My wife, my children, and I are all patients at the Palo Alto Medical Foundation (PAMF). I am grateful for the world-class care that we all receive there, and I continue to refer many friends and colleagues there.

We recently received a mailer from PAMF, addressed to my wife and personalized with her name showing what they think her summer to do list should include. (I’ve blacked out her name in the photo of the mailer below.) The list ends with: “Do something REALLY special for myself!”

My Doctor Says: Get a Boob Job

Cute, I thought, and wondered what would be inside. Perhaps some tips on exercise or eating smart, or a reminder to get caught up on important screening tests. My jaw dropped when I opened the pamphlet and saw: “To look and feel your best, you don’t have to look far”, and listed the following services:

– Breast Reshaping
– Tummy Tuck
– Face, Eye, and Neck Lift
– Liposuction
– Rhinoplasty (Nose Reshaping)
– Laser Skin Rejuvination

I think it is entirely appropriate that PAMF offers these services. However, I am deeply concerned that they are advertising them as the way — for a woman in particular — to do something really special for herself and feel her best. Body image issues aside, what does this say about our physicians? PAMF represents my wife’s primary care doctor (and mine), and I suspect many patients see this type of promotion as coming from their doctor. Did she approve this, we wondered? If so, what should we think when she recommends a mammogram or a colonoscopy? It begs the question of whether the primary goal is my health or profit for the health care provider.

I’ve commented previously on Atul Gawande’s eye-opening piece in the New Yorker about McAllen, Texas, a town where health care costs are among the highest in the country, while the quality of care is no better than average. Gawande explains:

About fifteen years ago, it seems, something began to change in McAllen. A few leaders of local institutions took profit growth to be a legitimate ethic in the practice of medicine. Not all the doctors accepted this. But they failed to discourage those who did. So here, along the banks of the Rio Grande, in the Square Dance Capital of the World, a medical community came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers.

Perhaps we are asking too much of physicians. They should have only my well-being in mind, while at the same time their decisions about my care often impact whether they can afford to send their kids to college. In case you’re worried about your own bills, don’t worry — as you see in the screenshot below, for these procedures you can get a FREE private consultation and financing options are available.

Ideally, it won’t be long before we get much better at measuring the quality of care, and physicians will get payed for delivering quality. In the meantime, demand the facts and make informed decisions.

P.S. I originally posted this on Huffington Post. I couldn’t export the comments and there were some great ones, so feel free to read the comments there.