Commentary on the Code of Medical Ethics and Deontology

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Chapter IX: advertising

It has been said that today's culture is dominated by advertising and medicine is certainly no stranger to this. Doctors have to make a living from their work and it is understandable that some are inclined to use advertising to make themselves known and thus expand their clientele.

In medicine, advertising must have certain specific features. The practice of medicine is not a commercial activity that aims to maximise profit: doctors do not sell their prescriptions or their certificates; they do not offer medical services of different quality at different prices; they do not launch promotional campaigns with attractive fee reductions or raffle gifts among their patients. His professional work is a service that must be offered to everyone honestly and without deception. The advertising in medicine must be guided by criteria and use very different means from those used by the commercial advertising .

It is also the case that in medicine there is a constant risk of mixing information with advertising. In order to benefit from medical progress, the public must be informed not only about the possibilities available to medicine in general, but also about what doctors can offer real patients here and now. The educational task on subject health and the information on the technical possibilities actually available can be manipulated by the doctor or the journalist in favour of the advertising promotion of certain institutions or individuals.

Often, in order to carry out the health Education in society, it is necessary to use the most widespread written or audio-visual media. In order to be in accordance with the Deontology, health Education must comply with certain requirements requirements: it must be based on the scientific knowledge , so that it enjoys authority; on the mastery of the art of communication in its different varieties, so that the message addressed to people of different ages and socio-cultural levels is effective; on the decorum and human quality that health education must have; and, finally, on weight and good judgement, because without them, health Education can cause more harm than good.

Doctors cannot instrumentalise their role as health educators and turn it into a hook to attract patients to their own enquiry. He/she should avoid with the utmost delicacy any detail that would lead the public to think that he/she alone possesses certain knowledge, skills or technical resources that place him/her above other colleagues, as this would be a more or less veiled form of advertising promotion. He should not allow radio or television presenters, or interviewers or editors in the written press, to praise him beyond what is decorous, or in any way to imply that he is superior to his other colleagues. If, on the occasion of a doctor's participation in a programme educational, patients present their problems to him or ask to be received by him at enquiry, he shall advise them to seek the advice of their regular doctor (see article 24.2 of the Code).

There are many reasons why the Code devotes a Chapter to regulating the ethical problems posed by the professional advertising . It might seem at first sight that these problems are subject peculiar only to private medicine, but today they also affect public medicine. Public medicine needs to enjoy the highest social prestige, for which it has to convince people that its efficiency justifies its high economic cost and that its level of quality is at least comparable to that which the best private medicine may have achieved.

article 37.1. The advertising must be objective and truthful, so as not to raise false hopes or propagate unfounded concepts.

This article defines the ethical features of the professional advertising . There is really only one ethical basis for a doctor's reputation: his or her skill and integrity. And the most legitimate vehicle for this good reputation are the patients and colleagues who are satisfied with the professional and human attention received. They are the ones who spread the word among the public about the genuine quality of doctors and thus create professional prestige. The good doctor does not need other agents of advertising.

As essential features of the ethically acceptable advertising , this article requires objectivity and truthfulness. The first factor of objectivity is that the information content of the advertising must be in line with what is permitted by the rules of the association. These prohibit advertising from being immodest and from implying to the public, directly or indirectly, that a doctor is more competent than his colleagues, that he is superior to others in his technical skills or knowledge, or that it is even more economically advantageous to go to him. Typical of the advertising prohibited by the Code is this 'differentiating' character, which attributes to the physician promoting it some subject superiority or advantage over his or her colleagues.

The forms that this inetic advertising can take are very varied and, in the articles that follow, some of them are specifically prohibited. But the general rule is set out in this article: the advertising and, where appropriate, information to the public may not raise false hopes or propagate unfounded concepts, nor may it be misleading or exaggerated. It is possible to make advertising on the occasion of informing if, on the occasion of a lecture addressed to the general public, leaflets or brochures with the address and times of enquiry of the lecturer are left in convenient places, or if a doctor inserts a advertisement on the same page of the newspaper in which one of his article appears from knowledge dissemination. It is possible to make advertising inethics through interviews or press, radio or television reports, if, with the consent or at written request of the physician, the journalist, in his information to the public, lauds the spectacular work of the interviewee, or declares that such a centre or person has the exclusive use of the most advanced diagnostic or therapeutic apparatus, facilities and procedures. All these statements leave the public with the clear impression that someone is doing things much better than others and that patients can consider themselves lucky to have access to such great advantages.

article 37.2. Mentions on practice door plates, on letterheads or prescriptions, in press advertisements and in yearbooks, guides and professional directories shall be discreet in form and content. When members are in doubt about this subject, they should consult the relevant Ethics Committee at high school.

This establishes the sober, concise, purely informative, non-promotional nature of the physician's advertising media. Discretion is recommended in the form, size and content of plaques and advertisements, so that they fulfil their primary function of being simple indicators of data, never instruments of advertising promotion.

The Colleges entrust their Deontology, Medical Law and Visa Commissions with the resolution of conflicts that may arise in this area: it is the specific responsibility of the Commissions to endorse plaques, letterheads and advertisements: skill . There are notable differences between the different Colleges in terms of the ways and customs in which doctors advertise in the local press or in the style, content and size of plaques and advertisements. These differences should gradually disappear in the future. The Ethics Committees of the Colleges shall apply criteria of austerity to the consultations addressed to them in this subject, so that, by means of their resolutions, they will adjust the advertising which they authorise to the rules of the previous article .

article 37.3. You may never make accredited specialization of an academic or professional degree scroll that you do not possess.

This article warns against the abuse of degree program: a physician may not appropriate titles he does not possess, invent illusory dignities or distinctions or distinctions not acquired in accordance with the law, or give titles he possesses an illusory appearance, so that they appear to be of greater value than they are.

In Spain, the use of the degree scroll de Doctor is frequently raised. It is true that, in the common speech of some regions and social strata, a doctor is called doctor. This is recognised by the Diccionario de la Real Academia. There is, however, a big difference between the common, non-technical meaning of the word doctor when people use it in ordinary conversation, and the technical, deontological meaning of the word Doctor, the abbreviation Dr., or the degree scroll Doctor of Medicine and Surgery, inscribed on the door plate of the doctor's office, on the letterhead of prescriptions, or on a advertisement in the press, or embroidered on the doctor's coat. It is not remotely within the intention of this article to prohibit people from calling their doctor a doctor. Nor is it the intention to order physicians not to tolerate being called doctor by their patients. Such social usage should be respected and even viewed with the utmost sympathy. But the message of article is clear: it is not compatible with the dignity of a physician to sport an academic degree scroll that one does not legitimately possess. To a certain extent, the improper use of the degree scroll of Doctor constitutes an affront to the graduate, which is as professionally dignified as the former and qualifies for the plenary session of the Executive Council practice of medicine.

article 37.4. If a physician uses a pseudonym when commenting on matters relating to the profession, he/she is obliged to declare this to his/her high school of Physicians.

Medicine is a profession that fosters development a strong sense of responsibility. Physicians must always be seen to be accountable at attention to their patients and in their professional actions. He or she cannot hide his or her identity under a pseudonym or in anonymity. When writing about professional matters, he may express his ideas freely, but he may not disclaim responsibility for them. He may wish, because of the particular nature of subject , that his name does not appear at the bottom of the article he has written, or that he prefers to sign his name under a pseudonym. He will then communicate this not only, as is required in honest journalism, to the editors of the professional publication in which his article or commentary will be published, but also to the board Board of Directors of high school.

article 37.5. Only the academic or professional degree scroll which is terminologically authorised by the rules and regulations in force, or the EEC Directives, may be mentioned.

Qualifications which may be mentioned in advertising materials are only those which are legally recognised: this excludes the use of qualifications in specialities which are not specified by law or diplomas which have not been and cannot be endorsed by a University, or a National Specialities Commission, or which have not been validated by the relevant Ministry.

In Spain, for example, Royal Decree 127/1984 regulates the procedure for obtaining the degree scroll de Médico Especialista. According to its article 1º, this degree scroll shall be compulsory in order to use, expressly, the designation of Specialist Doctor, to exercise the profession in that capacity and to occupy a work space in public or private establishments or institutions with that designation. The Annex to the same Royal Decree includes the list of officially recognised specialities.

Directive 75/362/EEC and the documents which have subsequently supplemented it (in particular Directives 82/76/EEC and 89/594/EEC) indicate the equivalences of diplomas, certificates and other qualifications which doctors officially receive in the countries of the European Community and the rules for their use with a view to the effective exercise of the right of establishment and the freedom to provide medical services in the European Community.

In general, the ethical rules of medical organisations in the EU countries accept the inclusion in advertising material (in general, the material referred to in article 37.2 of this Code) of the academic degree scroll and the officially obtained specialization program , but prohibit the inclusion of both references to the techniques offered and the apparatus or instruments available, and lists of the diseases being treated.