My Scibling DrugMonkey brought up a half-valid point. The half that was valid was that none of the medical bloggers spoke out about the surgeon who assaulted a patient. The half that was insane was where this is used as further evidence that doctors are arrogant pricks. Based on this comment and those of the commenters on my blog, some further clarification is needed.
I can't speak for other doctor-bloggers, but the story of the surgeon who tattooed a patient wasn't that interesting to me because of its isolated nature. When looking at antivaccine claims, altmed claims, and all manner of woo, we look for patterns of thought and behavior not in individuals but in society and in movements. If it were found that there were a true sub-culture of surgeons doing this to patients, I would probably rant for days about it.
That being said, there are certain aspects of the incident which seem to confuse our readers.
First, we as doctors are entrusted with the physical and emotional facts, secrets, and foibles of our patients. This creates a vulnerability in our patients (and in ourselves, but more on this another time). Violation of this vulnerability is the greatest of immoral acts in our profession, whether it is telling of their secret affairs, doing inappropriate exams, or making marks on their bodies.
The incident in which a surgeon apparently put a washable tattoo under the pantie-line of a patient is a gross violation of trust, physical integrity, and is attached to a whole lot of issues regarding power, violation, and abuse. A vulnerable woman (she was under anesthesia) awakes to find a mark on a private part of her body for no good reason.
It may or may not be hyperbole to call this an act of violence, but either way, this idiot should not be practicing medicine. These behaviors aren't usually isolated, so investigation may show a pattern.
But back to the other issue. A doctor committing an act of violence doesn't really illustrate much about the profession as a whole. It doesn't illustrate much of anything except that there is an asshole out there committing violent acts, and as he is a member of my profession, his acts are related to it.
The days of systematic pathologic paternalism on the part of doctors is long gone. It may linger in places, but it's just not part of the culture anymore. Doctors are authorities. We know things that others do not, and use that knowledge to help people. We have an unequal part in the doctor-patient relationship which is potentially (but rarely) abused. To level this relationship senselessly, to claim that doctors have no different skills or knowledge than others, is to abandon our responsibility to our patients.
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Actually, no physician I'm aware of has defended this doctor more strongly than with something along the lines of "it's really bad, but I'm not sure it rises to the level of battery." The emphasis on that part of the story is how some try to distract attention from the truly despicable use to which PP put this incident.
As for "not speaking out" about the surgeon who placed the tattoo on the patient, I wasn't even aware of the incident until I saw PP's rant.
Nor was I
There's a creepiness to this behavior that definately would disturb anyone that it happened to.
A sensible, mentally healthy patient without previous trauma will probably move on without permenant damage. That doesn't negate the seriousness of the offense.
The urge to place a mark (even a non-permenant one)on the body of an unconcious patient in a private area seems like the urge of a disturbed person.
The inability to over-ride that urge seems dangerous.
Where I would expect the medical profession to speak out is if this case is not handled appropriatly by the system.
The profession becomes responsible for the actions of individuals when it does not appropriatly address things like this, and gives their behavior a chance to be repeated or to escalate.
My only issue with calling the infraction "violence" is that it seems somehow miscategorizing. It doesn't necessarily lessen the infraction to say that it's non-violent. There are plenty of heinous crimes and infractions which are not violent.
I think it's OK to call this a "violent" act as long as we define "violence" explicitly. For example, in Fighting Words (2005) Hector Avalos starts off with a definition of violence which goes, roughly, "The infliction of pain and/or the modification of a human body to impose power differentials". If that's not what you mean by violence, fine (although I bet it overlaps). Shaving a prisoner's head during what we'd euphemistically call an "interrogation procedure" might not be particularly painful, but it'd still count as violent.
Having a comparatively broad definition of "violence" means that we'd be calling more things "mild violence", of course, but as long as we set up our terms explicitly I think we'll be OK.
The reason I accept violence as a description here is that the act makes the patient feel violated, powerless, scared. It is certainly OK to define violence as actual physical harm, but I think most of us understand that this is not a harmless prank. At least, I hope we all get that.
Violence is not simply physical assault. Intimidation is the threat of violence, and can be just as scarring as physical attacks. Someone finding that a doctor used the time that was for healing to instead place a symbol somewhere they thought was private (whether it's stitching their initials into the patient or a fake tattoo) is extremely disturbing. I'd qualify it as violence, just as much as someone using a drug to knock their date unconscious even if it didn't lead to rape.
The days of systematic pathologic paternalism on the part of doctors is long gone.
I know a *lot* of women who would disagree with you. So many conditions are misdiagnosed because the symptoms are dismissed as "all in your head". Ask migraine suffers. It's not merely that the diagnosis is missed, it's that the patient is blamed for exaggerating the symptoms. This happens much more to women than to men; most women I know have at least one such experience to relate.
Jonquil: Any references or real studies on this? I know a lot of women with lots of medical problems and they've never been dismissed by a doctor -- if they had, they'd be dead (the women, that is.)
I don't want to hear the fibromyalgia statistics, either. Or Crhon's disease either. Some things are hard to diagnose. Migraines are one of them.
I'm not sure what misdiagnosing migraines might effect, if the medication has any contraindications or adverse side effects, then the doctor may be in for a lawsuit for a misdiagnosis... see?
I spent several years with "You're depressed, here's a pill" or "You're depressed because you're fat, go to Weight Watchers and walk a mile every day."
I finally had to get on the internet, print out a checklist of symptoms of hypothyroidism, of which I had all but two, and say, "Look, I know I didn't go to medical school, but my mom is hypothyroid and my grandmother is hypothyroid and could we at least consider that I might be too?"
Lo and behold, I had a benign growth on my thyroid, and am now on supplementation and no longer depressed. Lost fifty pounds, too.
And paternalism isn't dead. It's just more subtle. Of course, so is racism and sexism. I have faith in time that both will be slowly educated away.
Alexandra Lynch: Back in 2001 one of my friends had very serious fatigue and other symptoms. Despite the fact that she was recently recovered from thyroid cancer, the condescending, paternalistic doctors dismissed her symptoms as psychosomatic malaise or some such thing. I said screw that, don't let anyone dismiss your symptoms, you keep on them, demand tests, go to different doctors until you are taken seriously. As it turned out, she had a liver disease.
A lot of MDs are cool - I know some - but the fact is that a not insignificant number of them are smug, arrogant pricks. (No wonder people turn to alterna-quacks.) That was even more the case a couple of decades ago. MDs, especially surgeons, used to be one of the "priesthood" professions, a caste of entitled males who viewed themselves as above the herd. Another such profession is (male) college professor; until recently many male professors thought that one of the perks of the job was acting as sexual mentor to female grad students. (I have a Piled higher and Deeper myself, and I have seen this kind of thing up close.) Many CEOs, of course, still have this a-hole attitude.
PalMD, I understand your getting defensively indignant about your physician brethren, and to be fair MDs and tenured profs have improved a lot over the years in this regard. But c'mon. Thou dost protest too much.
"To level this relationship senselessly, to claim that doctors have no different skills or knowledge than others, is to abandon our responsibility to our patients."
Yes and this meekness on the part of physycians, shepherds vulnerable patients, those looking for confidence, straight to the nearest woo practitioner who usually doesn't have any proballems with gushing certainties.
I understand that this is anecdotal evidence, however, insofar as it exists it certainly disproves the notion that "paternalism is long gone":
My sister's young daughter has recurrent stomach pains. Diagnostic examination has yet to reveal anything, although H. Pylori antibody titers were ambiguous (why none of the doctors though to retest in case of a lab screw-up, I don't know; I'm pushing my sister to do it now).
My niece loves doctors. Loooves. She ends up in a doctor's office and suddenly she's sunshine and giggles. This isn't unknown in my family: I was precisely the same way, regardless of how poorly I felt.
So, every time she goes to a doctor they look at my happy-go-lucky niece and tell my sister she's fine. Whatever her concerns are, whatever she may say regarding the girl's consistent diarrhea, pain, and anorexia - these things go out the window. We've been through a line of doctors, including some of the finest (one of them a true asshole of a pediatric gastro at Mt. Sinai).
None of them listen, brushing it off as hysterical mommy stuff - until I come along. I come along to the doctor's visits, and all I have to do is give them my stern I'm A Tough Guy (TM) look, and say "The child's ill. The child is very ill, and blatantly and obviously so. She's not showing it now, but night-time diarrhea tends to slip away during the early afternoon." And suddenly they're all over themselves to prescribe this medication and that diagnostic examination.
And the next time my sister goes *to those same doctors* without me, they're back to dismissing her entirely. It's gotten to the point where I have to come along to every doctor's visit for anything besides the routine ear infections and vaccinations just to ensure they actually *hear* her.
I can't say paternalism is neccasarily pervasive, but I *can* it's not gone - considering the condescending, "hysterical mommmy" disregard I've seen from one doctor after the next after the next, from the mediocre pediatrician to the Big Name Hospital & Manhattan Office specialist.