By Alex R. Thiersch, JD, Founder/Director of the American Med Spa Association (AmSpa)

Can you–and should you–live-stream medical procedures on social media? Recently, some of the most prominent plastic surgery societies—most notably the American Society of Plastic Surgeons (ASPS)—have begun to take a look at some of the ethical questions surrounding plastic surgeons broadcasting live video of the procedures they conduct on social media services such as YouTube and Facebook. The surgeons who stream these surgeries typically say that they do this for its educational value, but clearly these shows are also designed to raise the surgeon's profile. If the doctor successfully publicizes the event, several thousand people will tune in, and sometimes a staff member will even be in the operating room with the surgeon answering questions from the video's chat function on a computer.

There is nothing illegal or even necessarily unethical about this but, on occasion, these videos make the surgeon and his or her staff look unprofessional, especially if they are joking around or goofing off during the procedure. And while gimmickry such as this is almost expected from those posting to social media today, it certainly can be argued that medical professionals should hold themselves to a higher standard. If the purpose of the video truly is to educate rather than make the surgeon a social media superstar, this sort of behavior should not be highlighted.

A matter of respect

At AmSpa's Boot Camps, we often point out that in the medical aesthetic field, it is very important to incorporate sales and marketing techniques into the every day operation of a practice—certainly moreso than one would in a traditional medical setting, such as a doctor's office or a hospital. After all, medical aesthetics is a retail business, and if those in a retail business do not pay attention to this aspect of the operation, they are not likely to be in business for very long.

To that end, live streaming is an effective way for surgeons to get their practice's name on peoples' lips. But while we typically encourage medical spa owners and operators to engage in marketing techniques such as these, we feel that those who act foolishly in videos need to take stock of just how far they're going and make sure that they're still representing medicine in a professional manner. They also need to make sure that they're acting in a manner that is respectful to their patients, who often are unconscious on the operating table—it just looks bad when doctors are dancing, joking, and saying silly things to the camera while the patient is prone. It's easy for surgeons to lose sight of this when they are performing (because a live broadcast of a surgical procedure realistically is a performance), but it is something they should make a point to be mindful of. This is a competitive market in which many people are utilizing unorthodox sales techniques and, although medical aesthetic professionals have to ensure that a practice remains profitable, they are still dealing with medical patients.

Contracting trouble

While this should probably go without saying, it is critically important that any surgeon or medical spa planning on live-streaming a surgical procedure receives written consent from the patient that thoroughly covers all HIPAA and local patient privacy laws. The forms used for this must be very specifically drafted in order to address the legal minutiae of live-streaming a medical procedure, so anyone planning to do this needs to be very careful to ensure that the patient understands exactly what is going to happen. This is not the sort of form that anyone can simply download off the Internet—it will need to be vetted by an experienced health care attorney to guarantee that no legal entanglements result from this broadcast.

Again, it's worth mentioning that when patients sign such an agreement, they are consenting to the doctor streaming video of the procedure and to having their likenesses out there for the world to see for educational purposes, not to being a motionless prop while the surgeon acts foolish. It's not hard to imagine a scenario in which a patient would be fine with participating in an educational live-stream, but then appalled when he or she sees the surgeon and staff members messing around during the actual video.

Living with a low profile

There is a very strong division in the realm of plastic surgery between those with the old-school mentality that any sort of self-promotion is gauche and those who have no problem with marketing themselves. Medical spas are caught in the middle—they are mostly run by non-core doctors and, in order to compete, they often are forced to engage in promotional techniques that some medical professionals might find unsavory.

I think it is important for medical spas to be a responsible party and to not promote stunts that are too overblown, because if they do, there will be blowback if something goes wrong or a patient files suit because he or she feels misled. Those doctors with anti-promotional mind-sets will use the opportunity to try to take certain procedures out of medical spas' hands. The medical spa industry needs to be careful—it shouldn't get too brazen or overt with its marketing, because medical societies have much louder voices in halls of government than the medical spa industry does. A group of Northwestern Medicine authors recently proposed a code of ethics for videos, and I think this is a good idea. After all, if these videos truly are for educational purposes, they don't need the theatrics.