Recently I flew on both Southwest Airlines and American Airlines. On both flights, in a momentary fit of boredom, I reached for the in-flight magazine. In both cases I was surprised to see a feature story on the "Top Doctors in America."

The article consisted of a series of full-page, glossy, portrait-type photos of men and woman in expensive, tailored clothes. I had not ever heard of a single one of the doctors, despite having worked as a medical journalist for 25 years and being at a major medical university.

Surely if these were the top dogs, I would have heard of at least one of them.

Perhaps there had been a competition to be a top doctor? Maybe each had done significant research or invented something special? Perhaps their excellent rating was based on their excellent clinical care or was the result of their special surgical skills? Maybe the rating was based on patient recommendations?

I looked up the public ratings of many of these doctors online and they seemed merely average, with patient satisfaction scores of about 70 percent. Most doctors had no or very few published research studies. There were no reports that their clinical outcomes were superior or any better than other doctors' outcomes.

So what made them a "top doctor in America?"

The company claims to use some sort of survey to assure they are a top doctor, but the company would not disclose how it conducts its "survey," who takes the survey, or whether it is scientific.

Once certified as a "top doctor," the doctors pay large sums to be listed as a top doctor in this magazine, presumably to generate business.

The top doctor website claims that "In-flight magazines are one of the best- kept secrets for reaching a well-educated and affluent audience. There is an in-flight magazine placed in every seat pocket of every plane that the airline flies."

There are two problems with this. First, it means these doctors are paying to spread potentially misleading information about their skills, suggesting they are better than other doctors in America. Second, it calls into question the integrity of these magazines – Southwest's Spirit Magazine and American's American Way magazine.

The manner in which they feature these doctors creates the illusion of a feature story rather than a paid advertisement. Nowhere on the pages does it say this is a paid advertisement. This is both misleading journalism and misleading medical promotion.

So, are there top doctors in America? Within certain fields there are certainly better and worse doctors. But when I say this, I need to explain that there is no one measure of excellence and some people will value, say, a doctor's bedside manner over his speed in the operating room, while others will value the opposite.

Health care is not a competition. We can and should expect all licensed doctors to be excellent. But those who take out the biggest billboards and advertise the most are no better, and according to what my mother (and Shakespeare) taught me, they may be worse than those who are so good they need not advertise.

Methinks thou dost protest too much.

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