[TheDay] The point of Shila Renee Mullins’ brain surgery was to remove a malignant tumor threatening to paralyze her left side.  But Methodist University Hospital in Memphis, Tenn., also saw an opportunity to promote the hospital to prospective patients.

So, a video Webcast of Mullins’ awake craniotomy, in which the patient remains conscious and talking while surgeons prod and cut inside her brain, was promoted with infomercials and newspaper advertisements featuring a photograph of a beautiful model, not Mullins.

This time, Methodist did not use billboards as it has with other operations, deeming this procedure too sensitive. But its marketing department monitors how many people have watched the Webcast (2,212), seen a preview on YouTube (21,555), and requested appointments (three).

”The goal is to further our reputation as well as to educate the community, who will ask their physicians about our care,” said Jill Fazakerly, Methodist’s marketing director.

Faced with economic pressures and patients with abundant choices, hospitals are using unconventional, even audacious, ways of connecting directly with the public. Seeking to attract patients or donors, gain recognition and recruit or retain top doctors, hospitals are using Twitter from operating rooms, showing surgery on YouTube, having patients blog about their procedures.

They consider the methods inexpensive ways to stand out in an era of reality TV and voluminous medical information available online.

Some ethicists and physicians say the practices raise questions about patient privacy and could paint overly rosy medical pictures, leaving the hospitals and patients vulnerable if things go awry.

Jeffrey P. Kahn, a University of Minnesota bioethicist, sees “value in demystifying medical care,” but said this “creates an aura of sophistication and high-tech ability” that may not represent “quality of care at a hospital.”

”Do we really want to treat health care like other consumer goods?” he asked.

Tony Cotrupi, a health care marketing consultant, said hospitals “have come to marketing dragging and kicking, but because things are so competitive they have to.” Patients “used to go like sheep wherever the doctor sent us,” he said, and “spend more time researching what kind of toaster to buy.”

”But now, you have the curious consumer,” Cotrupi said, “and hospitals are doing all they can to open up the kimono.”

Henry Ford Hospital in Detroit uses Twitter from the operating room.

Bill Ferris, the hospital’s Web services manager, said that during an operation to remove a man’s kidney tumor, the surgeon, Dr. Craig Rogers, worried that the unexpectedly large tumor would require total kidney removal.

”Gosh, this is big,” Rogers said. “Could I have picked a harder case for this?” So an observing chief resident tweeted: “Dr. Rogers is saying because the tumor is large he may have to do a radical (total) nephrectomy.”

Then, “some bleeding needed to be controlled,” but “we just tweeted right through it,” Ferris said. Other Twitter-casts included a hysterectomy and a craniotomy, during which the hospital posted video on YouTube and photos.

Hospitals say patients give consent and are not compensated.

”One concern is what happens if something goes wrong,” Ferris said. “You’re making this public in a very real-time way. Our general plan is we would gently take a break from the twittering if the situation became very dire. You don’t necessarily want to be tweeting that somebody might be dying on the table, and God forbid the patient’s family learns about it that way.”

Methodist Hospital records an identical surgery on another patient, so if “something unforeseen happens and you need the camera to cut away from the surgery, you can fall back on your previous surgery,” Fazakerly said.

E. Haavi Morreim, an ethicist at the University of Tennessee College of Medicine, said, “If you don’t show the bad along with the good, people can end up misinformed or with excessively optimistic expectations.”

More than 250 hospitals now use YouTube, Facebook, Twitter or blogs, said Ed Bennett, Web strategy director for University of Maryland Medical System.

”There’s a lot of surprise hospitals are even doing this – hospitals are extremely conservative,” he said.

Scripps Health in San Diego searches Twitter daily for mentions of itself and tweets those people. Marc Needham, Scripps’s Web technology director, likened it to “a concierge service.” But, he said, aware that “it’s very big brothery,” they avoid contacting people who might respond “why the hell are you looking into my tweets.”

To a woman who tweeted about “a $377 bill for a 5-minute pediatrician visit for my 2 kids. Seriously Scripps? Gouge much?” Needham tweeted, “Sorry to hear about your frustrations.”

Not everything is high-tech. Tufts Medical Center recently covered floors under pregnancy-test racks in pharmacies and supermarkets with pitches “to spend the next nine months with you” to lure expectant mothers.

Dr. Oren Sagher, a neurosurgeon for the University of Michigan Health System, views these strategies with mixed feelings. A television advertisement includes him performing a craniotomy as Michigan fight song lyrics scroll by. “Patients come to see me because “You’re the guy in the commercial,”’ he said. Still, he said, when promotions make “second-rate” hospitals seem like “the cat’s meow, that’s not fair.”

Mullins, 42, of Oakland, Tenn., agreed when Methodist asked “if I would mind if they videotaped so other people could see what it was like.”

The video, which unlike Methodist’s other Webcasts was not shown live, vividly shows Mullins reciting ABCs while doctors separate tumor from brain. Although her left arm is partly paralyzed – a result not unexpected – leaving her unable to work, the video includes her testimonial praising Methodist’s care.

The neurosurgeon, Dr. Allen Sills, said he “was sold on the concept from our marketing people that this would be a contribution to our patients and families and to future patients.”

”They do what they do, yes, to help market our center,” he added, sometimes putting more video-production people than doctors in the operating room. But, he said, “we make it a point not to alter our routine.”

In one unexpected marketing success, after Methodist advertised a coming brain-surgery Webcast, a man called, volunteering to be the patient. Methodist agreed. “He told Dr. Sills that if he was operating live on the Web, he must be pretty darn good,” Fazakerly said.