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On Being a Doctor: Shining a Light on the Dark SideShining a Light on the Dark Side

Christine Laine, MD, MPH; Darren B. Taichman, MD, PhD; and Michael A. LaCombe, MD
Ann Intern Med. 2015;163(4):320. doi:10.7326/M15-1144
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In this issue, an anonymous author describes 2 incidents in which physicians acted disrespectfully toward unconscious patients. The Editors explain why they chose to publish this essay and explore strategies for handling inappropriate behavior in colleagues and superiors.

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Keep shining the light
Posted on August 19, 2015
Cristen Pascucci
Improving Birth
Conflict of Interest: None Declared
As a consumer advocate, I am so grateful to see this editorial and the accompanying article published. This is an overdue conversation and one I hope continue. Thank you.

ObGyn News published a response to them today, by an author who feels OBs are unfairly singled out and believes the incidents recounted by Anonymous are "extreme actions," not representative of anything that is tolerated in the field. Below is my comment to him, and I would extend my invitation to this forum, as well.

I am glad to see that Dr. Jaspan is appalled by this behavior, but I would caution that dismissing these "shock value" incidents as total aberrations may be part of the problem. I've spoken with hundreds of women who have relayed stories of disrespectful and abusive treatment in their maternity care, and they are dismissed across the board. No one believes them, or, if they do believe them, the complaint still is not taken seriously because it's seen as some sort of one-off.

In fact, Improving Birth, a national consumer maternity care advocacy organization, is holding 70+ rallies across the U.S next month with the theme of Respectful Care. This theme was chosen in part to bring attention to the problem of DISrespectful care, which women report every single day in almost every state in the country.

Last year, we published an article on this problem, including the video of a woman receiving a forced episiotomy (bit.ly/nodontcut), and launched a campaign in which thousands of women and others recounted stories of mistreatment (bit.ly/breakthesilencephoto). We (with other organizations) also submitted a legal brief including 42 firsthand accounts of such mistreatment earlier this year. It can be seen or downloaded here: http://www.humanrightsinchildbirth.org/amicusbriefpart1/

As for medical students, I've heard those stories, too, and the pressure in some places is overwhelming to keep silent about a culture that is not always respectful of residents and staff, either. I've spoken with an OB and a PA in the last week about this--both of whom left jobs to move to other facilities to escape some of that pressure.

Respectfully, I ask Dr. Jaspan and others who practice ethically to consider that this is, sadly, a real problem deserving of a real solution. For those of us who agree that this kind of behavior should never be tolerated, how can we achieve this goal together?

Dr. Jaspan, or anyone else who like to open up this discussion, please contact me anytime at cristenpascucci_at_gmail.com.

Thank you,
Cristen Pascucci
Vice President, Improving Birth
Light is good
Posted on August 20, 2015
Elizabeth Allemann, MD
Family Physician, Missouri USA
Conflict of Interest: None Declared
Thank you for shining this light. As a family physician, I hear stories weekly of physicians who discount the lived experiences of women. Reading this editorial and the article, I am inspired to reflect also on my own practice, now and in the past, and to pledge to do better, to listen more deeply, to honor all stories, but especially to find room in my heart to understand those who live their lives differently than I do, who make choices I would not, to see myself in "others" and "those people". We can do better. This will help. Thank you.
Lets REALLY shine the light
Posted on August 20, 2015
Robert J. Pegritz
Medical/Legal Consultant
Conflict of Interest: None Declared
Puckerbutts. That's what I call people who try to neutralize the levity that a surgeon or PA interjects into a surgical procedure in an effort to relieve the tension following an attempt to save a patient's life.

The person who wrote the article "Our Family Secrets" was a medical student who does not work in the O.R. daily.

Those who have not spent the hours, weeks, and years to save the lives and rid patient's of infections, carcinoma, and other adverse "growths" do not realize that with each day that comes, dedicated people walk into operating rooms and correct the mistakes of nature, using their abilities and skills so that they can return patients to their lives more normal than when they were first wheeled into an O.R. The stress on these professionals is SO great that once in a while, a little steam MUST be released in order to bring themselves and their teams back into some logical perspective.

There is no place in the O.R. or anywhere else for sexual assault and disrespect. If that medical student is correct, a very serious line was crossed. However, his or her comments come into question after reading that the patient was prepped with "cotton balls" and not a sponge stick.

The lay observer or medical student has no idea of the cumulative stress that can be present inside someone who daily cuts open living, breathing people. It is an ominous undertaking that is never understood unless you have walked a few hundred miles in that person's gown and gloves.

Respect and integrity are not lost when a surgeon or PA does the surgical equivalent of a victory dance. They've just saved a life or spared someone months or even years of suffering. And I'm certain that if the patient were awake during a surgery to bypass an expanding aneurysm or control hemorrhage in a patient with postpartum uterine atony, he or she would be singing the third part harmony of La Cucaracha right along with the surgeon and the P.A.
Let's turn the light on, not just the flashlight
Posted on August 26, 2015
Alvaro F. Vargas P.
Penn State College of Medicine
Conflict of Interest: None Declared
As a third year medical student rotating in labor and delivery while I write this comment, I must say I agree with Dr. Jaspan and urge everybody to consider his point (http://tinyurl.com/q4mczbk). As a field we do need to talk about the good, the bad, and the ugly, but featuring two of these ugly ob.gyn. stories in an internal medicine journal without input from ob.gyn. colleagues could have been counterproductive. If we are ready to talk about the darkside, it would probably be more beneficial to make a conscious effort to avoid targetting and start sharing the secrets of the whole family.
Posted on August 28, 2015
Richard A. Hogan, M.D.
Sturgeon Bay, WI
Conflict of Interest: None Declared
The Editorial "On Being a Doctor: Shining a Light on the Dark Side" gives physicians a chance to pause and do a gut check on our own behavior in similar circumstances. To be respectful to human life in all of its stages is a calling that all of us should feel, all who are entrusted to the care of the patient. We SHOULD have the courage to "call out " our colleagues when we feel the patient is being disrespected.

I am afraid we have another "family secret" that may need attention, that secret is the way we have treated each other. The times we have disrespected those in the health care industry who may not be our equals. I am referring to the disrespect that may be heaped on Fellows, Residents, Interns, Medical students, nurses, nursing students and the list can go on. When we allow, condone, participate or perpetrate disrespectful behavior toward any one of these groups we deserve to be called out on it. Also we should be able to"call out" the perpetrators without using the vulgar word the anesthesiologist used. Something like "troglodytes" would be more appropriate... or "Neanderthals" might be right. One disrespectful action should not lead to another.

As a resident back in the day I could not stand it at morning report when the attending "grilled" the interns and medical students with questions when he knew they would not know the answer. Watching physicians in training sweat was not my idea of a learning experience. There are plenty of other examples in medicine/medical training that are likely worse than what I saw. At times it seemed like some saw medical training as an opportunity for hazing and bullying.

You might at some point publish another editorial "On Being a Doctor" that might highlight this other "Dark Side" of medicine and our duty to avoid participating in or condoning or ignoring such activity.

PS: I wonder if "Dr. Canby" was simply letting off steam in a bizarre way after being in one of the most stressful situations in healthcare where a patient might die if you dont do the right thing and fast. We might cut him a small break since we know humans can act bizarrely after being stressed. This doesn't excuse the behavior but may help us understand it. Maybe LaCucaracha was the only Spanish song he knew? The dancing ... pretty bizarre.

Do not print faceless accusations
Posted on August 30, 2015
Linda Ray, MD
Conflict of Interest: None Declared
I was just tweeted by a local reporter that editorial regarding the OR incident. My Annals still sitting on the kitchen table, I read this as well as the editorial of the editorial. I hope that someone there understands the consequences of printing an ANONYMOUS report of what is likely more about the embarrassment of someone who did not stand up when they should have (and still isn't due to the anonymity) than anything else.

News media is going to pick this up as news , not self examination. I have never witnessed inappropriate behavior in the OR in decades, but certainly have in other areas and have no problem saying something. I do not know any nursing staff that would witness without reporting and they should.

I do not appreciate your actions which promote to the public what they already perceive as a trust issue with physicians in an area where a patient feels most vulnerable. The critics waiting for these kinds of comments which are viewed as credible will eat this up as validation for the belief that the medical profession demeans women.
What is wrong with this person that they did not speak up  Medical education should be training leaders , not followers. I appreciate that they wish to come forward, but by doing it this way, they seem to wish to implicate others as though the behavior is common, so he (or she) feels better about it. When did we allow people to make accusations for which they did not take credit. We have a grave responsibility as physicians. When I report abuse to child or adult protective services, I cannot do so anonymously. I know there will be consequences.
The decision to print this based on a faceless medical student and based on what experience. ?
Please review this decision to print, I find it egregious and no where does it discuss the policies in place to prevent and report.
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