Adverse Risks for Dermatologists: Insights From Canadian Advertising Medico-Legal Cases

To the Editor,

Physician advertising has long raised ethical and regulatory debate.^1,2 This study examines Canadian medico-legal cases to characterize advertising-related issues and the services and venues implicated, with particular relevance for dermatologists.

We conducted a retrospective review of all publicly available civil and provincial college medico-legal cases using CanLII, Westlaw, and LexisNexis databases. ³ Cases adjudicated between 1969 and 2022 (the latest identified cases) and involving practicing physicians with advertising-related allegations were included. Cases involving nonphysicians or administrative matters only were excluded.

Seventy-one cases met the inclusion criteria. Most occurred in outpatient settings (96%). Ontario accounted for 90% of cases. The remainder arose in British Columbia, Alberta, Nova Scotia, and Quebec. The majority involved family physicians (50%), followed by general surgeons and ophthalmologists (11% each), psychiatrists (5.4%), plastic surgeons (5.4%), and dermatologists (4.1%). Cosmetic procedures (18.3% each) were the most frequently advertised services.

Complaints were most often filed by physicians (32.4%) or patients (28.2%), followed by provincial regulatory colleges (15.5%). The most common advertising venues were print media (19.1%), websites (17.9%), and social media (17.9%), while fewer cases arose from clinic communications (8.3%), deal platforms (7.1%), in-clinic advertising (3.6%), or broadcast media (3.6%).

Among the 62 advertising-specific issues ruled against physicians, the most frequent were regulatory and compliance failures (32.3%), including refusal to cooperate with provincial college investigations or continued use of noncompliant advertising after cautions. Misrepresentation of credentials (22.6%) followed, such as false claims of board certification or professional memberships. Identity and association issues (14.5%) involved the use of physicians’ names or images to promote services they did not personally provide. Misleading or unverifiable claims (14.5%) included portraying procedures as “scarless” or “risk-free.”

Beyond advertising-specific issues, 27 additional findings were concurrently ruled against physicians. The most frequent involved records and documentation (25.9%), such as retroactive chart alterations following patient complications. Clinical oversight and safety failures (22.2%) followed, including inadequate supervision of nonphysician staff and unsafe surgical practices such as exceeding liposuction limits. Consent issues (14.8%) involved inadequate risk disclosure or obtaining consent under sedation, while communication lapses (7.4%) reflected failures to update practice locations or coordinate with referring physicians.

Most cases resulted in cautions (31.0%) or advice-only outcomes (29.6%), emphasizing education and remediation over punishment. Suspensions (8.5%) and license revocations (4.2%) were less common (Table S1).

Advertising-related medico-legal cases in Canada frequently involved regulatory noncompliance, credential misrepresentation, and misleading claims, particularly for cosmetic services. Based on the case findings, we drafted best-practice suggestions for dermatologists emphasizing the importance of avoiding unsupported claims, obtaining explicit consent for patient image use, accurately representing credentials, and ensuring timely regulatory compliance (Table S2).^4,5

This study is limited by its small sample size of cases and predominance of cases from Ontario, which may not capture unreported complaints or disputes in other provinces. Future work should also examine advertising-related medico-legal cases involving nonphysician providers.