Sunday, August 23, 2015

Our family secrets

In an anonymous essay published in the Annals of Internal Medicine this week, one physician describes -- in graphic detail -- what happened to two women when they were asleep in operating rooms. The stories are horrifying.

"I bet she's enjoying this," one doctor reportedly said while prepping a woman for a vaginal hysterectomy. In another case, a obstetrician performed an obscene dance after saving the life of a woman who was bleeding out after having a baby.

The article is an unusual one for the the journal, which was established in 1927 by the American College of Physicians and typically publishes technical articles about disease management and medical research.

In a letter accompanying the essay, the editorial team agonized over whether to publish the piece. They said everyone agreed that the piece was "disgusting and scandalous" and could damage the profession's reputation. But some argued that this was why they shouldn't publish it while others felt that was why they should publish it.

"The discussion was so impassioned and opinions so disparate that we needed a 'time-out,'" editor-in-chief Christine Laine and her deputies wrote in a letter accompanying the essay.

In the end they said they decided to do so in order to "expose medicine's dark underbelly." They said the first incident "reeked of misogyny and disrespect--the second reeked of all that plus heavy overtones of sexual assault and racism."

"It is our hope that the essay will gnaw on the consciences of readers who may recall any instance of their own repugnant behavior. The story is an opportunity to see what this behavior looks like to others and starkly shows that it is anything but funny," they wrote...

The author said he learned of the first incident when teaching a medical humanities course and asking, "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?"

A student he called David said he was observing the surgery when an attending physician made the lewd comments while cleansing and scrubbing the patient...

The author says the student turned the discussion around by asking him the same question. He said he "felt my face flush" and before he knew it, he told the class about the second incident, which occurred in his third year of medical school while he was on an ob/gyn rotation. He said that he ended up laughing and joining in on the doctor's disrespectful dance until the anesthesiologist in the room yelled "Knock it off" and swore at them...

The journal's editors said that they hope that medical educators and others will use the essay as a "jumping-off point for discussions that explore the reasons why physicians sometimes behave badly."

"If the essay squelches such behavior even once, then it was well worth publishing," they wrote.

Deborah Hall, president of the American Medical Student Association, told U.S. News and World Report that medical students might be reluctant to express their objection even though they know they should because they are at the bottom of the pecking order in an operating theater filled with doctors, nurses and technicians

"Students feel incredibly vulnerable," Hall told the publication. "It's incredibly difficult to speak up."

Anonymous.  Our family secrets. Ann Intern Med. 2015;163(4):321

Courtesy of Doximity


  1. I will never forget a particularly unsettling incident in the operating room while I was a young and impressionable medical student on my first surgery rotation:

    Attending Surgeon: "Intern, what’s the story on this patient?”

    Resident Intern (replies sheepishly): "This patient is a 51-year-old with a left breast lump, and 17 out of 20 lymph nodes positive for cancer, returning to the operating room.”

    Attending Surgeon (in a very matter-of-fact tone): “Oh, she’s F-----.”

    It felt as though the room temperature fell below zero for a moment — not because the OR is preserved like a freezer, but because the surgeon’s response seemed so cold. The intern fought hard not to appear uncomfortable in light of that deadened, crude response. But because medical school and residency have constructed a strict hierarchy, not unlike the military, there was no way that this intern was going to speak up in return — despite having a parent that also suffered from breast cancer.

    At the time, being so low on the totem pole, I found myself peering over the sterile field in the corner and thinking:

    A. I’m so glad surgery is not my field of interest. (Sorry, surgeons, but some of you can be pretty uninviting.)

    B. How in the world do physicians reach this surprising level of stoicism?

    Last week, I discussed how challenging it can be to say goodbye to patients, despite this unnerving feeling that we as physicians are not supposed to allow ourselves to feel for them. Why is that? Why do we seemingly model our behavior after vampires? And how can we effectively treat patients if we don’t display compassion?

    Read more:

    Courtesy of Doximity

  2. "I clearly remember one doctor during my residency," a physician wrote. "This man was unfailingly polite to me. However, he often spoke openly in surgery about the 'fat cow' he was working on (while removing a breast), and I once saw him roughly shoving a patient's newly operated on remaining breast tissue around in a hateful, deliberately rough way while muttering epithets. Yet when she was awake, he acted all nice and concerned. There was always dead silence among the women in the OR when he did things like this. He was also a curser and instrument thrower. I lacked the courage to call him out on his behavior."

    "Most of these problems with off-the-wall doctors can't be addressed by simple formal/informal conversation," a family physician maintained. "These folks who are abusive both at home and at work are actually crazy in the original sense of the word. You can have all the conversation you want, but if a physician has a personality disorder or bipolar disorder, the only way to correct it is by using industrial-strength mood stabilizers in conjunction with behavior therapy. Most importantly, the group has to find a way to terminate such a physician ASAP. These crazy doctors attract lawsuits and lawyers like sugar attracts ants. The accompanying headache is not going to be worth it."