"I know this is my silence to break."

August 18, 2015 4:24 PM

Today, respected medical medical journal Annals of Internal Medicine published a short, anonymous account called "Our Family Secrets" of two different sexual assaults (or, in the journal's words, situations with "overtones" of sexual assault) by surgeons on their unconscious patients. (trigger warning for sexual assault and misogyny)

In an accompanying editorial, Drs. Christine Laine, MD, MPH; Darren B. Taichman, MD, PhD; and Michael A. LaCombe, MD write:

Multiple interpretations of the piece are valid and lend insight. They were reflected in the lengthy and heated discussion that occurred among our editorial team when considering whether to publish the story. The discussion was so impassioned and opinions so disparate that we needed a “time-out” and came back to it a week later after we had ample time to contemplate the issues raised. We all agreed that the piece was disgusting and scandalous and could damage the profession's reputation. Some believed that this was reason not to publish the story. Others believed that it was precisely why we should publish it.

posted by sallybrown (36 comments total)

Yes. This needed to be published. As a young kid I remember getting genital exams that seemed totally unnecessary and awkward. I remember people saying of my discomfort "it's just doctors they see genitals all the time so therefore they can't possibly have sexual feelings about it."

To which I call bullshit. We tell ourselves that and we want that to be true but this isn't even fair to doctors, I mean really, can people help it if they get horny seeing someone attractive to them and they are going to be looking at and/or touching the genitals of? I mean I get the goal is professionalism, regardless of personal feelings, but I mean, if the doctor had been thinking that but not saying it, would it have been meaningfully different other than kept secret? What if the patient had been awake and the doctor was thinking that but not saying it? Then is it, or is it not abusive?

And what about if you're forced to deal with someone touching you and you feel like there's weird vibe and there really IS but you're required to not ever admit it? I feel like that's the story of my life interacting with men who I was never ever allowed to question the intentions of. Until after I'm getting assaulted and then it's my fault for not questioning and standing up to them more because of course I should have known better!

I've been reading about all the horrific stuff, the outright torture and damage, and the despicable misogyny in the medical texts of the 1700 and 1800's (many of which available for free on the internet right now!) and I can't help but read so much of it and think how much of these procedures were doctors wanting an excuse to see their patients naked- I mean really, genital massage, douching, sticking tampons up the vagina, sticking electrical shit up in the vagina-- sometimes even described as "a mean device" ... I mean... doctors are people and people are horny, and often creepy, sadistic, and predatory even when they can't acknowledge it in themselves.

I don't think that has spontaneously changed in the last hundred years, given the thousands of years of rape and sexual abuse being acceptable and generally only punishable if it affected a man.
posted by xarnop at 4:46 PM on August 18, 2015 [26 favorites]

I'm reminded somewhat of https://www.metafilter.com/150841/A-Rude-Awakening Where the man recorded his doctors behaving badly.
posted by gryftir at 4:47 PM on August 18, 2015 [5 favorites]

Good for them for publishing this.

I've been thinking about the concept of reflection lately - albeit for much more benign reasons. I believe that we can't ever truly improve in any field if we don't stop and reflect on our successes and our failures. This includes failures in courage or compassion or even basic humanity.

Similarly, for a profession (or, indeed, for humanity) to move forward, we need to be able to reflect - honestly, unflinchingly - on where we've failed. As the editorial mentions, yes the doctor in the second story saved the patient's life. That is a huge thing. But the doctor also treated her as something less than human - and by extension, made at least one of the people around him complicit in that behavior. That's also a pretty huge thing.

Anyhow, acknowledging horrible behavior is one of the first steps towards correcting it. As I said at the start, good on them for publishing it. I hope it truly leads to some introspection and agree that we should all be more like the anesthesiologist (regardless of our field).
posted by Joey Michaels at 5:19 PM on August 18, 2015 [8 favorites]

I wish I knew who that anesthesiologist was so I could send her or him an appreciative note.
posted by sallybrown at 5:23 PM on August 18, 2015 [10 favorites]

The thing that strikes me about these stories is how difficult it can be to stand up for what you know is right when someone in power over you is doing something wrong. Especially when there's a good chance that the person being wronged will never know about it. I've been in situations like this, though certainly never as terrible, where I panicked and didn't know how to respond. I spent the following days, weeks, months mentally practicing how I would respond if something like that ever happened again. But in the heat of the moment, it takes guts and huge presence of mind to say to a superior, "That's not ok." Maybe if physicians and nurses and everyone else in health care had to role play calling out a superior for inappropriate behavior*, the culture could finally change.

* not necessarily sexual assault on a patient, but even something relatively small like cursing out a colleague. Disrespect, in tiny and enormous ways, persists when nobody speaks up against it.
posted by vytae at 5:29 PM on August 18, 2015 [26 favorites]

The thing that strikes me about these stories is how difficult it can be to stand up for what you know is right when someone in power over you is doing something wrong.

Yes, and hopefully one effect of this article is the person on the tipping point of speaking up will read this and someday feel an invisible tap on the back when it comes time.
posted by sallybrown at 5:32 PM on August 18, 2015 [3 favorites]

This "person" felt that invisible tap.
posted by clavdivs at 5:36 PM on August 18, 2015

I'm glad they published this. In my experience, this is not the exception; it reflects a way of being in medicine that is the rule: the human body is treated not as a holy and sacred, but as laughable, irrelevant, uncomfortable. All of us in health care have been acclimated, through socialization and perhaps through an internal protective mechanism, to emotionally and spiritually distance ourselves from the intensity of the human body, from suffering, from the closeness to death and to new life that we encounter daily. It's not just surgeons who talk about baseball while touching our literal hearts, it's every nurse, nurse's aid, tech, doc, and anyone else who does this work. The way that the body is talked about and handled was the hardest thing to get used to when I started nursing and I hope I never get used to it all the way.

The first class in any med school or nursing school should be in practicing being emotionally present, aware, and full of respect when touching another human. Instead, it's the first thing we lose when we start doing this work.
posted by latkes at 5:38 PM on August 18, 2015 [33 favorites]

Those are nasty recountings of sexually assaultive behavior that doctors (and other powerful professionals) often get away with, due to their social power--but at least they are being framed as "unprofessional" and a problem. What disturbs me as an intersex person is how often doctors engage in behaviors that you would think everyone would decry, but are instead framed as professional and interesting and get published in medical journals. For example, there's the "research" conducted by surgeon Dix Poppas (apparently without IRB oversight) in which he sought to prove that the technique for feminizing intersex genitals which he prefers does not eliminate all sexual sensation by applying a vibratory device to the surgically-altered genitals of female-assigned children as young as five and asking them if they could feel it on various genital locations. This was meant to prove intersex advocates who oppose surgical reconstruction of children's genitals should hush up and trust doctors.

It did not have that effect, despite being deemed worthy of publication by the Journal of Urologyy and its reviewers.

Guh, I hate the medical profession sometimes.
posted by DrMew at 5:44 PM on August 18, 2015 [21 favorites]

So true DrMew, and what maybe disturbs me even more is the way that general attitude comes up not just in baseless research studies, but in the daily, routine interactions doctors have with anyone different: fat people, people with disabilities, people who are trans and as you mention, intersex. I see all the time the way the discomfort with difference creates these totally offensive interactions (or leads to such awkwardness and discomfort that providers find themselves unable to directly and respectfully ask about the way someone's 'difference' might impact their particular health concern)
posted by latkes at 5:55 PM on August 18, 2015 [12 favorites]

I have some fear of doctors and dentists and luckily, I'm mostly healthy so it's not a problem, but I do admit I don't take care of some things that I should because of this fear.

I was just thinking today how nice it would be to know a doctor or dentist that isn't so much a friend but I feel friendly with -- someone who isn't making me feel ashamed for whatever I've neglected in terms of my health and is on my side and wants to genuinely help me out (even if they are getting paid to do so). Even the best of the doctors/etc. I've been to still bring this weird authority over me. And that doesn't make me want to go to them. That just makes me feel nervous and vulnerable in a really uncomfortable way.

Obviously, these examples are so far beyond that, but they're part of my fears -- that I'll be treated less than human. I am not someone who is worthy of having dignity or agency. I'm just a thing or a job to them.

I get being a doctor can be hard -- I'm sure many doctors deal with all kinds of tragedy and I know people develop some inappropriate coping mechanisms there -- but I think this is why so many people put off going to the doctor until it's really a problem. There's just too much a chance you're going to get someone who doesn't really care and will take advantage of you when you're at a low point.

I wish more medical schools taught empathy and compassion. Maybe talking about it is a first step -- and allowing people to feel comfortable speaking up when they are witnesses to things like this.
posted by darksong at 6:09 PM on August 18, 2015 [9 favorites]

Here in Toronto there was an anesthesiologist sentenced for ten years after being found guilty of assaulting 21 patients. That was all over the news in the beginning of the year. So gross.
posted by biggreenplant at 6:58 PM on August 18, 2015 [2 favorites]

darksong: "I wish more medical schools taught empathy and compassion. Maybe talking about it is a first step -- and allowing people to feel comfortable speaking up when they are witnesses to things like this."

I suspect it is not quite so easy as that. I am in no way condoning this bad behaviour, but I suspect a majority of health care workers (ex worker myself, actually) can not empathize as strongly as we might wish as a coping mechanism of dealing with the downside of their jobs. They might start out in health care with the noblest of goals, but seeing people you tried your damnedest to save die no matter what you do makes it a bit more necessary to see them as "Patient 27B/6" instead of "the quite possibly dead soon, no matter what I can do, Arnold Ferguson".

Before we demonize the industry as we do like in what I quoted, let's try to remember that these are people too, they have limits like the rest of us do, and they have to cope like the rest of us do.
posted by Samizdata at 7:01 PM on August 18, 2015 [8 favorites]

"Before we demonize the industry as we do like in what I quoted, let's try to remember that these are people too, they have limits like the rest of us do, and they have to cope like the rest of us do."

I agree. When I was getting my wisdom teeth out I was remembering that facebook debacle with the dentists and a bunch of assaults I've looked up by dentists. And I was thinking, hey, you know what, these people are about yank my teeth out while blood is all over the fucking place.. I could NOT DO THAT, even if someone needed it, I'm not sure what state of mind I would have to get myself into in order to do that.

So I was thinking, hey I guess if they want to grope me up and manage to get a perk out of a traumatic horrifying job then as long as there's no piv sex (pregnancy/disease) then whatev?

That said, we also could remember that people coping with horrifying stuff might have abnormal empathy levels and not be trustworthy with vulnerable people. We might consider refraining from putting them in positions where they are alone with little oversight and given permission to do shit like "applying a vibratory device to the surgically-altered genitals of female-assigned children as young as five and asking them if they could feel it on various genital locations."

Because FUCK THAT.
This is also a big reason I don't even trust ethic panels who have gone through the scientific and medical training to get there to not be numb as fuck to pain, exploitation, violation, invasive procedures, harm, and force- and have abnormal tolerance for permitting heinous things to happen as they were indoctrinate into accepting harm, pain, and suffering as a normal thing to accept in the process of doing science or medical care.

I totally get why the doctors and medical professionals have gotten there, I don't get why we repeatedly ignore that is where they need to be and put an unrealistic level of trust in their capacity to withstand all that and still side with empathy do the degree that not only we would like, but even than meets a minimum standard of refraining from abuse and harm.
posted by xarnop at 7:12 PM on August 18, 2015 [1 favorite]

I am in no way condoning this bad behaviour, but I suspect a majority of health care workers (ex worker myself, actually) can not empathize as strongly as we might wish as a coping mechanism of dealing with the downside of their jobs.

I get this, but it doesn't mean you can't teach appropriate behaviour. Or teach that the opposite of empathy is not okay to exhibit. If there's a culture where surgeons are actively censured for behaving like that, then even if they don't have the right feels, then you can cut away at the culture.

When I was just out of school, I was part of a program working with medical students and gyn exams (this was a long time ago) which was started with seed funding from a poor women's clinic. The issue was that often the examining physicians were *so* insensitive that they frightened women with little education from returning. (The women talked about doctors making jokes in the stirrups like "hey-- I see some teeth marks. What have you been up to?")

There was at that time literally no other training available to these would-be doctors which dealt with the human side of the women on the table (at least not from a sexual health perspective). We did role play and educational introduction to the issues poor women might face, and why it was so important in making sure their care was successful.
posted by frumiousb at 7:31 PM on August 18, 2015 [11 favorites]

I'm glad to have read that, because like others here I've read of this kind of bullshit before and always think on the perpetrators of the bullshit. From this piece, I'll be remembering the anesthesiologist and the others who 'defended' the patient. Somehow, the horrible part to me is not that this kind of crap happens, but that it might not be called out as the crap that it is.
posted by Tandem Affinity at 7:58 PM on August 18, 2015 [2 favorites]

I am in no way condoning this bad behaviour, but I suspect a majority of health care workers (ex worker myself, actually) can not empathize as strongly as we might wish as a coping mechanism of dealing with the downside of their jobs.

One thing I like about the health network my family participates in is that one of their core values is dignity for the patient. That resonates deeply with me, because it counteracts fears that we have that we won't be treated with respect when we are at our most vulnerable. I've experienced it in the way that I see them treat my loved ones, and also myself when I have been hurt and vulnerable. You can often tell if a place genuinely exemplifies this value vs. using the word as a marketing technique. And honestly, as comforting a value as this, it isn't overly hard to do. You simply treat the unconscious or vulnerable patient as you would yourself, or as if they were awake watching you give them treatment. That's a pretty clear guiding principle that makes certain types of actions unambiguously wrong for everyone in the room. And the reason I state it in terms of right and wrong is because I honestly think that in the minds of some doctors, appropriate behavior gets muddled behind god-complexes and the eventual routineness of "compassionate" care. For some who have been at this for awhile in positions of power, it's actually okay to do.
posted by SpacemanStix at 8:43 PM on August 18, 2015 [1 favorite]

Enough articles to sink a small boat have been written on teaching empathy in medical education literature. Unfortunately empathy is one of those ineffable qualities, like good writing, wit or the perfect scrambled eggs, that there is no proven way to teach to those who lack it. Educators try their best, and med schools are willing to weed out bad apples that make themselves apparent. But this is one of those cases where the medical profession is going to need to be ceaselessly self-reflective and critical to maintain an environment where vile shit like this isn't tolerated.

Limiting empathy is not only a coping mechanism, it's also sometimes the only way to perform the job. The assumption is you're turning it back on when the hard part's over. Alas turning it back on is a struggle for everyone. Pediatric nurses and docs talk about this happening at home; a pediatrician mom might tie her sense of self worth directly to the emotional state and success of her kids, but completely forget that kids have every logical reason to react illogical in response to a minor pain. It's tempting to send the message, either overtly or subconsciously, to a kids that they're being ridiculous. But in reality, from the kid's perspective, a 12 year old has no experience base to suggest that stomach cramps AREN'T actually fatal. An otherwise intelligent primary schooler might have never even seen a deep laceration, thus the fact that all the vital organs can't spill out through 1/2 inch cut in the leg is an entirely unproven hypothesis.

The other problem is it's incredibly hard to call out a superior in health care, especially in public. I'm happy this article was published, but there are some serious structural flaws in power structure that make honest feedback way harder than it has to be. I have only recently stepped foot on a barely higher rung of a very inconsequential and isolated ladder, and I suddenly discovered that people at work find me a lot more funny and interesting than I was two years ago. That these power dynamics are only MAGNIFIED when you're talking about attending doctors and students, or surgeons and nurses. The potential for abuse this environment fosters is gross enough even when the real life examples are seldom as disgusting as the cases in the FPP.
posted by midmarch snowman at 3:34 AM on August 19, 2015 [10 favorites]

Changing gears: As someone who hates going to the doctor and loves listening to the reasons other people have a similar distaste for seeing a doc, I feel compelled to add:

For me, the hard part of finding a doctor isn't the thought they might secretly be a pervert or a sociopath, its the idea that they are likely suffering from some terrible social maladjustment (like many humans are) but I have no idea which one until I've been going to them for years. A few years ago I went to a doctor who seemed to suffer a propensity towards depression and counter-transference, which was awkward but once I figured out why he had such weird emotional reactions to random portions of my history, he became a lot more predictable and seeing him became a lot easier. My current doctor is a terrrrrrrible listener. Again, at this point I've stopped taking it personally and realized I need to be very direct if I have a problem I want addressed.
posted by midmarch snowman at 3:36 AM on August 19, 2015

Surely there's a difference between closing yourself off to emotional identification with the patient - because that would prevent you from doing your job - and deliberately, happily, treating the patient as a thing (the frisson of which depends on your knowledge that the patient is actually a person who is not in a position to object to being treated like a thing.) Not handling the patient in this way doesn't require any deep empathy, it only requires the absence of a positive desire to express your contempt for them. In these stories, the problem with the doctors isn't that they don't cry over each patient or remember each patient's name; it's that they specifically go beyond neutral professionalism to treating the patient with contempt.

I should think that many surgeons can and do develop a neutral and unemotional attitude to the patient's body, without then going on to develop an exploitative and humiliating attitude towards that body. In fact, the two seem inconsistent to me. It's only if you see your patient specifically as a woman that you can treat her body as an occasion for expressing your misogyny. If you just saw the body as meat or as the inside of a clock or as some other object with a technical function, which has nothing to do with people or women, there wouldn't be any temptation to treat it in that way.
posted by Aravis76 at 3:44 AM on August 19, 2015 [20 favorites]

Not handling the patient in this way doesn't require any deep empathy, it only requires the absence of a positive desire to express your contempt for them.

Absolutely right. Even an absolute sociopath can easily get through the day without sexually assaulting an unconscious patient. I think the biggest lesson is "don't be an asshole." Where have I heard that before?
posted by midmarch snowman at 4:21 AM on August 19, 2015 [4 favorites]

I recently had a pretty unpleasant gynecological procedure in the office of one of the most experienced (and wealthy) gynecologists in town. He's male, white, and a bit goofy in some ways, which I first thought was charming.

Then, during the elements of the procedure (which, you know, involved me being naked from the waist down, with my feet in stirrups, and both my internal and external organs on various forms of display), he just seemed so awkward with the whole thing. Like he'd never seen a naked female-bodied person before, and had to make silly comments to get through it.

Not at all assault, obviously, but just really weird that this dude making a living on examinations and procedures of the female body still acting like we should all be just a bit embarrassed to be in that situation. And I think this kind of discomfort probably can play out in many different ways...

Between that social expectation of "well, this is awkward" and so many physicians feeling so much power over patients' bodies, I think med schools need to lean hard on dignity and professionalism and just normalizing the female anatomy.

I mean, jeez.

Here's to lady gynecologists, is maybe what I'm saying.
posted by allthinky at 6:30 AM on August 19, 2015 [7 favorites]

Maybe I didn't understand, but weren't both actions medically necessary? I do understand that both doctors made tasteless jokes out of the situation, were assholes and should have been aware it wasn't appropriate or funny and should not have gone there.

I'd suspect that a doctor whose intent was to enjoy a sexual situation touching someone's genitals to get their rocks off would actually shut up in front of others rather than making a wildly inappropriate joke to call attention to the action in many cases. The fact that they made horrible jokes might even suggest that the situation is making them uncomfortable enough that they're blundering around trying to find an "out" through humor (which turns out is far from funny).

People do all kinds of dumb-ass crap when they can't cope with a situation. You'd think doctors would be more used to dealing and know better, but who knows.

I remember when I was a kid around 12 and a neighbor lady called to say her husband had died and she hung up before talking to anyone else. A family member asked who it was and what they wanted on the phone. I repeated the message in a "funny" voice because I was completely unable to process or deal with the role or emotions that had been dropped on me suddenly. It was a bad situation all around.

People react to extreme situations in bizarre and perhaps wildly inappropriate ways. Doctors should be aware of that and not react I those ways. They should be aware of their own reactions and deal. Perhaps even role play in medical schools "You just had to deal with X (wildly uncomfortable situation). How do you respond when you start feeling overwhelmed?" That way they're not maladapting on the fly.

Or maybe these were doctors who were just creeps and trying to be creeps, but I think t that reading is simplistic.
posted by clickingmongrel at 6:31 AM on August 19, 2015 [1 favorite]

Maybe I didn't understand, but weren't both actions medically necessary? I

Let's see here....

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.”

Nope, doesn't look like it.

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 vagina. He starts laughing. He keeps dancing.

No, not medically necessary either.

The point isn't the actions - it's the attitudes about them, and sharing them with underlings. That is extremely inappropriate.

I totally sympathize with what other people upthread talk about about developing a neutral sort of non-empathy to the body in order to, well, keep doing one's job. But there is a pretty clear line between having a mechanical look at the fleshy things you're treating, and... and saying and doing that.

ESPECIALLY AROUND YOUR FUCKING STUDENTS WHOM YOU ARE TEACHING.
posted by entropone at 6:38 AM on August 19, 2015 [10 favorites]

I agree that "it's the attitudes about them, and sharing them with underlings. That is extremely inappropriate."

These doctors need to control themselves and not do something bad in a situation like these. They should know better and practice dealing with extreme situations and know how to deal, they should act appropriately and be called on it when they are not. Even if the best they can manage is robot mode. Certainly they shouldn't be making these comments or going these places.

I do, however, want to draw a distinction between purposeful actions by doctors to get turned on sexually that some mention up-thread. Basic disrespect and inappropriate behaviour is common to both, yet I'm not so sure if both these situations stem from that.
posted by clickingmongrel at 7:00 AM on August 19, 2015

Surely there's a difference between closing yourself off to emotional identification with the patient - because that would prevent you from doing your job - and deliberately, happily, treating the patient as a thing

But I think these two things are deeply linked. I wish we were inculcated with the skills to be present, instead of emotionally cut off, while dealing with the intensity of physical trauma and disease. It's that process of being emotionally cut off that on one hand leads to the very common casual disregard for the profoundly important experience the patient is having, and on the other hand, in someone inclined this way, can lead to the racist and misogynist expressions described in this article. From an insider's point of view as a nurse, this strikes me as one connected continuum of attitude and behavior.
posted by latkes at 7:05 AM on August 19, 2015 [3 favorites]

I can understand that being emotionally cut off from the patient makes it easier to then express horrible attitudes towards them. I still think, though, that there's an important step in between which is captured by your "someone inclined that way." You have to be actually racist or misogynist before your emotional distance from a woman or an ethnic minority patient turns into an opportunity for racist/misogynist pranks. I feel like it's reasonable for surgeons to say that people can't expect them to see the body on the table as equivalent to the body of a loved one because that it would make it hard to do the job. We can 100% expect them to quit the misogyny or racism though (or at least quit expressing it in this type of context in front of their colleagues).
posted by Aravis76 at 7:49 AM on August 19, 2015 [10 favorites]

It's been a long time since I reflected on some of worrisome things I saw as a nurse , and honestly, the Annals would do well to publish equally outrageous articles on a monthly basis to spur more frequent reflection. I don't think the health care profession has ever found good way of instructing providers in terms of emotional presence, empathy or even appropriate detachment. I recently got this half-assed idea that the construct of emotional labor could be used as a basis to describe and inform desired provider-provider and provider-patient relations.
posted by klarck at 8:01 AM on August 19, 2015 [5 favorites]

I thought we had discussed this on the Blue, but possibly not:

Pelvic Exams While Under Anesthesia Sparks Debate

But Barnes says the exams are done without explicit consent more often than these doctors indicate. A 2003 survey of Philadelphia medical students found that 90 percent reported being asked to perform pelvic exams on women who had not explicitly consented to the procedure.

Both Barnes and York-Best said there are no recent data available on exactly how many hospitals nationwide are not abiding by the guidelines recommending that explicit consent be obtained.

In any case, Barnes said that guidelines do not govern real-world practice — for this, laws are needed. During his residency, Barnes said he raised his concerns regarding pelvic exams with his superiors, but was told these exams were a long-standing, standard practice. "In fact, I was told I was the first medical student or resident in institutional memory to express concern over the practice," he wrote in his editorial.

When I went to give birth, I really pissed off the nurse who wanted to let a lot of med students poke at me while I was in labor. "This is a TEACHING hospital!" she said. But as I told her, I was nervous enough about giving birth, I needed to concentrate, this was my first time, and I just couldn't handle it.

She was kind of a shit to me the rest of the time she was on shift. I received some other treatment at that hospital that made me think her attitude was pretty normal. How dare I assert boundaries on my own body in a teaching hospital!!

For the scared patient I was then, and for all the other women who suffered the same I say: fuck you, lady.
posted by emjaybee at 8:56 AM on August 19, 2015 [12 favorites]

Culturally I think we over-emphasize that it's okay to depersonalize our patients as a coping mechanism and under-emphasize empathy and respect (and friggin professionalism if all else fails). There's a difference between feeling like I can't break down and cry every time something sad happens in the hospital, and pretending your patients vagina if a fucking maraca or whatever was going through that jackasses head. The whole "I must see people as things or else I will be unable to perform medical acts upon them!" thing is a cover for a lot of really shitty unnecessary behavior. I'd rather have to occasionally step outside a room and collect myself when something horrible happens then turn into the kind of clinician who thinks it's okay to forget to treat people with basic human dignity.

I have to confess I find this attitude a bit childish as well. If you're going to work on the coal-face of health care then you're going to be privileged to see a lot of amazing stuff and meet a lot of amazing people. The down-side of course is that you're also going to see a lot of horrendous stuff and meet the occasional asshole. The highs of this job are often higher than what other people experience - how many people get to directly help save a life at work? But the lows exist too and I think we need better coping mechanisms for this than the ones currently on offer if they provide a haven for inappropriate bullshit.

This behavior is absolutely self-reinforcing and it absolutely is a culture that is set by the people with authority. Senior doctors who treat their patients like shit make it okay for junior doctors to do that. Senior nurses who talk about their patients with contempt make it okay for junior nurses. I think it's ludicrous to ask junior staffers to step up and put a stop to it when they can face very real repercussions for doing this. Right now in New Zealand it's been all over the news that medical students and house officers are being blatantly harassed by their colleagues and they feel unable even to report it to anyone for fear of getting torched for a job in the future.
posted by supercrayon at 9:14 AM on August 19, 2015 [13 favorites]

Ex-Nurse Charged With Sexually Assaulting Mentally Incapacitated Patient.
posted by clavdivs at 10:17 AM on August 19, 2015

The medical has a big problem with hierarchy and authority. There will continue to be problems with ethics and medical errors until they fix it. Fix the problem, not find a scapegoat, the scapegoat will never be the most "important" person in the room.

Anecdotes when my friend got her lab coat as a MD, suddenly the sea parted in the hospital. Everyone get out of your way when your a doctor, not as a young women. In one of her non hospital jobs, her nurses literally stand when she enters the room and offers chairs to her. No one told her she was leaving early or clarified when the shift was, because no one wanted to disrespect her, it was weeks when she found out and she was embarrassed. Again, this was probably more noticeable as a young women because of the lack of respect we often get.
posted by Gor-ella at 11:52 AM on August 19, 2015 [4 favorites]

supercrayon-- I realize my second comment may have come across as tolerant of degrading behavior toward patients by medical staff. What I meant to say is, if we are to be sympathetic that it's a hard job and maybe people crack and become uncaring in the process of doing it, we should not then consider them trustworthy in their care for vulnerable patients.

The checks and balances that need to be in place need to be stronger than asking more of vulnerable lower level staff who stand to lose their jobs or face repercussions on the job for doing so... for the reasons you mentioned that might not really be a good system.

I do not know what the answers are, but I would guess among them for consideration would be more patient advocates present in hospitals, more presence from overseers who are not staff of the doctors, less assumptions of alone time.

And I guess the age old question-- do abusers have reasons that make it understandable for their abuse? If doctors are innately going to treat people inhumanely, and we want to accept that as understandable, then we need to not act like doctors are all that innately trustworthy-- also perhaps put routine and non-risky care in the hands of staff who do not handle as much of the traumatic stuff and who therefore we aren't going to make excuses for if they treat people badly because "it's a hard job".

If doctors can't be expected to protect patients from their own abusive behavior, then it should fall to the rest of us to protect patients from them.

Or we should just expect them not to do this shit, call it unacceptable and abusive, and hold them accountable for it.
posted by xarnop at 7:14 AM on August 20, 2015 [1 favorite]

I read this paper on humanism and professionalism in medicine this morning, and a lot of it resonates with the comments here. It talks a lot about how treating patients disrespectfully has become a mark of "professionalism" in many hospital contexts, and how medical training should be emphasizing humanism rather than professionalism.

Humanism or Professionalism? The White Coat Ceremony and Medical Education

It is not clear who first stitched together the terms “medicine” and “humanism,” nor exactly what was intended at the time. For my purposes, I will adopt a fairly broad understanding of humanism, as articulated by one of my own mentors: the accordance of deep respect to humans individually, and to humanity collectively, and concern for their general welfare and flourishing. Although it is not at all difficult to imagine how this tradition intersects with clinical medicine, it is also crucial to understand exactly what it lends to the profession of healing. The hallmarks of humanism are its universality, its egalitarianism, and its scope. Its concerns, on the one hand, and obligations, on the other, apply to all humans equally; its training ground, for the most part, is experience—as a human and with humanity; and its ultimate vision is for human welfare, as broadly conceived as possible. It requires neither professional expertise nor special knowledge, only reflective and thoughtful human beings who are ready to engage one another across multiple dimensions. Furthermore, it is in no way bounded by clinical medicine but transcends it. Rather than embody the totality of humanism, the sensitive physician at most humbly participates in its venture, making his or her small contribution to the grander project of human well-being.

Professionalism, in contrast, is a socially constructed, local phenomenon. It is rooted in a sociological understanding of a “profession,” for which I rely on the late Eliot Freidson's classic definition in his landmark Profession of Medicine: a group of specialized workers whose expert knowledge earns them the right to function independently as a semiautonomous mini-society. The strength of a profession as a social unit lies in its members' assertion of a distinct and consolidated collective identity, whether through participation in professional organizations; the nurturing of a rich, internal professional culture; or censure of those who deviate from the profession's standards of conduct. Professionalism raises expectations for professional behavior to the level of ideology, encouraging all members to embrace the traditions of the profession and to be as “professional” as they can.

But what, exactly, does it mean to be professional? Though professional traditions do contain moral commitments, they also include a diverse range of other cultural components. Empathy, respect, and compassion, for instance, are certainly part of medicine's self-image, but so are certain standards of the appropriate dress, demeanor, language, and habits of a physician; a level of comfort in trespassing usual social taboos of exposing and touching strangers; a readiness to blend patient care with student mentoring in clinical contexts; a tacit understanding of the limits of physician responsibility; and a vision of medicine as an essentially scientific field. None of these elements by themselves are outright objectionable, but several of them are unquestionably value laden and could be subject to discussion, yet they are usually justified by little more than the traditions of medicine themselves. An ideology of professionalism simply promotes all of them indiscriminately without offering any basis for introspection.

Several other features distinguish professionalism as a guide for physician behavior from humanism (see Table 1 for a summary). While humanism appeals to universal values, professionalism is rooted in the local traditions of a group whose self-identity lies primarily in its distinction from the surrounding lay community. Anyone with a good head and sharpened sensitivities may comment on humanism, whereas the normative understanding of professionalism belongs to the professional group, which manages how much of a voice outsiders are granted. The content of professionalism, too, is narrower than that of humanism because the professional group defines what the content and issues for professionalism will be. Values such as courage, loyalty, patience, and humility, for instance, receive little attention in discussions of medical professionalism, whereas their relevance to everyday human interactions makes them central to humanism.

posted by jaguar at 12:19 PM on August 20, 2015 [2 favorites]

Made it to the nytimes.
posted by midmarch snowman at 1:32 PM on August 21, 2015

From the NY Times piece: Dr. Mark S. DeFrancesco, president of the American College of Obstetricians and Gynecologists, said in a statement that in his 31 years of practice, he had “certainly never witnessed activity like this.”

Give me a fucking break Mark DeFrancesco. Have you been practicing inside a lonely paper bag? OB is rife with terrible examples of misogyny and dehumanization, especially for these older dudes who came in before a wave of feminist young women entered the specialty.
posted by latkes at 5:33 PM on August 21, 2015 [3 favorites]