadcasted on social media channels, and, if they approve, get it in writing. Be specific about what you’ll do with the videos, and, when you edit the videos, make sure patient identifiers are censored. If patients agree to show their faces, get a special consent for that. Patients younger than 18 are considered minors and need parental consent. Allow patients to withdraw consent at any time and consider hiring a legal professional to draft the consent document.
· Be clear that patients can refuse consent without affecting the care they receive.
· Inform patients that images, including videos, might be saved, shared, changed. And even if the physician deletes them on the practice’s website or social media, copies might live forever online.
· Uphold standards of professionalism as advocated by the American Society of Plastic Surgeons Code of Ethics. (Physicians from other specialties might refer to their codes of ethics.)
· And concentrate on the procedure at hand — not on videotaping. Providers should consider hiring a professional videographer and training staff and others about maintaining professionalism and integrity.
The dynamic and rapidly changing social media environment will continue to challenge the medical community and its societies, according to Dr. Kluska.
“In medicine, the physician needs to not only adapt and overcome these obstacles that challenge our societies and their respective leaders but, the physician must also compete with these temptations by standing his or her ground based on [ethics], tradition and common sense,” Dr. Kluska says.