Plastic Surgeon Ethics Complaints: Expert Testimony, Marketing
The number of ethics complaints against plastic surgeons decreased significantly in recent years, according to a report from a group of researchers.1 Investigators reviewed complaints filed over an eight-year period with the American Society of Plastic Surgeons (ASPS).1
A similar study was published more than a decade ago examining complaints filed with the ASPS ethics committee.2 “We were interested to see if the types of reported misconduct had changed, given the massive uptake of social media [use] among plastic surgeons,” says Katelyn G. Makar, MD, MS, the study’s lead author and an assistant professor of surgery at the Indiana University School of Medicine.
There were 584 complaints filed from 2013 to 2021. In contrast, the authors of the earlier study found there were 677 complaints filed during a four-year period (2004-2008). The reason for the marked decrease in complaints is unclear.
“I would love to think that it is due to ‘moral progress’ among plastic surgeons, as I consider it my duty to educate and train surgeons according to the highest ethical standards. It is something that is worthwhile to track over time,” says Christian J. Vercler, MD, another author of the most recent study. “Fundamentally, the regulation of ethical behavior is intrinsic to the profession of medicine. This practice of ethical reflection is deeply central to what it means to be a surgeon."
Complaints are investigated by the ASPS’s ethics committee and are referred to the judicial council if a violation may have occurred. Of the 584 complaints, 21% were formally investigated by the ASPS ethics committee, and 26% of those complaints were referred to the judicial council.
Most of the investigated complaints were about deceptive advertising, such as using images that were Photoshopped, or using before/after photos in a misleading way. Some plastic surgeons used photographs of people in a way that made it look like they were patients, when they actually were not.
Other plastic surgeons made claims about themselves or their practices in their advertising that were untrue or could not be verified. “We have seen plastic surgeons around the country using social media in highly inappropriate, exploitative ways,” Makar says. “The issue of misrepresenting patient outcomes has been around for a long time but is perhaps more common now with the increased utilization of social media for marketing and education.”
A newer concern in advertising is the use of provocative photos of patients or intraoperative videos. “There are surgeons who take videos of human tissue in flippant, disrespectful ways. Any intraoperative video like this tends to generate followers simply out of morbid curiosity,” Makar says.
Most of the complaints referred to the judicial council involved plastic surgeons who gave expert testimony during malpractice litigation.
“The issue of expert testimony is another one of honesty,” explains Vercler, co-chief of the clinical ethics service and associate professor in the departments of surgery and neurosurgery at the University of Michigan.
It is a violation of the ASPS Code of Ethics for plastic surgeons to testify that a maloccurrence is malpractice if the care provided was within the standards of care. However, expert testimony occasionally equates a bad outcome with malpractice. In some instances, patients have experienced bad outcomes; sometimes, these bad outcomes simply cannot be prevented.
“In these cases, it is critical that the expert weigh the situation fairly based upon the expected knowledge base and expertise possessed by plastic surgeons,” Makar says.
It also is a violation of the ASPS Code of Ethics for plastic surgeons to testify outside their area of expertise. For example, Vercler is a craniofacial surgeon and limits his practice to that area. However, as a plastic surgeon, Vercler also was trained in hand surgery. If Vercler provided expert testimony in the area of hand surgery, it would be a violation of the ASPS Code of Ethics.
“There is quite a bit of money to be made in providing expert testimony,” Vercler notes. “There is an incentive that some people cannot resist that leads them to exaggerate their area of expertise.”
- Makar KG, Bajaj AK, Park JE, et al. A 9-year review of ethics complaints to the American Society of Plastic Surgeons. Plast Reconstr Surg 2023; Aug 3. doi: 10.1097/PRS.0000000000010958. [Online ahead of print].
- Verheyden CN. A 5-year review of ethics complaints to the American Society of Plastic Surgeons. Plast Reconstr Surg 2012;129:531-536.
Allegations concerned deceptive advertising, including using altered pictures and making claims that could not be verified. Also, some surgeons have been accused of exaggerating their expertise or scope of practice to cash in on lucrative expert testimony opportunities.
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