Promotion Rules for Doctors
19.04.2024
1. INTRODUCTION
According to data from USHAŞ, the relevant organization of the Ministry of Health, a total of 1,398,504 people came to Turkey in 2023 to receive healthcare services, generating USD 2.3 billion in revenues. Advertising activities related to health tourism and health services feed each other. Accordingly, there has recently been a significant increase in healthcare advertisements shared on social media channels. This increase has pushed some healthcare organizations and doctors to produce content in an unlimited and uncontrolled manner. However, there are also players in the health sector who want to carry out promotional and informative activities in accordance with ethical values and rules.
In this article, based on the Regulation on Promotion and Information Activities in Healthcare Services (“Regulation”), which entered into force on 29.07.2023, we will evaluate the relevant rules for physicians to promote and inform in accordance with the rules.
2. ADVERTISING FORBIDDEN! PUBLICITY AND INFORMATION ALLOWED
In our article titled Advertising Ban for Doctors and Private Hospitals, we examined the prohibition of advertisements in the health sector in general terms. According to the 1219 Law on the Mode of Practice of the Medical and Medical Professions, doctors are prohibited from making advertisements, except for the places of examination, the hours of examination, and their specialties.
Advertising refers to announcements like commercial marketing communication shared in any medium to create or increase demand and persuade people. It is these types of communications that the Law prohibits. However, promotions of doctors that include their professional and academic title, their main and sub-specialties, the days and hours of examination, the time and place where they accept patients, and health-protective and health-promoting information about the health services they are authorized to provide are considered lawful.
In practice, it may not be so easy to distinguish between advertising and promotion information. Each advertisement needs to be evaluated in detail. For this reason, we will examine some special cases in detail in this article.
a. General Promotions
In this section, we will assess the general expressions used by doctors to promote their activities. According to the Regulation, promotions must comply with public morality, medical deontology, and professional ethics. It is prohibited for these general introductory statements to constitute advertisements.
For example, according to the decisions of the Advertising Board, an ophthalmologist’s use of expressions such as “say goodbye to your glasses”, “hello to a life without glasses”, and “goodbye to glasses after the operation” are advertisements and prohibited. (Advertisement Board, D. 2022/3825, T. No. 329, T. 10.1.2023)
Similarly, statements such as “You can benefit from a free examination opportunity”, “We are with you 24/7”, and “Bursa’s Dental Center 24/7”, which doctors state without providing any details, are considered commercial advertisements. Doctors are also prohibited from using comparative advertisements. (Advertisement Board, D. 2023/6019, T. No. 339, T. 14.11.2023) For example, a dentist who used the phrase “The best dentist in town” was penalized by the Board. ( Advertisement Board, D. 2023/8065, T. No. 341, T. 9.1.2024)
As can be seen, the Board interprets the provisions of the Regulation very strictly in these general statements used by doctors. In fact, Article 5-1-d of the Regulation explicitly permits doctors to advertise the days and hours of examination and the time when they receive patients. Accordingly, we believe that penalizing the phrase “We are with you 24/7” is unlawful. In order to minimize the possible risks here, the expression “We are open 24/7” may also be used.
b. Areas of Expertise
According to the Regulation, it is lawful for doctors to state their professional and academic title, as well as their major and subspecialty specialties when making publicity. For example, a poster stating “Prof. Dr. Ahmet Yılmaz – Cardiovascular Surgery” should be considered lawful. However, specialties should be limited to those specified in Law No. 1219. For example, a doctor’s use of the expression ‘Facial Surgery Specialist’ is unlawful for this very reason. Apart from this, it is prohibited for a doctor who does not have the necessary certificates to use the title ‘Medical Aesthetic Physician’. (Advertisement Board, D. 2022/3735, T. No. 339, T. 14.11.2023)
c. Patient Comments and Evaluations
One of the most important things that bring indirect recognition to doctors is patient comments and evaluations. The Regulation restricts the sharing of these comments and evaluations by doctors or their presence on the relevant doctor’s website. For example, sharing comments such as “Thank you very much, I didn’t even have to come for a check-up, I will have it done by you regularly from now on, thank you very much”, “My Turkish is not that good and I can’t thank you enough, I can’t explain many things.” even if they are actually written by patients, creates a violation of the law. (Advertisement Board, D. 2023/1381, T. No. 338, T. 10.10.2023)
It is common practice for independent organizations/websites to share patient comments. In a situation where the content on these channels is not directly controlled by the relevant doctors, they should not be considered as “advertising”. However, if there is an indirect relationship between the channels and the doctors, a detailed evaluation should be made.
d. Before-After Contents
Another method used by doctors in their advertisements is before-after content. According to the Regulation, the use of before-after content that compares the effects of treatment and aims to create demand is prohibited. In addition, in order to use such content, the explicit written consent of the patient must be obtained.
e. Other Visual Content
There are also various rules for other visual content that can be used by doctors. As mentioned above, in order to use any image of the patient, the patient’s written explicit consent must be obtained. In addition, the patient has the right to see the visual content to be shared in advance. Doctors are also prohibited from providing discounted or free services to patients in exchange for explicit consent to the use of images.
In line with the legislation, the Board also considers the sharing of operation images and operating room images as unlawful. As can be understood, the use of visual content by doctors is restricted under very strict conditions. Accordingly, it is recommended that doctors act carefully when using visual content.
f. Active Sales Methods
The commercialization of health services can lead to different advertising methods. For example, calling people for affordable check-up services or conducting lotteries for these procedures are some of these methods. The Regulation prohibits such methods without any exceptions.
g. Alternative Medicine Methods
As in all positive sciences, new techniques and methods may emerge with the development of technology in the field of medicine. In addition, traditional or alternative methods that emerge as a result of the questioning and exclusion of modern methods may find buyers. It is an important health policy that these methods are not allowed to exploit desperate patients.
According to the Regulation, it is forbidden to make any statements about methods that have not been scientifically proven to be accurate, have not been defined as medical procedures by the Ministry of Health, and have not become established medical methods. The Regulation draws a sharp line in this regard. Doctors are likely to face penalties if they share any content related to these areas, even if it is informative. For example, activities such as Access Bars, and Holistic Life Coaching are within this scope. (Advertisement Board, D. 2017/397, T. No. 273, T. 12.6.2018)
h. International Health Tourism
There are special regulations regarding international health tourism in the legislation. For doctors or health institutions to benefit from these regulations, they must have the necessary authorization certificates.
The Regulation on International Health Tourism and the Health of Tourists describes the promotion and information rules for these organizations. Organizations holding international health tourism authorization certificates are prohibited from promoting in the Turkish language and in a way to create demand within the borders of Turkey. However, promotion in the languages of the relevant countries and/or in English is permitted.
For example, the organization that was found to be promoting in Muğla with the phrase “Hollywood smile is not far away” was imposed an administrative fine because it did not have the necessary authorization certificate. In a scenario where this organization has an authorization certificate, it is unlikely to be fined. (Advertisement Board, D. 2023/6693 T.No. 340 T. 12.12.2023)
3. SANCTIONS
In the event that doctors promote in violation of the legislation, the following administrative fines will be imposed by the Advertising Board depending on the medium of promotion.
| Television | 2.200.258 TL |
| Written Publication | 1.100.129 TL |
| Internet | 550.059 TL |
| SMS | 275.012 TL |
| Advert | 54.987 TL |
Doctors may also be subject to administrative fines under Law No. 1219. If the health facility that is found to have carried out promotional and informative activities in violation of the Regulation violates the Regulation for the third time within a year, the activities of the unit in the relevant branch of medicine or specialty will be suspended for three days.
If it is determined that the promotions made on social media endanger human health or adversely affect the diagnosis and treatment process, criminal complaints and measures to block access to the content can also be applied against those concerned.
4. CONCLUSION
- Promotion and information activities of doctors are strictly regulated in the legislation. The Advertising Board also strictly enforces these rules.
- It is lawful for doctors to advertise their consultation locations, consultation hours and specialties.
- Areas of specialization should be specified in accordance with the legislation.
- Doctors are prohibited from sharing patient comments and thank you texts.
- Careful consideration should be given to sharing before-after content with patient images.
- Doctors may be subject to administrative fines, as well as judicial and administrative measures, if their promotions and information are unlawful.