Monday, June 25, 2007


Should hospitals advertise?

In order for a hospital to be successful, it must fulfill its mission. To be wonderfully successful, the goals must be met with excellence. It is my contention that in so doing, the hospital will earn a well deserved reputation. It is this well deserved reputation that will guarantee that the hospital will be sought by doctors for their patients and by patients as the center for their hospital care. With careful financial management and unrelenting support for the excellent fulfillment of the mission, the hospital will be a financial success.

There is no place for solicitation of business or of self-serving publicity on the part of the hospital. Such activities are a diversion of funds at best, and at worst, are unethical. Until some thirty years ago it was universally accepted that it was unethical for hospitals to advertise and to solicit business. It was considered demeaning of the professional status of the institution and the participating health care providers. It was considered intrinsically misleading, putting forth self-aggrandizing claims. This was the practice of the medical snake-oil salesmen of the prior century, from whom modern medicine wished to differentiate and distance. For the first three-quarters of the twentieth century, the "Flexnerian Era" of modern, scientific medical practice during which hospitals grew and flourished, there was the distinction of a professional model that guided our behavior. Since the late 1970's, the forces of business, primarily the "third party payers", have shifted us, by overt coercion, into a business model. The vestiges of the professional model coexist unhappily with the business model.

The ethos of the business world is unconcerned with the ethics of the professional world. It is not only acceptable, but mandatory to compete. Competition has its own rules, a near biological imperative of eat-or-be-eaten. "Whatever is necessary" is what is acceptable. There is no accountability and no science (other than the statistical analysis of the marketplace and its applications for psychological manipulation.) Like a biological organism, there is only survival and growth. The larger the business organization, the more likely it plays by its own (self-serving) rules. Public relations and publicity are tools to distort the truth so as to appeal to the consumers. The worse the truth, the greater the PR required.

In our current world, it would take great courage to coexist with a voracious business-model-medical-center with no weapon but a rigorous adherence to an outstanding rigorously committed professional model. My final contention is that it is not only possible, but that it is the only way to survive. Real, earned, reputation for excellence will, in the long run, triumph over bigger bricks and bravado. The institution that cannot ever vie in a business model with a bigger, richer, powerful competitor, with any hope of triumph, can stop competing. The monster businesses demonstrate their inability to even see (or care) beyond the surface of their product. The professional hospital can see clearly what needs to be done and do it.

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