Do You Tip Your Doc for Botox®?

In the last few years, an increasing number of General Practitioners, Family Practitioners and OB-GYNs in the United States, Canada, and Australia have added revenue-enhancing cosmetic procedures to their core practice. Because 91 percent of cosmetic procedures are performed on women, OB-GYNs have a ready-made client base—but is the integrity of the physician-patient relationship, the practice of medicine, and ultimately the care of patients compromised when physicians offer cosmetic procedures and products that don’t increase the health and welfare of their patients?

“We are physicians who limit our practice to women,” writes David Levine, MD in the Journal of Minimally Invasive Gynecology, an OB-GYN and outspoken proponent of the practice, “and these same women are responsible for the bulk of the $6 billion per year spent on cosmetic treatments, it seems natural for us to consider offering these treatments.”

Levine’s argument seems logical on the surface, but in medicine, what makes sense financially is not always what makes sense ethically. We must face the fact that there are deep ethical implications of the rapidly increasing trend of General Practitioners (GPs) Family Practitioners (FPs) and OB-GYNs adding revenue-enhancing cosmetic procedures and products such as skin rejuvenation, Botox®, Radiesse®, liposuction, breast augmentation, and mesotherapy to their core practice.

As GPs, FPs and OB-GYNs continue to add cosmetic product lines and menus of cosmetic procedures to the general fare of PAP smears and annual checkups, they risk demeaning their profession by creating a public image that physicians are mainly businesspeople working to increase their income. This trend makes it easy for patients to wonder whether their health and safety is the priority or whether the physician’s income is the priority.

Daniel Frank, MD, an internist in Seattle, established his primary care practice in 2002. At the time other primary care practices were starting to offer cosmetic procedures, but he rejected the idea, “When setting up the practice, we were called upon by a number of sales people who wanted us to offer cosmetic procedures. I believe if there is too much of a financial incentive to offer a procedure or service, then my objectivity could be comprised, and even the best and most diligent and objective among us can’t help but be swayed by the economic factors, particularly in primary care. We did not want to detract from our primary mission, which is the care of our patients, so we declined.”

Until the medical community does something about this trend, we as consumers of healthcare need to raise awareness in our GPs, FPs and OB-GYNs. We need to let them know of the potential moral harms of adding cosmetic procedures to their practice, and we need to lobby for reform. Trust is central to the patient-physician relationship and little is more destructive to patient care than a widespread degradation of the public trust in the medical profession.

The integrity of the physician-patient relationship, the practice of medicine, and ultimately the care of patients is compromised when physicians offer cosmetic procedures and products that don’t increase the health and welfare of their patients. Let’s work to make this trend-line spike down.

Read the full Women's Bioethics Project white paper here.

*Question on Yahoo! Answers forum: Do you tip the doctor who does your Botox? How much? Answer: Docs are not supposed to get tipped as it conflicts with their Code of Ethics.