The ethical and communications challenges associated with celebrity patients and celebrity doctors
Celebrity doctors come in several flavors, but they are important to the rest of us through their outsized impact on patient perceptions of their conditions, treatments options, and expectations for outcome. And, in recent years, their influence has spread with the number of media channels available to them.
In 2010, the Los Angeles Times noted, “Today’s celebrity docs not only tweet and blog, they also have Facebook fan pages, websites, and bestselling books. Some have their own TV and radio shows, regular magazine columns, and companies that sell products they promote…Would-be patients trust them because, well, because they’re celebrities.”
In that article, psychiatrist and former broadcaster Tom Linden, now professor of medical and science journalism at the University of North Carolina, divided these physicians into medical journalists and medical showmen. He noted, “When information appears on major news media, it is reasonable to assume that the information has been vetted to a much higher degree than if it appears on a TV talk show or a reality show. Yet, people assume the two carry equal weight. Being on ‘Oprah’ or ‘Larry King Live’ is not a stamp of approval for medical or psychological legitimacy. They’re not news shows. They’re entertainment.”
Doctors to celebrities
As I thought about the types of celebrity doctors, particularly as they pertain to orthopaedic surgery, a different taxonomy presented itself. When doctors are presented in the lay media, many are the TV personalities that Dr. Linden mentioned. But, the public also hears about the criminals, area experts, and the doctors to celebrities.
The criminals are the doctors bilking Medicare or those whose actions contribute to the deaths of icons, such as Michael Jackson and Joan Rivers. After Dr. Spock in the 1940s, the next doctor that came to most Americans’ attention was Dr. George Constantine Nichopoulos, personal physician to Elvis Presley. When the coroner found 14 different prescriptions in Mr. Presley’s serum, newspapers took to calling Dr. Nichopoulos “Dr. Feelgood.” More recently, it was reported that Mr. Jackson’s personal physician, Dr. Conrad Murray, was paid $150,000 a month. These stories do little to enhance the doctor-patient relationship.
Of course, most doctors presented as criminals were not treating celebrities. Conversely, most doctors covered in the news for treating celebrities are not criminals. Their model of concierge practices has grown in popularity for even upper middle-income patients. However, the business model for these practices requires more of the “customer is always right” mentality than the rest of us face in daily practice. We all face challenges to our decision making and ethics, but that pressure must be intense when treating a small roster of very high-income, very demanding celebrities.
Most of us treat regular folks. So, the recommendations and treatments offered by celebrity doctors only occasionally impact our practices. As a spine surgeon, I have found that the recent travails of PGA golfer Tiger Woods and NBA coach Steve Kerr have been fodder for much clinic discussion. Many patients assume that one-size-fits-all and that the treatments offered or the problems encountered by these famous icons will be applicable to them. They assume that a celebrity, with access to relatively limitless resources, will choose an area expert to treat his or her condition.
Across the wider culture, most celebrity doctors are known for fad diets, skin care, or beauty treatments. But, are they experts? How solid is the advice rendered by these celebrity doctors? Authors of a 2014 article published in the British Medical Journal randomly selected 40 episodes each of “The Dr. Oz Show” and “The Doctors.” From each episode, they evaluated the evidence to support 80 randomly selected recommendations. At least some evidence (a case report or better) supported about half of the recommendations. There was no evidence for about a quarter and directly contradicting evidence for about 15 percent of the remaining suggestions. The magnitude of the expected benefit was described only about 15 percent of the time and disclosure of potential conflicts of interest occurred with 0.4 percent. While there has been some push-back from the medical community to these shows, it has garnered little traction from the lay media.
On Sept. 6, 2017, Scientific American blogger Farah Naz Khan, MD, noted that TV show doctors like Phil McGraw, PhD, and Mehmet Oz, MD, are only the tip of the iceberg. Dr. Khan writes, “But now, in the era of social media influencers, celebrity doctoring is no longer exclusively available through the handful of physicians writing books or starring in television shows; it can be found across just about every social media platform. Medical bloggers, doctor instagrammers, and physician twitterati are all reaching out to the American public, and this is a slippery slope to disaster.”
Dr. Khan noted that the all-important “online presence” began as a means of professional development for and as a way to disseminate medical information by physicians. More recently, though, these new media have demonstrated significant potential for harm, such as the “unnecessary hysteria” resulting from Dr. Oz’s claims regarding potentially unsafe arsenic levels in apple juice.
True area experts represent the opposite end of this spectrum. Typically, this physician or clinician scientist is interviewed on a news show. Most commonly, these stories involve groundbreaking discoveries or new dangerous epidemics. The interviewee almost always offers scientifically sound information.
While reality shows featuring doctors’ spouses or cosmetic surgeons abound, I am not aware of any featuring orthopaedic surgeons as of yet. As musculoskeletal specialists, when we orthopaedists are featured in the lay media, the story typically surrounds a professional athlete’s injury. Practices and hospital systems advertise their relationships with professional sports teams because, as noted by Ms. Laura Dyrda of Becker’s Orthopaedics Review, the “prestige of becoming the team physician for a professional team can gain you credibility and drive a higher patient volume.”
Since their reputations lie in caring for many athletes and their outcomes are often clear to sports fans, these orthopaedic surgeons are more like area experts than television personality doctors. As sports medicine specialist David Geier, MD, told Becker’s Orthopaedics Review, “If a player does badly and everyone knows you are the team physician, there could potentially be a lot of negative publicity.”
For the rest of us, the issue around celebrity sports orthopaedics lies in communicating with our regular patients. The aggressive treatment pathway selected for an elite athlete is not often appropriate for middle-aged office workers. For me as a spine surgeon, it means that not every back pain after a pick-up basketball game requires an MRI and a trip to Andrew Hecht, MD, in New York or Robert Watkins, MD, in Los Angeles.
Is it important?
Many of the issues surrounding celebrity doctors seem to be microcosms of wider changes affecting our society. With the rise of social media, medical misinformation is a small part of the “fake news” touted on Facebook, Instagram, and elsewhere. Alex Jones funds his Infowars broadcast with supplement sales with less medical credibility than Dr. Andrew Weil, whose “claims for his immune boosting supplements came with zero evidence that they could in fact ‘ward off’ swine flu.”
For us, the issues lie in our ethical responsibilities to our patients and in averting unnecessary confusion. In daily practice, patients already have trouble delineating MDs and DOs from other doctors, DPMs, DPT, DC, etc. As we extend these challenges to the world of celebrities, most of us know that Dr. Phil has a PhD in clinical psychology (but no license to practice), but many may not know that Dr. Laura Schlesinger holds a PhD in physiology and Dr. Ruth Westheimer an EdD. Dr. Oz, Dr. Drew Pinsky, and the physcians on “The Doctors” do hold MDs and have advanced training, but I doubt much of the public appreciates the difference.
Ever since the American Medical Association’s prohibition against physician advertising was lifted in 1977, MDs have increasingly utilized the media to attract patients to their practices. In many areas of elective orthopaedics, it could be argued that this approach has become, practically speaking, a requirement.
Yet, we all must continue to recognize our own and our patients’ tendencies to reach for the “easy answer.” That easy answer (a fancy new laser or a special bean from France) is almost always more compelling than the real, hard answers (there’s no cure, lose weight, and eat right). We also know that there are lots of gray areas, with limited evidence to direct our advice.
Moving forward, we must acknowledge our own bias and remember our standards of professionalism. Until the evidence supports the expense, outside of carefully conducted studies, we should be slow to adopt “stem cell” injections and other novel and appealing but unproven techniques.
Whether treating celebrity patients or presenting ourselves to the public, we must make our purpose clear. For the patient, “I am your doctor, I will put your interests first.” On social media or during radio or TV appearances, define your introduction by your purpose: “I am speaking from my training and experience as a board-certified orthopaedic surgeon.” Or, if it’s a talk show, consider, “I am here to entertain, not in my role as a physician.”
Whenever possible, make the level of evidence clear: “We don’t have great data about this treatment yet, but, in my experience I have found it to be helpful in conditions like yours.” Dr. Khan puts it best when she suggests physicians be “held to high clinical standards across every platform in which they practice—from their clinics to their Instagrams.”
Eeric Truumees, MD, is the editor-in-chief of AAOS Now and an orthopaedic spine surgeon in Austin, Texas, where he is also professor of orthopaedics at the Dell Medical School, University of Texas.