Author Topic: On being a doctor: shining a light on the dark side--from Ann. Intern. Med.  (Read 332 times)

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Offline agate

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Sometimes I spot a true horror story about doctors and post about it here. It's not that I'm against doctors. But all too many patients seem to have a blind trust in their doctors and to regard them as perfect, godlike creatures from some realm where no harm can be done.

Doctors are our employees. If we don't like a doctor or clinic, we can go elsewhere--with our ailments. AND our pocketbooks or our insurance cards.

It doesn't hurt to remind people sometimes of how very vulnerable we are when we're ill, especially when we're under anesthesia.  So here's an anonymous comment that appeared in Annals of Internal Medicine, August 18, 2015:

Quote
On Being a Doctor: Shining a Light on the Dark Side


One day in January, I was facilitating a fourth-year elective course with eight medical students. It was a medical humanities class, and the topic that afternoon was the virtue of forgiveness. A student named David led the discussion, and I listened as they exchanged ideas. When their energy waned, I asked, “Do any of you have someone to forgive from your clinical experiences? Did anything ever happen that you need to forgive or perhaps still can't forgive?”

I waited for an answer, but no one said a word. When a classroom becomes that quiet in response to a question, I sometimes have the strength to sit with the silence. So, I looked out the window and waited. I leaned back in my chair and waited. Finally, David said, “Something unforgiveable happened to me.”

“What happened?” I asked him.

“I was scrubbed into a vag*nal hysterectomy. The patient was under general anesthesia. My attending was prepping the patient's vag*na. He picked up a clamp holding sterile cotton balls and dipped them into Betadine. While he was cleansing and scrubbing her labia and inner thighs, he looked at me and said, ‘I bet she's enjoying this.' My attending winked at me and laughed.”

Someone gasped. I stared at David. He shifted in his seat and crossed his arms on his chest. A splotchy red rash appeared on his neck. Staring down at the table, he murmured, “Man, I was just standing there trying to learn. The guy was a dirtball. It still pis*es me off.”

David glanced at me. I asked, “When your attending said that and laughed, did you laugh, too?”

My question touched a nerve; perhaps my tone was accusatory. David snapped back, “Yeah, I laughed, but what was I supposed to do? Have you ever been in a situation like that?”

I looked down at the table in front of me and saw my black ballpoint pen. I focused on its gold clip for a moment. I placed my index finger and thumb beside the pen and spun it in place. It twirled and clicked as it spun around and around. I stared at the rotating pen and remembered. I felt my face flush. The spinning pen slowed, and then the clicking stopped. I looked up at David. “Yes, I have.”

“So, what happened?” David asked.

“It's my third year of medical school and I'm on Ob/Gyn. I deliver a baby girl and put her in the mother's arms. I can still remember the mom's name—Mrs. Lopez. I deliver the placenta, put it in a pan, and inspect it. It's intact. Then, I turn back to Mrs. Lopez. I see blood gushing from her vag*na. It comes in waves. I've never seen anything like it. I yell to my resident—the guy's name is Dr. Canby—'Hey, something's wrong. She's really bleeding over here.' He shoulders me out of the way and checks her perineum for a laceration. There is none. He puts his hand on her abdomen and aggressively massages her uterus. She keeps bleeding. Then Dr. Canby says, ‘She's got uterine atony. Start oxytocin and call anesthesia.' A nurse lifts the baby off the patient's chest.”

“A few moments later, the anesthesiologist walks in the room and asks, ‘What do you got?' Dr. Canby says, ‘Vag*nal delivery. Uterine atony. External massage failed. Give her some ketamine.'”

“Anyway, so I hear the anesthesiologist say, ‘Ketamine is in.' I look at Mrs. Lopez—her eyes are half-closed and vacant. Dr. Canby instructs me to hold her knee. A fellow medical student holds her other knee. Our job is to keep her legs spread. Canby then performs an internal bimanual uterine massage. He places his left hand inside her vag*na, makes a fist, and presses it against her uterus. I look down and see only his wrist; his entire hand is inside her. Canby puts his right hand on her abdomen and then massages her uterus between his hands. After a few minutes, he feels the uterus contract and harden. He says something like, ‘Atta girl. That's what I like. A nice, tight uterus.' And the bleeding stops. The guy saved her life. I was blown away.”

“But then something happened that I'll never forget. Dr. Canby raises his right hand into the air. He starts to sing ‘La Cucaracha.' He sings, ‘La Cucaracha, la cucaracha, dada, dada, dada-daaa.' It looks like he is dancing with her. He stomps his feet, twists his body, and waves his right arm above his head. All the while, he holds her, his whole hand still inside her vag*na. He starts laughing. He keeps dancing. And then he looks at me. I begin to sway to his beat. My feet shuffle. I hum and laugh along with him. Moments later, the anesthesiologist yells, ‘Knock it off, ****s!' And we stop.”

After I finish my story, I glance at the students; some gaze down at the table in front of them, while a few others look at me with blank stares. They are all quiet.

I know this is my silence to break.

Note: All names in this essay are pseudonyms.

http://annals.org/article.aspx?articleid=2427613

« Last Edit: December 30, 2015, 03:39:17 pm by agate »
MS Speaks--online for 17 years

SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010. Glatopa (glatiramer acetate 40mg 3 times/week) since 12/16/20.

Offline agate

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Some reactions
« Reply #1 on: August 19, 2015, 04:08:30 pm »
From MedPage Today (August 18, 2015), with quotations from the original article omitted:

Quote

Tales from the OR: Appalling? Criminal? And Anonymous

Bad actors in the OR, but who tells?


by Peggy Peck
Editor-in-Chief, MedPage Today

Annals of Internal Medicine is stirring controversy by pulling back the operating room curtain and exposing questionable behavior by surgeons, but it is doing so under the banner of anonymity.

This week a regular Annals' feature with the prosaic running title, "On Being a Doctor," presents an anonymous essay called "Our Family Secrets." The essay recounts two disturbing scenarios involving patients -- both of them women -- under general anesthesia.


The accounts, which were termed "appalling" by one retired surgeon and possibly "criminal" by a leading cardiologist, raise a number of questions, including a very basic one: is this true or hyperbole?

MedPage Today asked Annals about the vetting of the anonymous essayist and received this response, which was attributed to Christine Laine, MD, MPH, the journal's editor-in-chief:

"We believe that inappropriate behavior is a problem that occurs in all medical specialties and across provider types. Annals of Internal Medicine's aim in publishing the essay is to generate discussion to prevent such behavior. Like all Annals' 'On Being a Doctor' essays, the essay was subject to peer review.

"We know the author's identity but chose to publish this piece only if the author agreed to do so anonymously so as to prevent the identification of others in the story, most importantly the patients involved. The author agreed with anonymous publication and is indeed a physician involved in both patient care and teaching. Authors who submit fictional essays are required to identify them as such and in the many years since this section of the journal began, the overwhelming majority of submitted essays, including this one, are not identified as fiction."

[Much of the article is quoted here]

The Ring of Truth

"Why would anyone write this? And why would a respectable journal such as Annals of Internal Medicine publish it? Are they looking for clicks?" asked a retired surgeon who blogs as Skeptical Scalpel. "Unfortunately, the stories are quite credible."

He added that the ideal response when witnessing such actions would be to report them to the department chief, but he said that can be a daunting choice for junior personnel who might fear repercussions if they spoke up.

"Some hospitals have initiated anonymous hotlines so that unethical behavior can be reported. However, as a former surgical department chairman, I can tell you that it is difficult to discipline any physician unless witnesses are willing to come forward and testify at a hospital executive committee or medical board hearing," Skeptical Scalpel told MedPage Today.

Harlan M. Krumholz, MD, MS, who holds dual professorships in cardiology and social and policy studies at Yale, said, "There needs to be a mechanism where such behavior can be reported – and then the issue needs to be investigated by an ombudsperson and handled appropriately, which will depend on the circumstances. We want to avoid false accusations or misunderstandings – but also, some of these actions are downright criminal – and so need to be addressed immediately."

Roy D. Clark, Jr., MD, a Bainbridge Island, Wash., psychiatrist who specialized in addiction medicine, wondered how the scenes described in the essay could truly remain "Family Secrets" noting that in his experience such events would not escape "quick and decisive administrative actions."
"I wondered if the attending and resident involved would want their mothers, sisters, wives, or daughters treated in the same manner," Clark wrote.

"As a resident for 5 years and a surgeon for 41 years I thought I had heard most everything. but the vulgarity of the surgeon described by David is inexcusable," wrote John O'Connor, MD, a retired colorectal surgeon from Washington, D.C.

Endangering Patients' Trust

"Based on personal experience in high-risk settings such as the ER and Intensive Care Units, this account rings true," wrote Tracy Poling, RN, JD. Poling, Clark, and O'Connor were asked by MedPage Today to respond to the essay.

Poling, who lives in Georgia and works full time tending to the "medical, legal, and educational needs" of her severely disabled daughter, said how one responds to such scenes has a lot to do with experience. "Today, as a woman and female nurse, I would not tolerate the attending's behavior in David's story. I would likely warn the attending first that if he planned continuing to practice operating on women, he would not continue to speak in that manner. If that did not stop the behavior, I would go up the chain of command until I was satisfied."

She was, however, more forgiving of Dr. Canby, the resident described in the second scenario, noting that he was faced with an extremely stressful, life-and-death situation. As such, I would give more leeway to the comments and actions and not immediately see them as intentionally disrespectful. Instead, it was likely a poor attempt at humor after the life-threatening emergency had passed."

"Skeptical Scalpel" said the stories reminded him "of the recent case of an anesthesiologist who made several insulting remarks to a patient undergoing colonoscopy. The anesthesiologist did not know that the patient had accidentally left his cell phone on in record mode.


And there is this incident involving a Syracuse orthopedist who slapped patients' buttocks when they were asleep.

Krumholz summed up his reaction this way: "Patients trust us – and we need to be worthy of that trust at all times."

The entire article can be seen here.
MS Speaks--online for 17 years

SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010. Glatopa (glatiramer acetate 40mg 3 times/week) since 12/16/20.

Offline agate

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MS Speaks--online for 17 years

SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010. Glatopa (glatiramer acetate 40mg 3 times/week) since 12/16/20.