Unit 02: Ethics and this Social Media Doctor

Today, virtually everyone can get a real-life glimpse inside of a medical operation. One of the most popular social media plastic surgeons is Dr. Michael Salzhauer, commonly known as “Dr. Miami.” Dr. Miami has very active social media accounts and a relatively new reality series (Diaz, 2017; Kirst, 2016). On these platforms, he records him and his staff performing various surgeries including nose jobs, tummy tucks, Brazilian butt-lifts, and breast implants. The doctor describes his social media pages as educational, where prospective patients can get see what their desired cosmetic procedure involves (Andriakos, 2015). The doctor always makes sure to get permission from his patients to post, citing that he only posts two-thirds of the surgeries that he performs (Kirst, 2016). That said, this social media doctor has been described as controversial and even unethical (Diaz, 2017; Kirst, 2016) as he tests the waters of professionalism with his social media posts.

In many of his videos, Dr. Miami is playing hip hop or rap music as he performs his procedures. His staff can be found laughing and making jokes as he cuts, adds/removes, pulls and stitches the unconscious patient on the table. Most of his social media content shows before and after pictures of procedures, and photos of the doctor with his smiling patients (Kirst, 2016). He takes pride in the laid-back nature of his office, explaining that he likes that his team is both educating and entertaining (Kirst, 2016). He has also written a children’s book to encourage plastic surgery and has made a music video that shows a boy who gets a nose job so that he can win the attention of a girl (Diaz, 2017; Kirst, 2016).  While Dr. Miami is not violating HIPAA because he has consent for his social media posts, is his behavior truly ethical?

The American Medical Association (AMA) Code of Medical Ethics added an opinion to address professionalism on the internet (AMA, 2000). Opinion 2.3.2 explains that while social media usage can be beneficial, it also presents many challenges (AMA, 2000). Beyond following laws regarding privacy, informed consent, and confidentiality, it is recommended that physicians use privacy settings on social media pages (AMA, 2000). Today, Dr. Miami’s Instagram page has 1.2 million followers, but his page is private so new followers must request to see his posts (DrMiami, n.d.). The opinion goes on to explain that doctors should separate their professional and personal lives, and they should realize that their online content can negatively affect their reputations to clients and colleagues (AMA, 2000). The AMA code also notes that says that physicians must recognize that their social media usage can undermine public trust in the medical profession (AMA, 2000), which seems to be where many criticize Dr. Miami’s usage of surgery as entertainment. Interestingly enough, Dr. Miami’s personal website does not feature before and after photos, as is typical of many other plastic surgeon websites (Dr. Miami, n.d.). His website only features two pictures: one of a woman in a bikini and another of himself. Next to the photo of him is a biography that reads “A highly respected, ethical and experienced plastic surgeon” (Dr. Miami, n.d.), which seems to acknowledge and mock some of the criticism that he has received.

Perhaps where Dr. Miami truly becomes unethical is in his violation of AMA opinion 3.1.4 which discusses the recording of patients for public education (AMA, 2000). This opinion cites that professional standards must be upheld and that the public is made aware of the risks, benefits and alternatives to treatments (AMA, 2000). Dr. Miami’s posts, rarely offer alternatives or discuss how serious the operations really are. In fact, it was not until I was writing this that I thought of the significance of the surgeries that he performs. Is it ethical for a doctor, a leader in healthcare, to glaze over the alternatives and risks to the public, the very target of the social media education videos? At the very least, Dr. Miami’s promotion of plastic surgery does not balance with his conversation of the risks and alternatives in these “educational” videos.

The aforementioned AMA opinion goes on to state that the care and advice given to patients in regards to their participation in the video cannot be influenced by the possibility of financial or promotional benefits to the doctor or the patients (AMA, 2000). It is clear that Dr. Miami is a social media doctor and he relies on these videos that he posts to his social media to bring him referrals.  In 2016, he said that over 60% of his referrals were through social media, which resulted in his scheduling being booked over a year in advance (Kirst, 2016). It is likely that the clients that are featured in his stories may in fact believe that they will get a promotional benefit by being posted on his social media accounts, which each have over a million followers (Kirst, 2016). This idea is reinforced by his popularity among social media influencers (people who are very popular on social media) (Kirst, 2016). Maybe, what once started out as an ethical usage of social media for educational purposes has snowballed into an unethical glamorized display of plastic surgery, where a patient can gain social media status and Dr. Miami gain more popularity and money.

While the AMA can take action against those that violate its opinions (AMA, 2000; PSU, 2019), it seems that Dr. Miami carefully blurs the line of ethical and unethical behaviors. Although many people have frowned on his progressive practices, it does not seem that he has made any conclusive violations that would warrant an investigation with disciplinary action. It is important to mention that like the APA (American Psychological Association) Code of Ethics, the AMA Code also seeks to hold members to a higher standard than their legal duties (Albert Henry, 2018; AMA, 2000; PSU, 2019). To me, it seems like Dr. Miami and his team are doing the absolute minimum to barely meet the standards set forth by the AMA Code of Medical Ethics. As a leader to his team and in the medical profession, Dr. Miami should continue to evaluate his practices and determine if his decisions are truly ethically-sound. That said, I imagine that future changes to the AMA Code (and the APA Code) will include new regulations surrounding the usage of educational social media posts based on the prevalence of social media doctors today.

 

References

Albert Henry, T. (2018, September 14). Medical laws and ethics: What to do when conflicts occur. Retrieved from https://www.ama-assn.org/councils/council-ethical-judicial-affairs/medical-laws-and-ethics-what-do-when-conflicts-occur

American Medical Association. (2000). Code of medical ethics. Retrieved from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page

Andriakos, J. (2015, May 03). Meet the plastic surgeon who shows his surgeries on snapchat – butt lifts and all. Retrieved from https://people.com/bodies/dr-michael-salzhauer-shares-snapchat-videos-from-operating-room/

Diaz, J. (2017, March 28). ‘Dr. Miami’ reality series follows sometimes-controversial plastic surgeon. Retrieved from https://www.sun-sentinel.com/features/fl-dr-miami-series-wetv-20170322-story.html

Dr. Miami: Plastic surgeon. (n.d.). Retrieved from https://www.drmiamiconnect.com/

DrMiami [@therealdrmiami]. (n.d.) Posts [Instagram profile]. Retrieved from https://www.instagram.com/therealdrmiami/?hl=en

Kirst, S. (2016, February 28). Michael Salzhauer, aka Dr. Miami, discusses his plastic surgery snapchat videos and brand. Retrieved from https://www.forbes.com/sites/seamuskirst/2016/02/23/michael-salzhauer-aka-dr-miami-discusses-his-plastic-surgery-snapchat-videos-and-brand/#761734495567

PSU. (2019). PSY 833: Ethics and Leadership. Retrieved from https://psu.instructure.com/courses/1963919

3 Comments

  1. Matthew Ultsch February 24, 2019 at 9:34 PM #

    Hi Adriana,
    Thank you for such an interesting topic.  I couldn’t help but be reminded of a similar situation involving dermatologist Dr. Windell Boutte, which is pronounced “boo-tay.”  Yes, you can’t make this stuff up.  This doctor, nicknamed the dancing doctor, was stripped of her license to practice (Simon, 2018).  Dr. Boutte faces many malpractice lawsuits while Dr. Miami currently does not(Simon, 2018).  Outside of this difference, there are some striking similarities, which include posting videos on social media.  The comparison between doctors boils down to one question.  Does the safety of the patient need to be at risk for this to be an ethics violation?  While it may be worthwhile to examine all nine principles, I will focus on principle eight of the American Medical Association, or AMA, to answer this question (American Medical Association, 2001).

    Granted, I am anti-social-media and have a conscious bias against this type of behavior.  As such, I would never go to a laid back doctor like this.  Give me intense and focused, please.  The reason I do not participate in social media is due to the distraction of it.  Am I hiking this trail because it is its own reward, or is it to get a good picture for my feed?  While participating in life, I prefer not to decide between these thoughts.  There exists a similar type of distraction occupying the doctor’s thoughts.  The Hawthorne effect says a subject changes behavior due to the awareness of being observed (Zaleznik, 1984).  Filming is a distraction that can alter the doctor’s behavior.

    Is this distraction justified?  This fits in with your assessment of the AMA’s opinion 3.1.4 (American Medical Association, 2001).  Let’s look at the purpose behind filming.  Let’s assume the purpose is to educate and entertain.  There’s nothing inherently wrong with mixing entertainment with education.  When done well together, entertainment enhances education.  What exactly is educational about these videos?  Certainly, this isn’t the only resource about the subject.  In fact, how many identical videos does this doctor have?  He films two-thirds of his procedures.  Lets generously say these videos are somewhat educational.  However, these videos also have other intents.  It’s to entertain, as evidenced by the television show, and to advertise, as evidenced by the number of followers and additional business.  The videos have brought the doctor fame and financial gain through advertising, and resulted in getting his own television show.

    If filming causes a distraction and filming is not, at least solely, for any educational or greater purpose, is this an ethics violation?  Principle eight of the AMA code says the focus on the patient is paramount (American Medical Association, 2001).  In conclusion, by putting the his own desire for fame and financial gain above his focus on the patient, Dr. Miami violates, at least, principle eight of the AMA code (American Medical Association, 2001).  

    References

    American Medical Association. (2001). AMA Code of Medical Ethics: AMA principles of medical ethics. Retrieved from https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/principles-of-medical-ethics.pdf

    Simon. D. (2018, June 8). ‘Dancing Doctor’ Defends Music Videos, Says Patients Asked for Them. Retrieved from https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=11&cad=rja&uact=8&ved=2ahUKEwiNl4Wg6NXgAhUJWa0KHRRpChgQFjAKegQIFRAB&url=https%3A%2F%2Fwww.cnn.com%2F2018%2F06%2F07%2Fus%2Fgeorgia-dancing-doctor-speaks%2Findex.html&usg=AOvVaw1TEq1CdwS_yctN4JdZDdEc

    Zaleznik. A. (1984). The “Hawthorne Effect”: What Mayo urged in broad outline has become part of the orthodoxy of modern management.  Retrieved from https://www.library.hbs.edu/hc/hawthorne/09.html

  2. Adriana Vargas Smith February 24, 2019 at 6:19 PM #

    Unit 02 Comment –

    Hi Josh,
    Before reading your post, I was not aware that The American Society of Plastic Surgeons had their own code of ethics. Thank you for sharing!
    This code left me with mixed feelings, similar to Dr. Miami’s conduct. The emphasis on “art” and medicine in the code seems to be referring to the way cosmetic surgery requires an “artistic flair” (Sepehripour & Patel, 2012). In fact, one article says that plastic surgeons are “half artists” and many doctors are “eager to exploit this [artist] trend” (Choi, 2015).
    The Plastic Surgeons code does say that it applies to social media forums, but it does not discuss educational materials used on social media (Code, 2017). Instead, it seems to be referring to instances of confidentiality that cannot be violated on social media. As a result, Dr. Miami’s behavior does not constitute any direct violations to this code of conduct, either.
    Thank you for an insightful comment! This has certainly expanded my thinking on both, other codes of conduct and Dr. Miami’s behavior.

    Adriana

    References
    Choi, J. (2015). Cosmetic surgery: is it science or art?. Archives of plastic surgery, 42(5), 672.
    Code of ethics of the American society of plastic surgeons. (2017, September 25). Retrieved from https://www.plasticsurgery.org/documents/Governance/asps-code-of-ethics.pdf
    Sepehripour, S., & Patel, A. J. K. (2012). Art, Artistry, and Plastic Surgery. Plastic and Reconstructive Surgery, 130(4), 638e-640e.

  3. Joshua B Gray February 20, 2019 at 8:37 PM #

    Unit 02 Blog Comment:

    Hi Adriana,

    Thank you so much for sharing this extremely interesting post about the questionable ethics of “Dr. Miami,” or Dr. Michael Salzhauer. I found it very intriguing to do a bit of searching around about “Dr. Miami” myself. In terms of the American Medical Association (AMA) Code of Medical Ethics, it certainly does not appear as if Dr. Salzhauer is in direct breach of any of the codes that I have seen. I also read Code 2.3.2, which addresses the use of the internet, and I do see a bit of a problem with Dr. Salzhauer when I read over section g. Section g of 2.3.2 states that, “Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers…and can undermine public trust in the medical profession” (AMA, 2000). It does seem that Dr.Salzhauer’s method of advertisement, while not a direct ethical violation, could bring about some public questioning of the medical profession. I also visited “Dr. Miami’s” website, and the hokey and crude nature of his advertisement does not scream of professionalism and serious medical science (Dr. Miami, 2015).

    I found a website devoted to the Code of Ethics of The American Society of Plastic Surgeons. I recommend that you take some time to look over this very specific code of ethics. Here is a link to the page: https://www.plasticsurgery.org/documents/Governance/asps-code-of-ethics.pdf

    A bit in the preamble of the Code of Ethics of the American Society of Plastic Surgeons truly struck me. This preamble refers to plastic surgery as both an art and a science (CODE OF ETHICS, 2017). It seemed strange to me to refer to a branch of medicine as an art, and appears to be fairly representative of this particular niche of medicine and surgery. The code of ethics goes on to actually promote advertising, so it seems that “Dr. Miami” might truly be a product of his chosen branch of the medical profession. He seems to be in the business due to strict cosmetic interest, whereas other plastic surgeons likely focus more of their efforts on other types of surgery that are more “medical” in nature. To Dr. Salzhauer’s credit, there is a section on his webpage wherein he claims that safety is the number one concern of his practice (Dr. Miami, 2015). The website goes on to describe how the doctor will only perform surgery on people who are under 50-years-old, in good health, and have a body mass index of 30 or under. This section also claims that the guidelines for surgery appropriateness are very stringent (Dr. Miami, 2015).

    Finally, while his methods might seem tacky and outlandish, I agree with your notion that Dr. “Miami” Salzhauer does not appear to be in direct violation of any specific ethics code of the AMA or any other organization that I could find. He does walk the line that often blurs into quite a grey area. Ultimately, as long as he is following the rules of consent and privacy, adhering to proper medical procedures etc., he is not in breach of codes. In all likelihood, his patients are probably carefully selected based upon a bevy of tests before we ever see them appear on social media. As with all social media outlets, everything must be taken with a grain of salt. While his public image might not be the best look for medicine overall, “Dr. Miami” is a businessman, and probably would love to know that we are even writing about him. I suppose that whatever he is doing is working.

    Thank you again for this interesting discussion!

    Best,

    -Josh Gray

    References

    American Medical Association. (2000). Code of medical ethics. Retrieved from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page

    CODE OF ETHICS OF THE AMERICAN SOCIETY OF PLASTIC SURGEONS. (2017, September 25). Retrieved from https://www.plasticsurgery.org/documents/Governance/asps-code-of-ethics.pdf

    Dr. Miami. (2015). Retrieved from https://www.drmiamiconnect.com/

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