A Rude Awakening
June 30, 2015 11:58 AM   Subscribe

Sitting in his surgical gown inside a large medical suite in Reston, Va., a Vienna man prepared for his colonoscopy by pressing record on his smartphone, to capture the instructions his doctor would give him after the procedure.

But as soon as he pressed play on his way home, he was shocked out of his anesthesia-induced stupor: He found that he had recorded the entire examination and that the surgical team had mocked and insulted him as soon as he drifted off to sleep.
posted by katie (113 comments total) 10 users marked this as a favorite
 
Geez, it really wasn't professional and maybe it was actionable, but I hate that making fun of someone to a couple of coworkers is "defamation".
posted by ftm at 12:07 PM on June 30, 2015


Some people only learn the hard way.
posted by SLC Mom at 12:09 PM on June 30, 2015 [4 favorites]


Docs being rude assholes...yeah...unprofessional, but not illegal. My co-workers and I will routinely trash-talk some of our....ah...more difficult....customers amongst ourselves. Never in a way we could get caught. However...

Falsifying the chart, lying to the patient. Yeah. Line was crossed there.
posted by Thistledown at 12:11 PM on June 30, 2015 [14 favorites]


ftm, did you read the article? They actually wrote a misdiagnosis on his chart for LOLs. They talked about lying to him after he woke up. This is way beyond mocking a funny haircut or something.

I would not want this asshole treating me or anyone I cared about. Because if they really see the patients that way, how can I trust they are giving good care?
posted by emjaybee at 12:12 PM on June 30, 2015 [78 favorites]


Smartphones make it Incredibly easy to record people.

I'm surprised we don't see more of this.
posted by cacofonie at 12:14 PM on June 30, 2015 [3 favorites]


Yeah, the chart falsification...I can't imagine what the reasoning for that was. I wonder if that's what made the juror who originally didn't think any monetary amount was appropriate budge a bit.
posted by ghost phoneme at 12:16 PM on June 30, 2015 [1 favorite]


I wonder if the anesthesiologist has a drug problem. Common in the profession, and indicative of all sorts of unhappiness.
posted by wuwei at 12:16 PM on June 30, 2015 [3 favorites]


Docs being rude assholes...yeah...unprofessional, but not illegal.

It's not illegal, but it could very well be a tort, as this case has shown.



They actually wrote a misdiagnosis on his chart for LOLs. They talked about lying to him after he woke up. This is way beyond mocking a funny haircut or something.

But $100,000 of the judgement was awarded for defamation. The anesthesiologist defamed him by telling her coworker that he had syphillis and tuberculosis.
posted by mr_roboto at 12:17 PM on June 30, 2015 [3 favorites]


The defamation argument is stupid. People being mean to you when you secretly record them should not be a thing you can sue over.

The fake medical problem... yeah, that's a suin'
posted by French Fry at 12:20 PM on June 30, 2015 [2 favorites]


The defamation argument is stupid. People being mean to you when you secretly record them should not be a thing you can sue over.

I should be able to sue my doctor if she tells someone I have a disease that I do not have.
posted by mr_roboto at 12:22 PM on June 30, 2015 [73 favorites]


Private gallows humor is what makes these jobs tolerable to start with, but when that veil between locker room and exam room is breached, you'll never see a resident turn white faster.
posted by dr_dank at 12:22 PM on June 30, 2015 [10 favorites]


... and that they were discussing matters beyond the scope of the colonoscopy.

*rimshot*
posted by gurple at 12:22 PM on June 30, 2015 [24 favorites]


“These types of conversations,” testified Kathryn E. McGoldrick, former president of the Academy of Anesthesiology, “are not only offensive but frankly stupid, because we can never be certain that our patients are asleep and wouldn’t have recall.”

Oh jeez this is terrifying on so many levels. What do you mean you can't be certain your patients are asleep and won't have recall? Isn't that the anesthesiologist's job? And this is like saying "It's stupid to do something wrong in conditions where you might get caught." This is something teenagers say to each other. I expect better from a professional organization of doctors.
posted by bleep at 12:24 PM on June 30, 2015 [16 favorites]


The defamation argument is stupid. People being mean to you when you secretly record them should not be a thing you can sue over.


I think it depends on who's being mean. Fast food workers, fine. Someone who my life is literally in their hands and they obviously have some kind of weird vendetta against me? No, not okay.
posted by bleep at 12:26 PM on June 30, 2015 [21 favorites]


Private gallows humor is what makes these jobs tolerable to start with...

I think the mid-six-figure average salary might have more to do with its tolerability.
posted by Etrigan at 12:27 PM on June 30, 2015 [57 favorites]


Telling someone that a person has a venereal disease is one of the small group of per-se actionable types of slander. You don't have to prove damages, the damage is considered self-evident.
posted by 1adam12 at 12:30 PM on June 30, 2015 [27 favorites]


How terrible i have to deal with people for $300k/year
posted by benzenedream at 12:31 PM on June 30, 2015 [22 favorites]


The fact that they claimed he had syphilis is important here, as claiming that someone has a "loathsome disease" (generally meaning sexually transmitted diseases) is something that is recognized in most states as defamation per se.
posted by Bulgaroktonos at 12:32 PM on June 30, 2015 [4 favorites]


The defamation argument is stupid. People being mean to you when you secretly record them should not be a thing you can sue over.

Unprofessional doctors who have time and lack of focus to fuck around (to the extent shown in the recording) while also examining the inside of your body also have time and lack of focus to give you a perforated bowel and sepsis, which can kill you. The medical record falsification is the very least of it.
posted by a lungful of dragon at 12:34 PM on June 30, 2015 [39 favorites]


In >90% of the sedated procedures I have witnessed, nothing untoward was said about the patient (but people definitely talk about inappropriate things, for varying degrees of inappropriateness. But the other 10%... I have heard some truly appalling things. It's definitely worse if the patient is a young, attractive female. This is with completely different staff, in different facilities, for different procedures. Maybe everyone should be allowed to record their procedures.
posted by Missense Mutation at 12:34 PM on June 30, 2015 [24 favorites]


Can someone explain how the one-party consent provision works here legally, given that the patient was unconscious and wasn't a part of the conversation being recorded?
posted by un petit cadeau at 12:35 PM on June 30, 2015 [2 favorites]


I should be able to sue my doctor if she tells someone I have a disease that I do not have.

At the very least, isn't this a violation of HIPAA? You aren't even supposed to talk to other doctors about a patient's treatment unless it's relevant to their care, I don't think. We have some reasonably strong privacy laws about health information for a reason, including "so doctors don't identify you when they tell hilarious stories about your diseases", even if they are sharing real information, which in this case they weren't.
posted by Mrs. Pterodactyl at 12:36 PM on June 30, 2015 [2 favorites]


How terrible i have to deal with people for $300k/year

I have heard that some med students are attracted to anesthesiology because you only have to deal with conscious patients for a very short time before and after surgery
posted by muddgirl at 12:37 PM on June 30, 2015 [5 favorites]


What do you mean you can't be certain your patients are asleep and won't have recall? Isn't that the anesthesiologist's job?

Anesthesia is very likely to make you unconscious, but it's not 100% effective. One study estimates that 0.13% of patients have anesthesia awareness, although another estimates 0.0068%. (Citations on Wikipedia)

It's hard to be certain if anesthesia has worked on a particular patient, because we don't even understand what this "consciousness" is that we're trying to suppress. All we can measure are correlates like replying to questions, muscle movement, brain activity, but really we want to know if the patient is having subjective experience or not.

Dr. Giulio Tononi is one of many scientists and philosophers attempting to define consciousness in terms of non-subjective phenomena (his idea is "integrated information"), which could lead to a "consciousness meter" that prevents anesthesia awareness.
posted by Rangi at 12:37 PM on June 30, 2015 [16 favorites]


Oh jeez this is terrifying on so many levels. What do you mean you can't be certain your patients are asleep and won't have recall?

You really, really don't want to google for "anesthesia awareness".
posted by bac at 12:37 PM on June 30, 2015 [4 favorites]


Oh jeez this is terrifying on so many levels. What do you mean you can't be certain your patients are asleep and won't have recall? Isn't that the anesthesiologist's job?

I've got some bad news.
posted by Mr.Encyclopedia at 12:37 PM on June 30, 2015 [2 favorites]


How terrible i have to deal with people for $300k/year

I thought most anesthesiologists chose their specialty to avoid dealing with/inflicting themselves on awake patients...

(I mostly kid, some of the most charming medical professionals I know are anesthesiologists or nurse anesthetists)
posted by ghost phoneme at 12:38 PM on June 30, 2015 [1 favorite]


The defamation argument is stupid. People being mean to you when you secretly record them should not be a thing you can sue over.

A doctor telling other people you have a STD is not defamation ?
posted by Pogo_Fuzzybutt at 12:38 PM on June 30, 2015 [9 favorites]


Curse you, bac!
posted by Mr.Encyclopedia at 12:38 PM on June 30, 2015


We all bitch about customers/clients, but for god's sake, to do it while you're providing medical care to their unconscious bodies is a real low. And I personally reserve any bitching for people who have actively tried to make my life difficult; this guy appears to have just shown up for his colonoscopy, informed his doctor about a condition he had (as he should) and then got this douchecanoe talking trash and fucking up his chart.

I mean, even if he was difficult, he didn't deserve this, but there's no evidence that that happened either.

But the other 10%... I have heard some truly appalling things. It's definitely worse if the patient is a young, attractive female. This is with completely different staff, in different facilities, for different procedures. Maybe everyone should be allowed to record their procedures.

Well, I certainly have incentive to now!
posted by emjaybee at 12:38 PM on June 30, 2015 [12 favorites]


Christ, what an asshole....
posted by photoslob at 12:40 PM on June 30, 2015 [2 favorites]


Brosician, heal thyself
posted by thelonius at 12:49 PM on June 30, 2015 [9 favorites]


A doctor telling other people you have a STD is not defamation ?

I'm not condoning it, but I don't feel one doc giggling to another about "penis ebola" is actually meant to convey factual information. For one thing, there's no such thing as penis ebola.
posted by ftm at 12:49 PM on June 30, 2015 [5 favorites]


For one thing, there's no such thing as penis ebola.

For the love all that is holy, do not google that.
posted by blue_beetle at 12:52 PM on June 30, 2015 [18 favorites]


I'm not condoning it, but I don't feel one doc giggling to another about "penis ebola" is actually meant to convey factual information. For one thing, there's no such thing as penis ebola.

The lawsuit against the doctor who made the ebola comment was dropped. This judgement was against a doctor who told her coworker that the patient had a syphilitic rash on his penis.
posted by mr_roboto at 12:55 PM on June 30, 2015 [10 favorites]


What do you mean you can't be certain your patients are asleep and won't have recall? Isn't that the anesthesiologist's job?

Part of the thing here is that this is a colonoscopy, which is usually done under twilight anesthesia, not general.

I have recall of a procedure done under twilight. I mostly remember the nurse-anesthesiologist being annoyed that I had maxed out on one of the drugs they were using and they couldn't give me any more. I also remember having SO MANY QUESTIONS and being really, really annoying (sorry, surgical team!) and had the impression that I had been semi-conscious (and asking questions) for a while -- which is why I'm pretty sure I remember less than I was "awake" for. Fortunately it wasn't upsetting in the slightest (I was lucid enough to remember things, but I was still really, really drugged and feeling nooooo pain).

Everyone on the surgical team was very nice and I like my specialist and have no regrets and 100% would have that procedure again. But, yeah, people waking up during twilight anesthesia and remembering things... this is a thing that happens.
posted by pie ninja at 12:56 PM on June 30, 2015 [5 favorites]


Brosician, heal thyself

"After five minutes of talking to you in pre-op,” the anesthesiologist told the sedated patient, “I wanted to punch you in the face and man you up a little bit," she was recorded saying.
posted by echocollate at 12:56 PM on June 30, 2015 [8 favorites]



Because if they really see the patients that way, how can I trust they are giving good care?

You cannot because they are not giving good care.
posted by notreally at 12:58 PM on June 30, 2015 [14 favorites]


But the other 10%... I have heard some truly appalling things. It's definitely worse if the patient is a young, attractive female.

Creepy fucking postsurgical behavior from male doctors is why I will only have female surgeons do any kind of operating on me while I am unconscious.
posted by poffin boffin at 12:59 PM on June 30, 2015 [15 favorites]


French Fry: "The defamation argument is stupid. People being mean to you when you secretly record them should not be a thing you can sue over. "

False claims that someone has an STD spoken out loud in front of ANY number of other people -- from one to a million -- is pretty much textbook defamation. I mean, literally, most statutes specifically mention STD accusations!

I was a little taken aback with the gossip some of the nurses were sharing while I was getting stitched up from my C-section, about colleagues, as if I wasn't in the room. I mean, what else are you gonna do for forty-five minutes of boring stitching-up after the baby's been born and headed off to the nursery with dad? But it was definitely the sort of gossip you share in an undertone in the break room after looking of your shoulder, not while rooting around in an awake person's abdomen. I mean, personally, I found it amusing, as I had to kill the 45 minutes too and nobody was talking to me, so eavesdropping was fine, but I was a little surprised they were so indiscreet in front of a patient.

My other C-section we talked about NCAA basketball. It is weirdly hard to find appropriate small talk for "I'm being operated on while awake and this part is really boring for all of us."
posted by Eyebrows McGee at 1:02 PM on June 30, 2015 [14 favorites]


Creepy fucking postsurgical behavior from male doctors is why I will only have female surgeons do any kind of operating on me while I am unconscious.

But the creepy fucking postsurgical behavior in this case was from at least one female doctor toward a male patient. Check out the audio.

Just pointing out that this kind of thing is not specifically gendered. Maybe your female doctors wouldn't talk shit about you, but maybe they would.
posted by echocollate at 1:13 PM on June 30, 2015 [13 favorites]


I can read, thanks. And in my personal experience creepy fucking behavior is in fact gendered towards the male doctors who made me feel unsafe being unconscious around them.
posted by poffin boffin at 1:17 PM on June 30, 2015 [25 favorites]


I have recall of a procedure done under twilight.

Yep, I also woke up, chatty and annoying, during a minor surgical procedure done under twilight a couple of weeks ago. I woke up with a drape over my face and was like, "Hey, what's going on? Is that you, Dr. [Surgeon]? Why is this thing on my face?" Then I told some rambling anecdotes until they were done. I'm sure they do not remember me as charming.

Reading this story made me feel so embarrassed about my anesthesia-inducing babbling, and it made me just cringe for this poor patient, who had such a dreadful experience.
posted by purpleclover at 1:19 PM on June 30, 2015 [4 favorites]


Further reinforcing the old saw that a colonoscope can be "defined as a long metal tube with an asshole at each end."
posted by spacely_sprocket at 1:24 PM on June 30, 2015 [21 favorites]


A few years ago I had oral surgery for which I was awake but pretty drugged up. My periodontist (male) and his assistant (female) spent the entire time gossiping about the longtime receptionist they'd just fired for having an affair (she was married at the time) with one of the patients. The whole thing was extremely graphic and I assume not meant to be overheard. Though I wasn't the object of discussion I still felt weird enough to switch periodontists.
posted by echocollate at 1:33 PM on June 30, 2015 [1 favorite]


They should all lose their licenses if you ask me.
posted by drpynchon at 1:38 PM on June 30, 2015 [7 favorites]


Re: anesthesia-indiced babbling, don't fret it purpleclover. Most teams aren't that dickish and are probably used to some amount of chatting under twilight. They could be amused, (I mean, depending on what you said, perhaps you are a comic genius!).

While being wheeled out, my dad promised to come back and finish a lecture for the staff that he had started under twilight. He's an exercise physiologist. It was probably not overly exciting, and being a professor he can be a bit verbose without drugs. According to my mother the nurses thought it was adorable and graciously thanked him.
posted by ghost phoneme at 1:39 PM on June 30, 2015 [4 favorites]


Reading this story made me feel so embarrassed about my anesthesia-inducing babbling,

You shouldn't feel bad, that's a perfectly normal reaction and they should be used to it. It's probably pretty funny a lot of the time (I know I made the dentist's team laugh when I was partly under getting my wisdom teeth out. No idea what I said. But I was feeling noooo pain and all my inhibitions were down, so I'm sure it was hilarious.)

And I'm not offended at the idea of amusing a surgical team with something I've muttered, or them exclaiming if they found something they didn't expect (though of course that's generally never good). I don't mind them ribbing each other or even discussing their weekend while I'm out. Just save the insulting comments about my body for when you're at the bar or something. It's still jerky, but I'll never know.
posted by emjaybee at 1:39 PM on June 30, 2015 [5 favorites]


Nothing beats the stories you hear at the dentist, usually while your mouth is being pried open. I found out that my dentist and I went to the same college! And he streaked naked through the quad after jumping out of a girl's dorm window! Good times!
posted by RobotVoodooPower at 1:41 PM on June 30, 2015 [4 favorites]


The worst I had from my endodontist was discovering that she and her assistant were both lexical prescriptivists.
posted by ursus_comiter at 1:43 PM on June 30, 2015 [16 favorites]


Would have loved to have heard trash-talking from the medical team that actually gave Dick Cheney a human heart.
posted by jfwlucy at 1:46 PM on June 30, 2015 [6 favorites]


my dad promised to come back and finish a lecture for the staff that he had started under twilight

Did he?
posted by jeather at 1:47 PM on June 30, 2015 [2 favorites]


> Part of the thing here is that this is a colonoscopy, which is usually done under twilight anesthesia, not general.

I had to get a 'scopy last year due to some familial risk (I'm ten years younger than the standard first time) and they administered propofol, which knocked my ass out the second I saw it approaching the needle in the IV tube. This is the SOP for that and many clinics now.
posted by Burhanistan at 1:55 PM on June 30, 2015 [2 favorites]


Would have loved to have heard trash-talking from the medical team that actually gave Dick Cheney a human heart.

I'm pretty sure they were required to continuously recite Aramaic and Latin incantations backwards through the entirety of the procedure.
posted by prize bull octorok at 1:55 PM on June 30, 2015 [31 favorites]


What I kept wondering was "what precisely was so off about this guy"? It seemed like this particular anaesthesiologist had some homophobia issues, per the rest of the article. I would be at least a little more sanguine about the surgery/dark humor excuse except that I strongly suspect that a lot of it is surgery/racism humor, or surgery/homophobic humor, or surgery/fatphobic humor. I actually worry a little bit that someday I'll need to have a procedure of some kind and I'll get a homophobe who will take one look at me, start screwing around or decide to lie about something petty and end up killing or disabling me.
posted by Frowner at 1:57 PM on June 30, 2015 [17 favorites]


Would have loved to have heard trash-talking from the medical team that actually gave Dick Cheney a human heart.

they were walled up in the hospital basement immediately afterwards as a sacrifice to whichever eldritch horror spawned him originally.
posted by poffin boffin at 2:03 PM on June 30, 2015 [20 favorites]


I don't know, as a doctor you have to be a pretty thoroughly socialized human being, and yet there you are, sticking a machine up the ass of someone you've barely met as far as it will go.

How many barriers and inhibitions do you have to break down to be able to do something like that?

I'm not too surprised this doctor lost a few more inhibitions than was quite desirable.
posted by jamjam at 2:03 PM on June 30, 2015 [1 favorite]


I don't think so...but I think he seriously considered it: they were hosting a conference that was somehow related (that came up after he started lecturing). But his secretary wasn't informed of the promise, so I'm pretty sure he got back to the office and was distracted by whatever study he was working on at the time.
posted by ghost phoneme at 2:04 PM on June 30, 2015 [1 favorite]


Can someone explain how the one-party consent provision works here legally, given that the patient was unconscious and wasn't a part of the conversation being recorded?

IANAL, but I imagine if it's twilight sedation it's kind of like being drunk. i.e. can you legally record a conversation with someone while *you're* drunk in a one-party consent state? I'd guess the answer would be yes, even if you don't remember the conversation you recorded. Seems the anesthesiologist spoke directly to him at times, making it harder to claim it wasn't a "conversation".
posted by RobotVoodooPower at 2:07 PM on June 30, 2015 [1 favorite]




They forgot their Hippopotamus Oath.
posted by devious truculent and unreliable at 2:16 PM on June 30, 2015 [1 favorite]


What, according to doctors like this, are needle-phobic patients like me supposed to do? I always thought that telling the doctor, nurse, or phlebotomist ahead of time was what I should do. It's not like needle phobia is a rare condition, either- I've seen estimates that 10% of the population has it to some degree.
posted by Anne Neville at 2:18 PM on June 30, 2015 [7 favorites]


I don't have much to add except that I find this terribly upsetting. I interact with doctors with a hefty dose of trust, vulnerability, and good faith, and people who don't take that power seriously are disappointing to say the least. With great power comes great responsibility, as they say.
posted by delight at 2:18 PM on June 30, 2015 [2 favorites]


False claims that someone has an STD spoken out loud in front of ANY number of other people -- from one to a million -- is pretty much textbook defamation.

That may well be the case, but that doesn't mean it should be. Defamation should really have to prove damages, otherwise every time someone shit talks their cheating ex boyfriend, they'd be liable.
posted by corb at 2:19 PM on June 30, 2015


Also ... a juror sez right in the article that they wanted to "give him something, just to make sure that this doesn’t happen again" so there you go. Not much legal bean-plating required.

I also missed the part where the plaintiff told the staff that he was actually taking medication for a rash on his penis. Hmm. I wouldn't touch it either.
posted by RobotVoodooPower at 2:20 PM on June 30, 2015


On multiple occasions I have had to ask people to stop inappropriate conversations. It hasn't happened to me, but several times a year in my institution we get a reminder that sedated patients' families show up unannounced outside their ICU rooms and hear everything. To some, once drapes go up the patient becomes an object in their mind rather than a person, as they kind of have to to stay sane. It's still inexcusable, and this can't have been the first time someone objected.

Intraoperative awareness is a pretty rare event, depending on the definition that you use. People will often wake up during light sedation for minor procedures, but usually not remember as long as there is adequate analgesia. For most sedation and anesthesia strategies, you will notice the patient moving (or non-skeletal responses if they have been given a muscle relaxant) substantially before they are capable of forming memories. In cases with higher risk for intraoperative awareness, continuous EEG monitoring is a good choice and available.
posted by a robot made out of meat at 2:33 PM on June 30, 2015 [2 favorites]


Defamation is dependent on a reasonable expectation that the information will be taken as fact. There is no reasonable expectation that these doctors, acting like a bunch of fuckwads, believed these statements as fact while bullshitting each other about this guy.

They are jerks and should lose their jobs and be sued for the false edit of the medical records. But Defamation angle seems very sue-happy and slippery to me.
posted by French Fry at 2:36 PM on June 30, 2015 [4 favorites]


Defamation does seem kinda sue happy. But, I'd be very sue happy if this happened to me as well.
posted by ian1977 at 2:45 PM on June 30, 2015


I remember waking up post-op and being all *oh, shit, I feel terrible*

Then a nurse close to me said to another nurse, "That guy [referring to another post-op patient] puked and shit himself at the same time."

My reactions were:
a) Well, at least I'm not that bad
b) How does it feel to puke and shit yourself at the same time.
c) I kind of didn't know it was possible to do that

This is an anecdote not designed to throw light on the problem raised by the FPP one way or another.
posted by angrycat at 2:45 PM on June 30, 2015 [2 favorites]


You've never had a stomach bug where you've had vomiting and diarrhea, angrycat? It's pretty common for them to both happen at the same time.
posted by Anne Neville at 3:03 PM on June 30, 2015 [4 favorites]


None of this is making me very happy about the surgery I have to have soon...
posted by sarcasticah at 3:04 PM on June 30, 2015 [4 favorites]


I take it you've never had gastroenteritis, angrycat? Were it not for copious amounts of a particular inhaled antiemetic, I would have required a trash can while on the toilet when I had a bout of it some years back.

Even said antiemetic only helped the nausea for about 15 minutes at a time.
posted by wierdo at 3:06 PM on June 30, 2015 [2 favorites]


In the last couple of years there has been a move to make sure patients are out cold, the selling point being surgery causes ptsd in some patients. Maybe now we have a glimmer of understanding as to why some people are subliminally traumatized during procedures. I think this goes on a lot. So the extra memory erasing drugs are really another case of a sick status quo, and wallet based medicine.
posted by Oyéah at 3:09 PM on June 30, 2015 [1 favorite]


From what I understand, asking my surgeon why he couldn't knock me out cold for my colon surgery last year, the problem is that when you knock someone out cold they begin breathing deeply, like when they're asleep. That causes the diaphragm to rise and fall a lot, which in turn causes the colon to move a lot, which makes colonoscopy (and colon surgery) both more difficult and more dangerous.

Oyéah: "So the extra memory erasing drugs are really another case of a sick status quo, and wallet based medicine."

They use the memory erasing drugs here in Japan, and medical treatment here is not the insane money grab that it is in the US, so I highly doubt that it's wallet-based medicine.
posted by Bugbread at 3:13 PM on June 30, 2015 [2 favorites]


In fact, now that I think of it, while surgery is done with anesthesia, they tend to try to do basic colonoscopies without any anesthesia, only using it if requested by the customer. So, yeah, highly doubting the memory erasers is primarily a money thing.
posted by Bugbread at 3:17 PM on June 30, 2015 [1 favorite]


Maybe now we have a glimmer of understanding as to why some people are subliminally traumatized during procedures.

Um I think the whole A PERSON IS CUTTING YOUR BODY OPEN WITH SHARP THINGS AND MESSING WITH YOUR INTERNAL ORGANS part probably sufficiently explains subliminal surgical trauma, no?
posted by We put our faith in Blast Hardcheese at 3:21 PM on June 30, 2015 [13 favorites]


I actually had a colonoscopy without anesthesia, more or less happily. The staff was wonderful, and seemed sort of excited that I wanted to share the experience with them, or something like that. It really humanized the whole thing. Plus watching your intestinal tract scroll by is a trip.
posted by emmet at 4:06 PM on June 30, 2015 [4 favorites]


I too have had a colonoscopy while mostly fully alert and only a light sedative to mellow me out. The doctor and assistant were in fact engaging me in conversation the whole time about my family name and my experiences as an overseas Korean (this procedure was done in Seoul). I don't know if I would recommend it exactly -- I feel like I found out about all the corners in my colon -- but it was totally hilarious to sit in a waiting room with a bunch of adults all wearing hospital-provided pants with butt flaps.
posted by spamandkimchi at 4:41 PM on June 30, 2015 [1 favorite]


What I noticed about the recording was that the man is a lawyer.
I would have been sad and offended if doctors talked about me like that during a medical procedure, but I would also have listened and thought about it. All the offensive stuff they say are jokes: ebola on the penis! They are joking about his hypochondria, and if there is one thing I believe is fair game for doctors, it is hypochondria. I'm writing this as a person who has just had ten extra tests done. I suffer from anxiety, for many good reasons, and this makes me imagine illnesses, but all my tests are taking time out of my busy doctor's tight schedule. (Then sometimes, I am actually ill, and whoa, but I can see where these doctors are coming from. Imagined diseases costs us all a lot).
Contrary to what was suggested above, to me this shows that doctors are not only about grabbing money and performing unnecessary procedures.
Also, I grew up among anesthesiologists and I'm used to their sick humor.
posted by mumimor at 4:55 PM on June 30, 2015


Oyéah: the selling point being surgery causes ptsd in some patients

Sorry I can't find a link, but 20-odd years ago I remember there being several stories about studies that indicated that people who had been anesthetized were able to remember specifics of conversations overheard in the operating room or in the elevator afterwards, even if they weren't "conscious". There was some discussion about whether hospitals (in Canada) should implement policies to caution doctors about what they said in earshot of anesthetized patients.

(Not disagreeing with you about ptsd - just adding a data point about how patients should be treated like human beings, no matter how skilled the doctor.)
posted by sneebler at 4:55 PM on June 30, 2015 [1 favorite]


Ingham then mocked the man for attending Mary Washington College, once an all-women’s school, and wondered aloud whether her patient was gay, the suit states.

Wow, what a repugnant human being.

I remember when Doctors were idolized in America. They were portrayed as saints on television. Compare how LA Law portrayed 80s lawyers to how Trapper John portrayed 80s doctors. Also, Thirtysomething with advertisers and Hill Street Blues with cops. Realistic portrayals of doctors were the last to appear on television.

I remember having such respect for the medical profession. I always felt in awe around doctors. Not anymore. I no longer see doctors as heroes. I see them as profiteers. Smart, yes. Disciplined, yes, but also corrupt and dishonest. I think they see patients not as people but as money making opportunities. I think they will deceive and distort to maximize their profits, and I don't think most doctors care about anyone who can't give them money. I feel bad about this, but I think good doctors are like good cops. If they won't come forward to report ethics' violations or corruption, they aren't any better than those they cover up for.
posted by Beholder at 5:27 PM on June 30, 2015 [6 favorites]


Contrary to what was suggested above, to me this shows that doctors are not only about grabbing money and performing unnecessary procedures.

Mumimor, did you miss the part where they falsified his medical records as part of the joke?

They should be deregistered, both to protect future patients and as a lesson to other medical staff.
posted by Joe in Australia at 5:56 PM on June 30, 2015 [11 favorites]


Beholder: "I remember having such respect for the medical profession. I always felt in awe around doctors. Not anymore. I no longer see doctors as heroes. I see them as profiteers...corrupt and dishonest. I think they see patients not as people but as money making opportunities. I think they will deceive and distort to maximize their profits, and I don't think most doctors care about anyone who can't give them money. "

"If they aren't excellent, then they must be horrible"

How about seeing doctors as people? Some saintly, some good, some average, some bad, and some horrible?
posted by Bugbread at 6:20 PM on June 30, 2015 [10 favorites]


How about seeing doctors as people? Some saintly, some good, some average, some bad, and some horrible?

Didn't you read the part where I wrote that doctors are like cops. If they know of ethical violations (or worse) and choose to look the other way, they aren't any better than the corruption they are witnessing, and that goes double if they profit from it. Hospitals aren't healing centers. They're profit factories. When you are in a hospital, you are in a building dedicated to separating as much money from you as possible, in any way possible. The medical profession is asset forfeiture for smart people. I stand by every word.
posted by Beholder at 6:40 PM on June 30, 2015 [3 favorites]


Beholder: "Didn't you read the part where I wrote that doctors are like cops. If they know of ethical violations (or worse) and choose to look the other way, they aren't any better than the corruption they are witnessing"

Yes, I read that, and what I'm saying is that, unlike the police, for example, we don't have widespread evidence that most doctors know of ethical violations and look the other way. That's the assumption I'm talking about.

Beholder: "When you are in a hospital, you are in a building dedicated to separating as much money from you as possible, in any way possible"

Oh, come on. In the last month alone I've had a doctor at one hospital dissuading me from using anesthesia for a transnasal stomach examination, even though it would make the hospital more money, and another doctor at a different hospital dissuade me from taking cholesterol medication, even though it would make the hospital more money. These are not the actions of buildings "dedicated to separating as much money from you as possible, in any way possible". Profit-making buildings, as opposed to conclaves of saints? Sure, but you can be profit-making without "profiteering" "as much as possible" "in any way possible".
posted by Bugbread at 6:49 PM on June 30, 2015 [9 favorites]


Yeah, many of my doctors have acted in large or small ways over the years to save me money. I certainly agree that most doctors, like most people, are not saints. It's been my experience, however, that most doctors, like most people, derive satisfaction from a job well done and the occasional act of kindness.
posted by gilrain at 6:56 PM on June 30, 2015 [3 favorites]


I wonder how much experiences with healthcare providers are colored by living in Japan, as opposed to the United States, where providers are generally profit centers. If doctors were such altruists in the US, they wouldn't turn away Medicare patients in the numbers that they do, for instance.
posted by a lungful of dragon at 7:00 PM on June 30, 2015 [4 favorites]


Were it not for copious amounts of a particular inhaled antiemetic, I would have required a trash can while on the toilet when I had a bout of it some years back.

My first thought after reading this was: woah, they've formulated antiemetics for inhalation? My second thought was: oh.

So the extra memory erasing drugs are really another case of a sick status quo, and wallet based medicine.

The drugs aren't given to deliberately erase memory. They're sedatives that just happen to do so, for the same reason that alcohol makes you blackout when consumed in large quantities. There's actually been a shift away from using sedatives so heavily in the ICU setting because they tend to cause confusion and delirium, which can ultimately make the experience more traumatic. So the focus now is on analgesia first, sedation second.
posted by dephlogisticated at 7:06 PM on June 30, 2015 [2 favorites]


Incidentally, I'm in the US and am a Medicaid patient.
posted by gilrain at 7:06 PM on June 30, 2015 [1 favorite]


I don't think comparing doctors to police helps, at all. Just not a useful comparison at this point.

The medical establishment in the USA is more like the political system, where large corporations work together with large corporations to make money for each other. Most doctors aren't benefiting either way from the way the USA medical establishment's profiteering. They make good livings, but not more than a doctor in a comparable position in the UK or EU. The real profiteers are NOT direct service providers. Just like most people working in city hall aren't looking to run for congress.

Doctors can be dicks, doctors can be dismissive, disrespectful, cruel and angry. I had a doctor at 19 that called in a bunch of staff to watch him freeze HPV stuff off of my dick with dry ice. He was a fucking piece of shit doctor. Still, no way to compare that to most cops.
posted by kittensofthenight at 7:21 PM on June 30, 2015 [2 favorites]


Random observations:

1) This is egregious, unprofessional behavior.

2) I've heard many conversations like this, they involve many caregivers and don't occur in a vacuum. I can imagine this being the result of one of many scenarios:
i) The patient was extremely obnoxious, possibly borderline abusive to staff, and may have repeatedly exhibited manipulative behavior during the pre-operative period, a time of high stress for patients but those most mundane part of the caregivers jobs. This happens.
ii) The anesthesiologist is a sociopath who has created a toxic work environment which allows her to act in an overtly unprofessional manner and cultivates unprofessional behavior among her team. This is not an unheard of OR phenomenon.
iii) The anesthesiologist cares for her patient and strives to maintain a professional demeanor, but is socially clueless as to the bounds of good taste. In other words, she thinks she's funnier than she is. This is a common OR pathology.
iv) The anesthesiologist and the OR staff are good hearted people but they have recently been subjected to severe or prolonged stress and several team members are acting out with regressive coping strategies and immature humor.
v) The anesthesiologist and OR staff are good hearted people but having been working for a long time as an isolated team. Minimal outside influence has allowed norms of taste and decorum to drift significantly. In-jokes have snowballed to a point where they don't even refer to the putative targets, such as the plaintiff in the case, and unprofessional behavior may be able to co-exist with the highest regard for patients.
vi) Some combination of the above.
3) The hemorrhoids thing doesn't really make sense to me. It almost seems to be a reference to a conversation that occurred earlier.
While this is besides the point, to those worried that falsifying the medical record would pose harm to this patient, this is absurdly unlikely. To some extent, recording "hemorrhoids" as a diagnosis or finding is meaningless. Some old school docs would chastise students about hemorrhoids being normal part of rectal anatomy and "varicose hemorrhoids" or "hemorrhoid disease" being the correct nomenclature for the pain in the ass of piles. Hemorrhoids aren't diagnosed with colonoscopy. Also no one reads the anesthesiologist's notes except for the next anesthesiologist taking care of the patient. They're useless to everyone else. Here the things the anesthesiolgist cares about: airway anatomy, airway disease, lung disease, heart disease, bleeding disorder, adrenal disease, recent viral illness. Anesthesiology notes are useless.
Anyways, as I said, this is beside the point. Improper medical diagnosis is unprofessional and joking about it then doing it is egregious.

4) Disrespectful humor is common in all professions and physicians are no exception. It's true our words influence our actions. But, I've seen extraordinary good doctors with ample supply of care and empathy use humor that was extremely disrespectful in private.

5) Having a BMI over 35 significantly increases the risk of something rude being said about you during surgery. It's nothing personal. Having extra adipose increases the risk of you suffering surgical complications in about 300 different ways. This stresses doctors out. Because those complications are bad and they don't want them to happen to you.
It also increases the risk of work place injury among the staff. I've seen an obese nurse swear under her breath while trying to move an obese patient, then spend 20 minutes padding every potential pressure point to prevent nerve damage or skin breakdown during the operation, then after the operation lovingly sing to the patient while the patient awoke. Even rude caregivers still love their patients.

6) I've seen plenty of unprofessional behavior on par with this. I've seen people (a) do nothing cause "you gotta pick you battles" (b) publicly chastise the rude person (c) privately chastise the rude person (d) report the rude person to bosses who suspended / fired the rude person. I feel like lawsuit was a weird choice in this situation. I think letting it go to trial, given the publicity and unpredictable nature of jury verdicts, was career suicide on the part of the anesthesiologist. Bizarre choices all around.

7) "How many barriers and inhibitions do you have to break down to be able to do something like that?" That is a very insightful observation. Socially I felt very normal compared to a lot of my colleagues at the beginning of training. Now, everything I do at work is very socially inappropriate to do anywhere other than work. I work with kids, so this includes funny faces and booger jokes. My sense of what constitutes socially awkward has been destroyed. I agonize over which age-specific non verbal cues I might have missed at the end of every day.

8) To everyone concerned about embarrassing things you did while narcotized; don't worry, it wasn't that weird, no one cares or remembers. I'm not sure what someone would have to do to stand out as 'memorably weird' to most medical professionals. As JamJam alluded to, nothing is all that normal...
posted by midmarch snowman at 7:26 PM on June 30, 2015 [22 favorites]


Incidentally, I'm in the US and am a Medicaid patient.

Your experience is not shared by more Medicare patients, also in the United States.
posted by a lungful of dragon at 7:57 PM on June 30, 2015


Lungful, if I'm reading that right, doesn't that link say that 81% of Medicare patients share gilrain's experience and 19% do not? Obviously, it should be 100%, not 81%, but 81% is still very solidly in the majority, so I don't see it as evidence for writing off the whole profession.
posted by Bugbread at 8:23 PM on June 30, 2015


Having a BMI over 35 significantly increases the risk of something rude being said about you during surgery. It's nothing personal.

What? Of course rude comments are personal. They always are.

And it's really really really disturbing to read the word 'customers' to refer to patients.
posted by feckless fecal fear mongering at 8:23 PM on June 30, 2015 [9 favorites]


"And it's really really really disturbing to read the word 'customers' to refer to patients."

Interestingly enough, in my own personal day-to-day the largest push in recasting patients as customers has come from advocates who see it as a way to promote respect for patient autonomy, and increase patient satisfaction with care. I can see why people find the paradigm distasteful, but it probably has done some good in supporting the basics in listening and active communication.

The improved patient-service through better customer-service paradigm does break down in new exciting and surprising ways, though...
posted by midmarch snowman at 9:20 PM on June 30, 2015


Had my first colonoscopy less than two months ago, under general anesthesia. Torn between wishing I'd recorded it and being glad that I didn't.
posted by Halloween Jack at 9:30 PM on June 30, 2015


Defamation should really have to prove damages, otherwise every time someone shit talks their cheating ex boyfriend, they'd be liable.

You seem to have difficulty distinguishing between the truth and a lie. The truth is never defamation. A lie may be defamation.

If you don't know the difference between the truth and a lie, I can see why you might fear being charged with defamation.
posted by JackFlash at 10:19 PM on June 30, 2015 [5 favorites]


Defamation isn't necessarily false. It just means injuring someone's reputation. Different jurisdictions have (and have had) different legal actions based on this injury. Truth has often been considered a defence to those actions, but not necessarily, and it has not always been a complete defence: statements that are made in bad faith are often excluded from that defence, even when they are true.
posted by Joe in Australia at 10:39 PM on June 30, 2015 [2 favorites]


jesus christ snowman.

3) The hemorrhoids thing doesn't really make sense to me. It almost seems to be a reference to a conversation that occurred earlier.
While this is besides the point, to those worried that falsifying the medical record would pose harm to this patient, this is absurdly unlikely.


and yet it happened.

5) Having a BMI over 35 significantly increases the risk of something rude being said about you during surgery. It's nothing personal.

and when is that ever ok? why the need to be rude? what is it about bmi that makes it ok to be rude?

I've seen an obese nurse swear under her breath while trying to move an obese patient, then spend 20 minutes padding every potential pressure point to prevent nerve damage or skin breakdown during the operation, then after the operation lovingly sing to the patient while the patient awoke. Even rude caregivers still love their patients.

well, if an obese person that you know was frustrated that makes it ok! must be love. it is a nurses job to be competent, not love or sing to me.

8) To everyone concerned about embarrassing things you did while narcotized; don't worry, it wasn't that weird, no one cares or remembers. I'm not sure what someone would have to do to stand out as 'memorably weird' to most medical professionals. As JamJam alluded to, nothing is all that normal...


apparently all you have to do to stand out is be overweight. you said that one can reasonably expect for rude comments to be made if they pass a certain bmi threshold. whenever is it ok to be rude to a patient, sedated or not? gross.
posted by futz at 10:40 PM on June 30, 2015 [9 favorites]


Defamation isn't necessarily false. It just means injuring someone's reputation.

Nope, in the U.S. the truth is a complete defense in a defamation suit. There are two elements to a defamation suit:
1. The statement is false.
2. It is defamatory to one's reputation.

If you can't pass the first hurdle, the second is irrelevant. Depending on the situation and jurisdiction, who has the burden of proving the truth, plaintiff of defendant, may vary. Telling the truth is never defamation in the U.S even if the truth harms someone's reputation.
posted by JackFlash at 10:54 PM on June 30, 2015 [1 favorite]


Having a BMI over 35 significantly increases the risk of something rude being said about you during surgery.

We JUST HAD a thread about the harm that medical fat-shaming can do. I don't care if this shit is "personal"; being a fucking shit to fat people as a medical professional endangers lives.
posted by NoraReed at 10:59 PM on June 30, 2015 [16 favorites]


gilrain: Incidentally, I'm in the US and am a Medicaid patient.
---
a lungful of dragon: Your experience is not shared by more Medicare patients, also in the United States.

Medicaid and Medicare are *vastly* different programs, often conflated, sometimes combined to provide more coverage.

Doctors turn Medicaid patients down far more frequently as eligibility is typically dependent on super-low income, and it is state-funded and reimburses less. You basically have to end up in the ER to see any specialist, who has to be an attending physician on call at the time you show up with an emergency, basically.

Medicare is the super-low-overhead federal program for certain categories of disability and 65+ year old patients, and gives any doctor willing to see patients over 65 years of age (among other categories) access to a "customer base," because they would otherwise be too expensive to insure. Medicare tends to reimburse less than anything else except for Medicaid, but most doctors don't have as much of a problem with Medicare unless they only want to see patients under 65, or wealthy patients.
posted by aydeejones at 11:04 PM on June 30, 2015


Whoops, and I totally missed the point there getting hung up on the comparison. In my experience Medicare is more accepted and Medicaid more often shunned, but that wasn't specifically what was being argued. I was once in a primary care doc's office and heard the front desk haranguing a potential new patient for having Medi-CAID? insurance instead of Medicare. Like "who scheduled you, how did they miss this fact that you are teh poor."

Carry on...
posted by aydeejones at 11:07 PM on June 30, 2015 [1 favorite]


midmarch snowman: " I'm not sure what someone would have to do to stand out as 'memorably weird'"

futz: "apparently all you have to do to stand out is be overweight."

"Doctors will say rude things about you" =/= "memorably weird"
posted by Bugbread at 11:21 PM on June 30, 2015


The playground level of the abuse is weirdly disturbing. I don't expect adults to talk in these 'retard! Lol Ebola!' terms, let alone working doctors.
posted by Segundus at 11:21 PM on June 30, 2015 [1 favorite]


Interestingly enough, in my own personal day-to-day the largest push in recasting patients as customers has come from advocates who see it as a way to promote respect for patient autonomy, and increase patient satisfaction with care. I can see why people find the paradigm distasteful, but it probably has done some good in supporting the basics in listening and active communication.

I was gonna point out the same thing, although the new hotness seems to be "Patient Experience," which I like. I think "customer service" as a healthcare model ends up being about repeat business and free marketing vs. better patient care. "Patient care" and "beside manner" are the best frames in the healthcare delivery setting, in the exam room or OR.

"Customer service" is important in the scheduling and billing and answering the phones and returning voicemail context of healthcare, but when it turns into "5 Star Customer Service" modeled on Ritz Carlton with the intent of delivering fancy hotel-like experiences in a hospital or clinic, I think progress in increasing access to healthcare inevitably suffers because those facilities are geared towards well-covered affluent patients and strategically located to serve certain demographics.
posted by aydeejones at 11:24 PM on June 30, 2015


Someone under anesthesia, wearing a flimsy gown, ass exposed, is vulnerable. Making fun of them relentlessly is meanness and bullying. Meanness and bullying are everywhere, on tv, in movies, social media. It's toxic as hell, and makes the world a crummier place. The behavior was incredibly unprofessional, and the widely publicized judgement should be used as a learning experience. Grow the hell up, treat patients with respect.
posted by theora55 at 4:58 AM on July 1, 2015 [17 favorites]


Gallows humor is one thing, but to my mind calling your patient "a retard" or making homophobic jokes is not at all workplace appropriate. Look, a lot of us work in shitty jobs. It's not like we're unused to the idea of making it bearable by making jokes about other people. This isn't incomprehensible to non-doctors. But there's a line.
posted by Solon and Thanks at 6:57 AM on July 1, 2015 [10 favorites]


The other piece here is that knowing that doctors talk shit about you makes the medical experience scarier and more frustrating. That alone is a reason to crack down, because it's making going to the doctor worse for people (and probably a partial cause for people avoiding care - I certainly know that fear of/experience of medical ridicule is one of the things that keeps trans friends away from the doctor.)

If people have the impression that doctors are cracking homophobic or hateful jokes about patients the minute they think that the patients can't hear them, that screws up the doctor-patient relationship, even for doctors who don't do that kind of thing, because suspicion is pervasive.
posted by Frowner at 7:02 AM on July 1, 2015 [9 favorites]


People are allowed to bring phones with them into surgery? That surprises me. But I'm glad this came to light.
posted by three_red_balloons at 8:20 AM on July 1, 2015


Defamation isn't necessarily false. It just means injuring someone's reputation.

You are wrong, full stop.

Now, there are torts for public revelation of private facts. They also hinge, as defamation often does, on the person's prominence. But truth is an absolute defense (but not the only defense) for defamation.
posted by phearlez at 1:25 PM on July 1, 2015 [1 favorite]


Is there any bigger leap of faith people take when they agree to surgery? You agree to let people bring you to the brink of death and then do extremely violent, invasive things to your body. If this isn't grounds for her to lose her medical license then the bar needs to be a lot higher for OR conduct.
posted by Room 641-A at 3:14 PM on July 1, 2015 [5 favorites]


Whether or not truth is an absolute defense for defamation varies by country. The user saying that defamation is not always false is, judging from their username (Joe in Australia), presumably not in the US, and his statement explicitly states that "different jurisdictions have (and have had) different legal actions based on this injury." So it should be fairly clear that he's not talking about the definition of defamation in this case or the definition of defamation in the US, but about defamation in general.
posted by Bugbread at 3:32 PM on July 1, 2015 [3 favorites]


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