The latex gloves are off in Metro Detroit, where rival hospitals are spending millions of dollars on increasingly aggressive marketing campaigns designed to lure coveted patients.
It's already hard to turn on TV or radio without hearing health systems tout their skilled doctors and caring staff.
But these feel-good messages increasingly are being overshadowed by harder-edged ads that critics say often scare patients and overhype treatments.
"When we need health care, we are sick and in vulnerable positions," said Dartmouth Medical School instructor Robin Larson, who authored a study of hospital advertising. Patients "don't understand that this information is aimed at generating revenue."
Visit Beaumont Hospital's Web site, and a pop-up window flashes: "Are you at risk for a heart attack? Do you have a Beaumont doctor?"
Pass by any Detroit Medical Center hospital and it's hard to miss flashy ads promising that ER patients will see a doctor within 29 minutes.
A St. John Health System billboard in Roseville counters the DMC pitch: "In an emergency do you want fast -- or good?"
In an era of intense competition and soaring costs, hospitals say marketing is critical to keeping their beds full and patients informed.
The troubling side effect, according to critics, is an increase in ads that can be misleading and even unsafe.
"They make us a bit paranoid," said Thomas Gore, an insurance agent from Clinton Township who says he tries to ignore all types of health-related ads. "They never had this stuff in the past and people seemed to survive."
Hospital marketing that pushes specific procedures and doctors is a national trend that's cropped up recently in southeast Michigan.
Larson's study of 17 top-ranked university medical centers -- including the University of Michigan -- found they often advertise unproven services and use fear to attract patients. "They're contributing to a sense that more care is better, that higher tech care is better," Larson said. "They give an exaggerated sense of how good medical care is."
The study also found that hospital marketing now appeals to the emotions of potential patients more often than it touts the prestige of the institution.
Some hospital marketing specialists say hawking hospital service is no different than selling cola or a car. Others say they try to err on the side of restraint given the high stakes nature of health care.
"We really use the doctors out there in providing input with advertising," said Rose Glenn, Henry Ford Health System vice president of marketing and public relations. "We understand how consumers might get confused."
The touchy nature of hospital advertising was illustrated in two recent lawsuits filed against Beaumont.
Patient Janet Tipton sued Beaumont, claiming its award-winning "Do you have a Beaumont doctor?" campaign attracted her to the hospital -- and a risky doctor. Tipton and her husband heard a Beaumont ad on the radio while they were looking for a doctor to deliver their first child.
The Redford pair picked a doctor with help from the hospital's referral service. Their son, Destin, suffered trauma during delivery and died two and a half months later. Tipton later learned the doctor had five malpractice claims against him, none of which resulted in a verdict or settlement.
Tipton filed two suits, one claiming she was misled by Beaumont through its advertising and referral service, and another claiming malpractice. The Michigan Court of Appeals last month upheld a decision to dismiss the first suit. The malpractice claim is pending.
"It made them sound very good, like they were the best doctors around," Tipton said. "Hospitals should take a little more responsibility for the information they put out there."
Mike Killian, Beaumont marketing director, said it's the patient's responsibility to thoroughly check out doctors. "Patients ought to ask every question they can, probe into everything that worries them," he said.
Beaumont has a $1.1 million advertising budget this year, up from $1 million last year. Other health systems wouldn't say how much they spend on marketing.
The area's major health systems for the most part are taking in more patients, but they also face growing bills for uncompensated medical care for the uninsured.
DMC credits its 29-minute campaign for helping revive the system's reputation after years of financial turmoil. In weekly meetings, DMC President and Chief Executive Officer Mike Duggan grills hospital presidents who don't meet goals for patient volume.
Marketing is a proven way to attract patients. At DMC's Sinai-Grace Hospital, one doctor who performs a minimally invasive knee replacement surgery is booked through August after the hospital launched a campaign touting his arrival.
Sinai-Grace President Conrad Mallet said patients who come for the knee surgery, and the visitors who accompany them, bring much-needed business to the hospital that helps pay for other services.
"Are "People don't make decisions based on fact. They make decisions based on feelings," Killian said. "If you don't connect with somebody emotionally, you don't connect."
Patient Terry Caig says a hospital promotion helped her get the excellent care for her ailing knees. The home-care nurse from Cass City came to Detroit's Sinai-Grace for two knee replacement surgeries. Part of the draw was the hospital's offer to put her and her husband up at a hotel for three nights for each surgery. The pair saved about $500, she said.
"It made my decision a lot easier," Caig said.
You can reach Sharon Terlep at (313)223-4686 or sterlep