Stumbling block to medical tourism

Rigid rules have placed Malaysian doctors and hospitals in a disadvantaged position as the race for a piece of the global medical tourism pie intensifies.

THEY are young, talented and good looking. Dr Paul Ching and Dr Henry Kok who serve in a Hong Kong hospital lead exciting lifestyles, both at work and at play.

They depict the new breed of doctors whose pictures are highlighted on medical tourism websites these days.

But Dr Ching and Dr Kok are actually Lawrence Ng and Bowie Lam –leading actors playing doctors in the popular Hong Kong medical drama Healing Hands.

The 1998 drama series was so popular that it went into its second season in 2000 and a third in 2005.

The storylines revolving around the lives and loves of doctors and nurses at the fictitious Yan Oi Hospital in Hong Kong has been reputed to have even influenced many students to pursue medicine.

And if the manner in which the characters in Healing Hands have endeared themselves to their viewers is anything to go by, doctors or hospitals too should be able to attract more business.

As such, the intense race for a piece of the global medical tourism pie has given rise to more creative promotions and advertisements.

Strict guidelines

But certainly not in Malaysia where the rather stringent guidelines on medical advertising are a damper.

For instance, Malaysian doctors are only allowed to put up MyKad-sized photos, names, qualifications, job titles, telephone numbers and places of practice in their advertisements.

Even medical websites must be approved by the Medicine Advertisements Board which comes under the Health Ministry.

This is a stark contrast to doctors and medical institutions overseas whose websites include among other things, virtual tours of hospitals or clinics, and testimonials from their patients.

"Healthcare is not just another commodity on sale in the market"- DATUK SERI LIOW TIONG LA

Some doctors have sections in their websites in which they can even talk about their families.

While conservative doctors may argue that advertisements have nothing to do with medical skills or treatment, the reality is, branding and promotion have become inevitable these days.

On his part, Health Minister Datuk Seri Liow Tiong Lai cautions that healthcare is not just another commodity on sale in the market.

While his ministry will do its best to help promote medical tourism –from expediting approvals to cooperating with parties involved in the business – Liow is firm that any form of advertisement should not breach the medical code of ethics.

Less than three years ago, the Malaysian Medical Council (MMC) lifted the advertising ban imposed on registered medical practitioners.

Unlike doctors in some foreign countries who can even pose like actors or actresses on their websites to promote their services, Malaysian doctors are only allowed to put up MyKad-sized photos with their names, qualificaions, job titles, telephone numbers and places of practice in any form of advertisement.

All medical advertisements, including websites, must also be approved by the ministry’s Medicine Advertisements Board (MAB).

Over the years, there have been many complaints on the rigid guidelines on such advertisements. Advertising agencies too, are not spared such controls either.

For example, actual copies of advertisements must be submitted to the board for approval and no changes will be allowed on the copy after approval.

MAB’s control has also blockaded the advertising industry, barring it from foreign advertisements and revenue, running into millions of ringgit.

For instance, foreign healthcare facilities and tourism agencies wanting to advertise in the media in Malaysia, including through advertorials, are not allowed to name the healthcare facilities.

Who will want to put up an advertisement without even naming the hospitals, the types of treatment available and the list of medical specialists?

As a result, more and more healthcare facilities and tourism organisations are now advertising in foreign magazines which are on sale in Malaysia.

Is it time to relax the rather stringent rules imposed on such advertisements? The reactions from doctors are mixed.

Malaysian Medical Association (MMA) president Datuk Dr Khoo Kah Lin says he would rather be a little conservative than over-advertise.

He feels that the Malaysian Medical Council (MMC) and the healthcare industry can always discuss ways to make medical tourism more attractive, adding that some doctors will have the tendency to make excessive claims in the name of boosting medical tourism.

Malaysia is certainly not the only country to impose strict guidelines on medical advertisements.

In China, advertisements on hospitals and doctors also need prior approval from the Ministry of Health and the State Administration of Industry and Commerce.

Dr Xu Zhiwei who works in the Shanghai Ruijin Hospital says: “We are not encouraged to advertise ourselves, and our applications hardly get approved.”

Dr Xu says dentistry and plastic surgery centres currently top the list in terms of the number of media advertisements.

Boton Yue, an advertising executive from Shanghai, says his clients, who are mainly private hospitals, will opt for advertising over mobile television or on public transport such as buses and metro trains.

And contrary to the calls to relax medical advertisements to promote medical tourism, the Chinese government had in February issued a circular prohibiting actors/actresses or celebrities from hosting medical programmes on radio and television – after a few actor impersonators were discovered on such advertisements.

The law has also been tightened. Now, only basic information on medical organisations like the name of the hospital, address, type of treatments and business hours are allowed, a situation similar to that in Malaysia.

Asked what foreign patients look for as far as medical tourism is concerned, Dr Khoo, a private cardiologist, highlights three aspects – the qualifications of the doctor, patient safety and pricing.

Dr Milton Lum, an obstetrician and gynaecologist in Kuala Lumpur is adamant that the choice of doctors is not dependent on advertisements.

“Advertisements certainly can make things look very nice on the surface. This is the job of the advertising industry,” he says.

If and when there is a review on the present advertising guidelines, Dr Lum says it will be good if private hospitals highlight the types of treatment they offer, rate of success and rate of complications for each and every type of treatment.

He says putting up such information is a form of transparency and this is already practised by some hospitals in the United Kingdom.

In the United States, doctors are cautious in advertising themselves although there are no laws barring them from publicising their services.

Cautious approach

The major reason for doctors to shy away from publicity is to avoid expensive lawsuits, according to some medical professionals.

“While the law says we can advertise, it is very strict. If a patient were to complain that the advertisement is misleading, we could end up being slapped with multi-million-dollar law suits,” says a Manhattan doctor who declined to be named.

The doctor says those operating small clinics are more likely to just seek listing in medical journals or websites and telephone directories instead of placing advertisements touting their services.

“The occasional advertisement that appears in the newspapers or television is placed by leading private hospitals which have received special awards or are mentioned in medical journals,” says the Manhattan doctor.

Meanwhile, a spokesman from the American Medical Association (AMA) says “aggressive high-pressure advertising and publicity should be avoided.

As such, the AMA spokesman says the information published may include the education and background of the physician, the basis of which fees are determined (including charges for specific services), available credit or other methods of payment and any other non-deceptive information.

The Chicago-based AMA also cautions doctors on the use of testimonials by patients.

“For example, testimonials of patients as to the physician’s skill or the quality of the physician’s professional services tend to be deceptive when they do not reflect the results that patients with conditions comparable to the testimonial’s condition generally receive,” says the AMA spokesman.

In Thailand, private hospitals advertising their range of services try to avoid naming their doctors or specialists.

“To avoid any violations of rules, some even present their advertisements to the Thai medical council for review and approval,” says Deloitte Consulting Ltd’s managing director Janson Yap.

Like in Malaysia, medical practitioners are not allowed to stake claims, using superlatives like “world-class, world-renowned” or “best” in their advertisements. They can only list the types of services avaiable, Yap adds.

He says advertisements are prevalent for services like cosmetic surgeries, dental services and health screening.

Cosmetic surgeries ranging from eyelid enhancement, tummy tucks, breast augmentation to sex change are very popular in Thailand.

Thai hospitals which focus on medical tourism report revenue from overseas patients (non-Thais) in excess of 50% and this is a significant figure and still a growing percentage, Yap adds.

The medium of advertisement on medical tourism in Thailand covers all forms of print media and websites, while billboard advertisements near transport gateways like airports have been catching up in recent years.

Advertisements on medical tourism is certainly not without its boundaries.

In Malaysia, advertisements on medical tourism in other countries must get approval from the ministry’s Medicine Advertisements Board.

Advertising industry sources say only general information on tourism in foreign countries are allowed in the local media.

Specific promotion on healthcare facilities or hospitals overseas are not allowed, says one source, adding that the media has been made to understand that such promotion may pose a threat to the local medical tourism as well as encouraging locals to seek treatment overseas.

This, however, cannot be imposed on foreign publications which are on sale in Malaysia or websites in an increasingly borderless world.

Source : STAR
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