Should doctors be allowed to advertise?

Members may notice that there are recent reports in the media on the proposal of the Medical Council of Hong Kong (MCHK) to allow doctors to advertise. In fact, the issue was brought up by the Ethics Committee of the MCHK in the 3^rd November 2004 policy meeting of the MCHK. They proposed amendments to relevant paragraphs of Professional Code and conduct on practice promotion so as to allow doctors to publish notices containing their service information in journals, magazines, newspapers and periodicals in Hong Kong or elsewhere. A notice may contain only factual information relating to the doctor’s professional service and the size of a notice must not exceed 300 square cm.  The permitted contents of the notices are the same as the permitted contents of doctors’ directories as described in the February 2004 Issue of Newsletter of the Medical Council of Hong Kong.

As a matter of fact, the issue has been debated in the profession and majority of the profession has turned down the proposal all through the years. However, it was brought up again by some hardliners, who are specialists, in the MCHK. I shall try to analyze the pros and cons for members’ reference.

Reasons for the proposal

As reported in the media, some members of the Medical Council thought that since there are many countries in the world nowadays allowing doctors to advertise, Hong Kong doctors should follow as well. The reason they put forward is: this is the world trend that we should not resist. That is exactly the reason given by the MCHK on CME linkage with the annual renewal of practising certificate. Another reason they put forward is since HMOs or medical service providing companies (whether run by doctors or not) are already advertising, it would be to the doctors, especially those solo medical practitioners, disadvantage not to allow them to advertise. Allowing doctors to advertise may help in narrowing the gap of inequality between HMOs and doctors in competing for patients.

Spokesmen for patients’ rights of course welcome such proposal of “hyper transparency” of doctors' services so that patients can have an “informed” choice of doctors. The patients can fish out for themselves who are the specialists that they should go to receive treatment for their health problems. Some patients’ representatives even advocated doctors who have been disciplined professionally should have a benchmark indicating such so that patients can have a better choice.

Reasons against the proposal

While colleagues, mainly those in general practice, would question the usefulness of the proposal. Most of those in primary care, unlike specialists, would not have any particular skill to advertise. After all, they would not spare money to advertise. Say, if the doctor’s business is poor, that solo practitioner would not have much money to advertise. And if the business is real good, there is no need for him to advertise too. The end result will be even more compartmentization in an already compartmentized medical population after the establishment of the Academy of Medicine of Hong Kong.

Another drawback is there would be a lot of grey areas that doctors can contemplate on. Say, if he is associated with a medical group or HMO, his advertisement can be printed side by side with that of his associated HMO in certain Magazine. On one hand, the wordings in advertisement of that HMO can boast of superiority of its services over other doctors or doctor groups and on the other, the doctor’s advertisement bears the logo of that HMO. Every body with clear mind understands this doctor is indirectly claiming superior services over other doctors. However, the MCHK can do nothing about this. Should we allow that?

All along, we have been advocating Medical Service is not purely commercial. We have been using this principle repeatedly when we talked to the Housing Authority to fight for the rights of our public estate doctors. The liberation of advertisements for doctors would certainly go against such principle. After all, increase business in one doctor’s office means decrease business in another. So, at the end of the day, we doctors lose money as a whole to the advertising agencies.

The last but most important reason against Doctors’ advertising is that it is against the principle of Gate Keeper function of the Primary Health Care Providers. The new Secretary for Health, Welfare and Food has already spoken out clearly to support a strong primary health care system in Hong Kong, (the exact reason why he is firm with CME linkage with the annual renewal of practising certificate) so that there should be less unnecessary referrals to the specialists to save Public Health Cost. I can imagine the situation would be the same in the private sector where the insurance companies or even the HMOs would try to deter unnecessary specialist referrals to contain cost. If it is the intention of the Government to build up strong primary care and at the same time rely heavily on medical insurance for a heavy Health Care Budget, I can predict the graveyard of advertising by Specialists is not too far away. As doctors, are we happy with our patients digging out in newspaper everyday for a cardiologist when in fact his praecordial discomfort is due to his oesophageal reflux; or to look out for an opthalmologist when in fact his subconjuntival haemorrhage is due to his hypertension. Should we commercialize like the HMOs or the lawyers? Should we destroy the universally accepted importance of primary health care providers as gate keepers of the health care system?

All and all boil down to the emergence and flourish of the HMOs in our community in recent years. If there is no advertisement from these HMOs, there would not be too much cry from certain specialists for liberation of doctors’ advertising. Should we not persuade the Government to regulate them, as we are persuading our Government to damp down on Undesirable Medical Advertisements of numerous “health foods” nowadays? In order to regulate HMOs, we have forwarded the Medical Practice Act of Australia on "Corporations Engaged in the Provision of Medical Services" to the authority for consideration (refer to P. xx of this Bulletin). We would be most grateful to receive suggestions from members on how to cope with HMOs’ advertisements.

Dr. Yeung Chiu Fat Henry