The days of plastic surgeons donning costumes, dancing and juggling breast implants during live surgery videos on social media may soon be over.
The first ever code of ethical behavior for sharing videos of plastic surgery on social media is up for a vote at the upcoming meeting of the American Society of Plastic Surgeons (ASPS) in Orlando. They are also published in Plastic and Reconstructive Surgery.
No official ASPS guidelines exist regarding video sharing on social media platforms, and the need is growing based on ethical concerns.
“There is increasingly vulgar content by a growing number of plastic surgeons that is not in the best interest of the patient,” says Clark Schierle, MD a plastic surgeon and faculty member of Northwestern University Feinberg School of Medicine.
“We hope this will make its way into the official ethical code of conduct for board-certified plastic surgeons,” Schierle says in a news release. Board-certified plastic surgeons who belong to ASPS must agree to abide by its voluntary code of conduct.
First, do no harm
In one post, Schierle saw a plastic surgeon cradling an abdominal tummy tuck specimen in his arms like a baby and then used a Snapchat filter to put an “infant’s” face on it.
“This is inappropriate handling of human tissue for entertainment purposes,” Schierle says.
The ethical conduct guidelines, which Schierle wrote with first author Robert Dorfman, a third-year medical student at Feinberg, is based on the four guiding principles of medical ethics dating back to Hippocrates.
The four principles of medical ethics include: 1) respect for autonomy of the patient; 2) beneficence or promoting what is best for the patient; 3) nonmaleficence, also known as “do no harm” and 4) justice. Related principles include disclosure and informed consent.
Finding the line between appropriate and inappropriate behavior isn’t easy, Schierle says. “It’s like pornography. I know it when I see it, but how do I define it?”
The challenge is to come up with an ethical framework that bridges “old fashioned” with “hip and cool,” Schierle says. “We have to find boundaries we can all agree on as a society that provide a framework for proper ethical behavior in the setting of patient care.”
The surgeons are not filming the videos for educational purposes. “It’s about notoriety,” Schierle says. “It’s about showing the most outrageous content to attract more viewers and build your business.”
Even when surgeons obtain consent to post videos on social media, Schierle and Dorfman question the validity of the consent.
“The relationship between a doctor and patient still remains somewhat hierarchical,” Schierle explains. “The patient may feel coerced -- even if subconsciously -- to participate in being filmed in order to be a ‘good patient.’ There is an inherent power disparity.”
More than 15 minutes of fame
Some patients may request to have their video shared on social media -- particularly those who sought out the surgeon based on his or her social media presence -- as a way to experience their own brief moment of fame, Dorfman says.
But patients risk their images being copied, manipulated and redistributed, as well as possible revelation of their identity.
They may not realize that a video on Snapchat, which disappears in 24 hours, may be screenshot and posted on YouTube or any other website where it can live indefinitely, Dorfman adds.
Downplaying of risks
He calls for greater transparency about the risks involved including the permanency associated with posting videos on social media and the Internet.
There also is the risk to the patient of having a distracted surgeon. “Instead of focusing on providing the most efficient surgical procedure to help the patient, the surgeon is distracted by hamming it up for the camera,” Schierle says.
And the videos can misrepresent the risks involved with undergoing a surgical procedure.
“When surgeons are dancing in the operating room, people may misperceive surgery as this lighthearted event,” Dorfman says. “Yet there are risks associated with going under the knife, such as infection, excessive bleeding or possibly blood clots. The videos may be giving some people false illusions of what surgery is actually like.”