“Life’s hard. It’s even harder when you’re stupid.” ― John Wayne (1907-1979)
A friend and colleague recently used John Wayne’s quote after bringing a recent malpractice suit to my attention. The case involved an anesthesiologist, gastroenterologist and a medical assistant in Vienna, VA, who were involved in the care of a patient presenting for a screening colonoscopy.1 Apparently the patient had significant anxiety about the procedure and had annoyed the anesthesiologist and other team members during the pre-anesthetic interview. The healthcare team, emboldened by the unconscious state of the patient, acted on their irritation and defamed and insulted the patient verbally during the course of the colonoscopy. Tragically for all involved, the patient had a cellphone on his person during the procedure that had inadvertently been left on, accidentally recording the disparaging comments of the colonoscopy team. I will not rehash the sordid details of the unprofessional display, as that information can be found easily enough on the Internet. Suffice to say that the character assassination of this patient was severe enough to warrant a half-million dollar award from a jury and the attention of the Virginia medical licensing authority.
First, audio recordings within an operating room environment are never a good idea. Notwithstanding this case, the professional banter (of which this case is not an example) within the complex and sometimes stressful operating room should not be a matter of public record. Everyone in the operating room needs to be able to speak freely and openly without possibility of reproach, for the sake of patient safety and optimal care. Of course the public’s trust that the conversations concerning an unconscious patient are professional, as would be expected, has been put into question by the stupidity of these particular providers.
The term “patient” refers to someone who has voluntarily placed himself or herself under the care of a doctor or medical team. The seat of purpose for medicine is the patient. If it were not for the willingness and trust of the public to subjugate themselves as patients, there would be no modern medicine. The relationship between the patient and a physician is encoded within our laws and sanctified by the oaths we take when we enter the profession. I would suggest that respect and reverence for our patients is a necessity for medical professionals and the foundation of any successful medical career.
These are indeed lofty ideas and, as such, are not perfectly within the reach of any flawed human healthcare provider, which we in federal medicine all happen to be. In my career, I have been guilty of more than my share of off-color remarks. I have experienced patients whose irrational thought processes taxed me to my core. I have encountered patients whose particular antics still cause me to chuckle to myself to this day. I have even had patients so irritating to me personally that I have asked a colleague to intercede and take over my care responsibilities when I felt my objectivity was compromised. I have done the same for other providers.
Perhaps on some level I am also guilty of unprofessionalism, although my transgressions do not seem comparable to the situation described above. Like every other physician, I am guilty of being human and subject to the character quirks and professional inconsistencies inherent in the species.
I believe what shocked and shamed me so much about this news story is the venom with which the healthcare team verbally attacked this patient. The unethical conduct demonstrated by this team was so onerous that its harsh light brought my own comparatively minor transgressions into sharp focus. This team crossed an ethical boundary in that their comments suggested a complete loss of respect for the sanctity of the patient/provider relationship. It is a line that I have never crossed in my career, even with enemy combatants in war, and as a matter of honor and principle never will. Just as an enlightened society cannot tolerate, nor should it, any level of racism, however it is expressed, the medical profession cannot abide any level of disrespect to patients.
The purpose of this editorial is not to disparage the medical team being used as an example here. I believe they have paid and will continue to pay for their actions. I desire this tragedy to serve as an example and warning that our relationship to our patients is sacred and should always be treated with utmost respect. As human providers, we will fail from time to time, as I have personally, as the stress and complexity of medicine bring our lesser flawed and debased selves into the mix. When we feel ourselves slipping, when we hear ourselves or colleagues dishonoring patients, we should reflect upon this example and the unnecessary pain it has inflicted on all involved and the damage done to the public’s trust in our profession. Success in medicine depends on our ability to maintain the public’s trust, and we must do so by maintaining higher standards of conduct for those in our profession. As the house of medicine grows ever more complex and sophisticated, we as providers can ill afford such easily prevented self-inflicted wounds to our ethics and honor.
If John Wayne had been a physician, I believe we would have adjusted his statement to, “Medicine is hard. It’s even harder when you are stupid.”