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.
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