Holy crap, a doctor talks about her training experience, and I’m horrified.
So here I was, handling the plane (the layer, or space) around the IVC [inferior vena cava] with care to avoid ripping it. It seemed like the intelligent thing to do. My attending asked, “Why are you being so dainty with your dissection there?” I answered that I wanted to avoid ripping the cava because they’re so much harder to fix.
I take it he interpreted my comment as fear, and decided upon a teaching moment. He took his scissors and incredibly, before my eyes, and with no warning or preparation of any kind, cut a one-inch hole in the cava.
I was stunned. As I tried to process what I just saw, incredulous that he would actually intentionally make a hole in the cava, and as dark blood poured out of the hole, the tide rising steadily in the abdomen, he remarked, “Well, are you just going to stand there or are you going to fix that?”
Whatever happened to “First, do no harm”? The patient was there to have an aneurism fixed, not to be a surgical dummy, and the doctor just decided to create an unnecessary complication as a training exercise. Stabbing a patient in a major vein next to the heart is a criminal act, and I don’t care if all the tools and expertise needed to deal with it were right there at hand — it was a deep violation of trust.
If the patient had died of complications from tearing their vena cava, would the doctor have been tried for murder? It would be the only appropriate option.
Can we also have a list of the names of doctors who think it’s OK to slash up the insides of their unconscious patients to give students something challenging to do? I’d like to avoid them. I’d rather not ever be a “teaching moment”.
Reading the first three sentences I already knew that the surgeon telling the story is a woman and her attending surgeon was a man. Which turned out to be true. Funny how “I’m an criminal asshole in a position of power who can bully and dominate anyone I want” translates into “man” and “I’m just trying to do my job as carefully and responsibly as possible” translates into “woman”. It’s almost as if it’s problem IN EVERY FUCKING PLACE (remember the airplane pilots’ tantrum from a few months back)?
As for PZ’s question:
Of course not, don’t be silly. He’s a respectable doctor who is well insured and protected by a battery of lawyers.
The woman doctor, on the other hand, would have been screwed royally.
No matter what the outcome, he should be charged and prosecuted fir attempted murder. Because that is what this was.
Dark Jaguar says
That is the most horrifying medical story I’ve ever heard! Yes, even more horrifying than those stories about doctors inexplicably throwing a temper tantrum in the middle of surgery and shredding up someone before wandering off. At least those are exceptions, this seems more like a “rule”.
I wonder if this person is a psychopath? I think all of us normal people need a good tool kit to detect and eliminate psychopaths from positions of power. If you are pathologically incapable of caring about other people, the world would be better off without you.
Alex W. says
This is completely normal. When I was training to be a dentist, they’d send us out with hammers to knock a few people about. Then we’d spend the afternoon practicing fitting replacement teeth to our new patients. “Hammer Tuesday” we’d call it. Good times.
Wait. “dissection”, they were practicing on a dead body and the blood came out because pressure from gravity, right? Right!?
Wait a minute: the guy deliberately caused a massive hemorrhage? On a living patient?
Forget about Hippocrates: what about not giving a patient’s relatives reasons to start a fucking vendetta against you?
Giliell, professional cynic -Ilk- says
The most frightening part is that the writer agrees with the actions of the advisor:
In retrospect she sees this as an important exercise that prepared her for er exams because they are so much more important than the life of the patient on the table.
Saganite, a haunter of demons says
That is beyond horrendous. I’m very understanding of honest mistakes, of things getting out of control, of all sorts of things I probably shouldn’t be understanding of, certainly not in any sort of medical context. But this, this is just incredible and I find it horrifying that no consequences came of that. Was she the only one who saw it and kept her mouth shut to protect herself? Was there no anesthesiologist? A surgery assistant/nurse? Did nobody else say anything? It makes it sound like the entire system is rotten if this attending physician could just get away with something like that.
“I guess I made the cut.”
Woah, I’m noticing some possible double-meaning there, as in not just “passing a test” but making “the cut in the IVC”. Like she’s taking responsibility for the “teaching moment”? I hope I’m just interpreting too much into it, but that choice of words is… peculiar.
Even with the patient surviving, that is assault and battery. She should have reported the attending to the police. He should be criminally prosecuted and do 5 to 10 years, as well as losing his license. And of course it is totally unethical not to tell the patient.
Well, he’s a surgeon, so… probably.
The article strongly suggests that this was an actual patient, not a practice cadaver (with the blood flowing only under gravity). Which sure as fuck strikes me as grounds for criminal charges – attempted murder, or at the very least malpractice, ABH or GBH, assault … jesus h, how is it possible that someone could do this and suffer no repercussions whatsoever? Not on the spot, obviously, but immediately afterwards? Criminal prosecution, as cervantes says (not cute puns about “making the cut”).
slithey tove (twas brillig (stevem)) says
but of course the patient was never at risk. If the student was incapable of repairing the incision, the teacher/doctor would have stepped in, and taken over, saving the patient’s life.
Is what I imagine must have been going through that teacher’s mind, when he sliced that cava, he was just preparing her for “slipups” that happen during even routine surgeries. A form of “pop quiz” to test the student before releasing them onto the vulnerable public.
That is fine, hypothetically, but for an actual event it is, as PZ noted: horrific, unjustifiable, unethical, etc.
Seems an appropriate time to quote Naked Lunch:
And I always thought that book was supposed to be surreal satire. My mistake.
As the joke goes: What’s the difference between a consultant surgeon and God?
The author is now apparently claiming that this was a fictional account (the column is written under a pseudonym, but she’s responded on Twitter to the many, many legit accusations of malpractice in this scenario).
Gregory Greenwood says
If, as seems to be the case at first glance, this was done to a living patient just to throw a student a curve ball, then that is monstrously unethical and clearly rises to the status of a criminal act – the teaching surgeon in question should be prosecuted, imprisoned, and be subject to a lifetime ban on performing any form of medical procedure.
I would like to believe that a horrific event such as this would not be allowed to happen in a modern medical system, that all doctors took their Hippocratic oath seriously and would never dream of taking any action that would needlessly endanger a patient, but my days of such naive innocence are long behind me.
Giliell, professional cynic -Ilk- @ 8;
As you say, this is the most frightening thing of all – this is not just one individual doctor who likes to play god with patient’s lives in order to spice up his teaching regimen; he has clearly succeeded in creating at least one more surgeon just like him, who see patients lying on operating tables as expedient slabs of meat rather than human beings. How many more of his acolytes may already be out there? And where did he himself get this attitude from? It seems at least possible that this is indicative of wider cultural rot within the medical profession, and that a substantial proportion of surgeons (while perhaps paying lip service in public to the whole ‘first, do no harm’ thing) are privately dismissive of their patient’s lives and humanity, which is terrifying indeed.
So, which is worse: It’s a true account and the doctor code of silence is so strong that she’s forced to deny it, or it’s a fictional account and she honestly didn’t realize that there were any ethical implications?
Body cameras for surgeons!
Gregory Greenwood says
freemage @ 16;
So now she claims that it was all just fiction? Why not make that clear from the outset? Why present it as a personal experience from her own life? Talk about irresponsible.
And she is sorry for any offence given or upset caused? It really surprises her that effectively making up claims of the attempted murder of patients during surgery might maybe be of concern to the general public?
Either she is titanically irresponsible and lacking in empathy for the fears and anxieties of patients (which itself calls into question her suitability to practice medicine), or she is back peddling out of fear that bringing this event to light even as an anecdote could hurt her career – neither scenario paints a particularly comforting picture if you are a patient.
And what’s with that apology?
How about “sorry I lied to you about something this horrifying, and sorry to all my fellow surgeons who I implied were psychopathic maniacs.”
Rowan vet-tech says
F.O.- dissecting also refers to carefully separating something away from another thing to avoid as much tissue trauma as possible and avoiding cutting across tissues.
This story is to me beyond horrific, as someone who works in the (animal) medical field. The worst I’ve heard of in my field is during final exams for anesthesia the teachers (for both vets and techs) will wait for a moment of inattention and turn the oxygen flow to the patient off. If the student does not catch it in time, the teacher will turn it back it on before it becomes a danger to the patient (there is still oxygen left in the tubing that connects to the patient) and the student fails. Thus, when I’m monitoring anesthesia, every 30 seconds or so I’m doing a glance at the oxygen flow meter, the anesthetic gas %, the volume of anesthetic gas, the reservoir bag, the patient’s gum color, Sp02 %, heart rate, etc. I’m almost constantly checking shit because I’m terrified something is going to wrong.
The attending obviously should never again see the inside of a patient. But every one who was in that room is complicit for not reporting it. I have spent my entire career teaching surgery to residents. This would not be tolerated in the world I live in.
The local DA should be filing charges and subpoena-ing the shit out of this doctor.
As for notions of surgeons being psychopaths, there’s more than a little truth to the notion. People whose job involves hurting other human beings, even if it is intended ultimately to help them, have to have a mindset that allows this. A person who can cut into a living person without qualm isn’t necessarily limited to only doing it when the person is ill or injured. Add to that the ego lift of literally saving people’s lives, and you have an occupation that attracts and creates this kind of person.
Obviously not all surgeons are like that. But I bet the personality profile is more prevalent among them than the general population.
Giliell, professional cynic -Ilk- says
So it was all a joke?
And then doctors wonder why patients don’t trust them…
From the story:
That’s a great way to make terrible decisions. Pilots figured this out when it became clear that ignoring the problem would kill them.
Jackie the social justice WIZZARD!!! says
I thought the way surgeons talked about patients on medical card was hateful. Silly me. Of course it gets much, much worse.
For the laymen out there, “dissection” doesn’t imply a dead patient – every depiction of the human anatomy you’ve ever seen conveniently leaves out the layers upon layers of gristle and fat surrounding everything, and dissection refers to the essential exercise of moving all of that crap out of the way to expose the thing you’re actually interested in.
Anywho, med student here, just finished my surgery rotation, and I find this story mostly believable. Vascular surgery attracts a special breed of asshole, and not without reason, insomuch as it requires hours of sewing with an eyelash-sized needle with telescopic lenses, and unlike skin or fascia you simply cannot undo or revise things, and also the clock is ticking because bodies need blood. There was a surgeon fired from the hospital I rotated at who might possibly actually be the same person, he was notorious for cancelling operations if the resident didn’t know the patient’s BMI for example, or even barging in irate and demanding that an operation be stopped midway on a conscious patient for reasons that turned out to be mistaken. Also some shady insane business involving performing a quickie autopsy on a patient who died on the table. He was eventually fired for creeping out a patient in clinic with his godawful bedside manner and instigating a lawsuit.
He would have done this. But he was a ticking time bomb. It’s fine to grill the residents on how they would handle complication X, Y, and Z before starting such a case, and go further into what secondary disasters might result from their response. But cutting the cava as a learning exercise is like lighting a match on the Hindenburg to test the ushers’ emergency evacuation skills and the classic God-complex surgeon would shit his pants at leaving his perpetually inadequate resident to fix a life-threatening situation. There are enough teachable moments to go around and creating them should end a career at the absolute least. The kind of person who would do this would, as others upthread mentioned, have seriously freaked out everyone else in the OR – I can understand a nurse or a tech feeling intimidated into silence, but certainly the anesthesiologist would have no qualms bringing the hammer down on this surgeon since he’s on the hook for a dead body as well.
If this is true, props to the author for successfully executing a surgical triple axel, but “I passed the test!” is not an adequate response.
My sister is a respected cardiologist. I’m sending this link to her to see how horrified she is.
Reading through the comments on the post, transitioning from explaining how this was a different era, how residents are coddled these days and time will tell if that matters, how there’s no good way to simulate this stuff, to… “I made it all up, calm down” seems like a dodge worthy of a GOP presidential candidate. Which makes me much more likely to believe that her original telling was the true one.
Saganite, a haunter of demons says
Yes, well, that whole “wolf”-thing: Now I don’t know what to believe. I guess it could’ve been fiction, a really bad joke. Or it could be a lie to cover the actual horrible event that she described in earnest earlier. She clearly didn’t think people would react that badly to what she considers a teaching moment and a sort of test to qualify as a cool-headed surgeon. How in hell am I supposed to just believe her now that there’s no truth to this story?
From freemage’s #16
That doesn’t make any sense. If it’s fiction then what was the point of the article? You can’t use a made-up scenario to make a point like that.
It’s like if a firefighter fabricates a story about saving a baby and a kitten and says, “see, my example shows firefighting is a noble profession.”
You know what really pisses me off? Framing any kind of negative reaction as “offence”, in service of blowing it off as inconsequential.
I’m not “offended” by the story, I’m appalled. Different thing entirely.
Raging Bee says
Even with the patient surviving, that is assault and battery.
IANAL, but I’d say it was mutilation. And if I was the woman in that scenario, I would have told the patient what had happened, and advised him/her to get a lawyer. (At the very least, the patient needs to know about that extra cut, in case it has longer-term repercussions.)
Huh. Whether this is made-up or a true story, looks like someone learned a lesson today. Yes, patients kind of expect you not to intentionally harm them when they’re lying unconscious at your hands. For some reason. I know, it’s shocking. But they get easily offended and upset like that.
PZ Myers says
#22, Rowan vet-tech:
I’ve been there! When I was training med-students in an animal surgery, that was my primary job: they were doing the cutting, I was trying to keep the animal alive, and it was constant, nerve-wracking monitoring. My personal nightmare was not giving enough anesthetic, and having the poor thing wake up mid-surgery — you were constantly trying to keep the animal in this narrow window between death and consciousness.
Rabbits were the worst. That window was so narrow, they were so fragile, and if they woke up they’d start screaming. I’d have to hover over them constantly, watching heart rate and breathing rate, and adjusting the anesthetic practically minute by minute.
Rabbits convinced me my future was going to be in invertebrates and fish.
Rowan vet-tech says
I get to monitor anesthesia on a rabbit today, as a matter of fact.
I fucking hate rabbit anesthesia because of that and the breath holding.
Second worst is guinea pigs because they sound like their lungs are full of fluid once they hit the right plane. The gurgling makes me twitch even though i know it’s normal.
congenital cynic says
I’m currently recovering from a very recent major surgery. And I’m 100% certain that if you queried the surgeon who did the job, he’d tell you that he had quite enough on his plate fixing what was wrong already without wilfully adding to the challenge. But he’s not working in a teaching hospital, so no surgeons in training in the OR. And he has never given me the slightest cause to think he’s an egomaniac or has any psychopathology.
That said, I wonder about the veracity of the story. If true, it’s horrific, and if not true, the author is warped. Might be worth watching Snopes on this one. Nothing shows up there now, but this all seems suspect.
Ugh, PZ, that must have been awful. Rabbit screaming is the worst. They sound like human babies. I have rabbits in my suburban backyard and we also have a local fox, and every now and then the fox gets a rabbit and takes so damn long to finish it off. I get it, the fox needs to eat, too; nature red in tooth and claw and all that. But when it gets all Silence of the Lambs in my backyard, I am not happy.
slithey tove (twas brillig (stevem)) says
From freemage’s #16
PZ Myers says
Once you hear a rabbit scream, you never want to hear it again. I got to be pretty good at sensing when their anesthesia was weakening, and I’d be right there to give ’em an extra bit of the good drugs.
And here I’ve been labelling my fear of doctors, hospitals and anaesthesia as an irrational fear.
The article now has this note appended:
Misconstrued? We didnt misconstrue anything. You lied. That’s not the same thing.
That’s the final drop for me. I’m going to write a complaint to KevinMD, the site that hosted this post. I suggest others do the same. The contact page is here.
Raging Bee says
As for notions of surgeons being psychopaths, there’s more than a little truth to the notion. People whose job involves hurting other human beings, even if it is intended ultimately to help them, have to have a mindset that allows this.
That broad-brush attack on surgeons and surgery in general is uncalled-for unless you have something to back it up. I find it hard to believe one has to be a “psychopath” just to be able to cut into a human body, if one is doing it to save a life, and acting according to one’s specialized training and experience. Do you have to be a “psychopath” to lance a blister, or reset a broken bone, or pry out a splinter?
Yeah, that is ridiculous. Nothing in the article even suggests that what one is reading is a fictional account. The title alone implies it’s a real story: “A lesson in the OR that prepared this doctor to be a surgeon”. She’s saying it prepared her to be a surgeon… meaning it happened to her, meaning it’s real.
She’s sticking that note at the very end of the article like it’s a reminder for something the reader should obviously have known from the start.
I think the story is true, and this is her very poor attempt at avoiding any involvement in it (like her failure to report the crime and violation of medical practice). If it wasn’t true, a doctor would take great care to mention from the start that it’s not.
Raging Bee says
“dear patients: it’s fiction. It was not meant to offend. Sorry it upset you.”
The entire purpose of the story is to make a point using an real-world experience. Calling it “fiction” totally undercuts that purpose.
Also, it just makes the whole thing all the more fishy. Offhand, I’m guessing it really did happen, and she told the story to make a point, and then she felt some pressure, real or imagined, to retract it. I’m kind of reminded of Elan Gale saying some really gratuitously mean things about a female passenger, and then, when he realized people were getting offended at his treatment of a stranger, turned around and said it was all a joke and it was everyone else’s fault for not having a sense of humor.
At the very least, some investigators need to do some digging, identify the surgeon most likely to have done the alleged deed, and then do some more digging to find out whether it really happened. This is a criminal justice matter, plain and simple.
Raging Bee says
If it wasn’t true, a doctor would take great care to mention from the start that it’s not.
I suspect that if it wasn’t true, a doctor would take great care not to mention it at all in the first place.
Complain about what exactly?
Either she lied or she lied about lying. Either way an inquiry should made, but she’s either the accused or the witness.
I have no idea what KevinMD should or could do since, on the face of it, they could be either dealing with a troll writer or a major cover-up in the medical field. They can’t handle the latter and any attempt to deal with the former might just increase my suspicion regarding surgeons (since any KevinMD action can also be considered part of a cover-up).
PZ’s and others’ comments made me google screaming rabbits.
However, I do understand now why the sadistic kids in the kindergarten were so keen on looking for baby rabbits. It really is the closest you can come to torturing humans. (piglets are a close second)
If we accept the ‘fiction’ claim, then the author has a Christ-complex, believing she is spreading enlightenment to the ignorant masses about how unimportant medical ethics are in the face of the much more important field of never questioning the medical hierarchy.
Seriously, this just keeps getting more and more bizarre.
From a medical malpractice defense lawyer: Doctors are very, very rarely prosecuted criminally for assault and battery. The reasons are manifold. Many jurisdictions (including the one in which I practice) have ethics rules that prohibit an attorney from instigating a criminal proceeding to gain an advantage in a civil case. Since even a mere appearance of impropriety can get a lawyer — especially a plaintiff’s lawyer — in a lot of hot water, an attorney would be very reluctant to assist a patient with getting a criminal prosecution going, or take a civil case on behalf of a patient who attempted to do so on his own. Hospitals, for their part, are reluctant to report wrongdoing by their own doctors (for obvious reasons) and their internal “quality-control” investigations are to a large extent privileged. DA’s are reluctant to prosecute because doctors don’t come off as stereotypical baddies; getting one convicted for how he practices medicine is an unhill battle, and a very unattractive one for a DA who’s trying to rack up convictions in order to further his own career.
What is likely, however (in the event the wrongdoing is discovered) is a malpractice lawsuit and administrative consequences. A hospital may be reluctant to report a cavalier doctor to the authorities, but it can effectively end the doctor’s career by revoking his privileges. And, while state licensing authorities don’t like to second-guess specific treatment procedures, falsifying patient records — which was almost certainly done in this case — is a license-yanking offense. (An unlicensed doctor can still work in the VA system, however.)
What’s particularly disturbing to me here is that the resident is trying to rationalize what the attending did. She needs to understand that what he did was malpractice, pure and simple. It’s malpractice both in the sense of inflicting damage on the patient without any arguable benefit and in the sense of failing to obtain informed consent. It doesn’t matter how “teachable” a moment it is, or how valuable a skill the resident learned, or how well they fixed up the patient after the attending sliced him up; it’s malpractice. That’s the lesson the doctors in this story need to learn — and from the looks of it, they will both learn it the hard way.
The story strikes a personal cord with me because I recently handled (rather out of character) a malpractice case on behalf of a plaintiff whose surgeon also decided to orchestrate a little intraoperative crisis to teach a valuable lesson to two senior residents. Unfortunately, the lesson snowballed to the point where the patient lost a healthy organ; and so much blood, he nearly died on the operating table; and developed a devastating infection afterwards that left him with an open surgical wound for 12 weeks; and spent six months inpatient (instead of the originally planned 10 days). This “teachable moment” ended up costing the patient unspeakable suffering and years off his life; and the hospital, a seven-figure settlement.
Well, I’ve complained about the author, recommending that the site bar her from writing any posts in the future, since, either way, she’s a liar. That’s about as much as they can do.
Ideally, the issue should be investigated by the police, but I’m not sure how to make that happen.
Here in the Netherlands we had quite the riot about 10 yrs ago when it became clear gynecologists made interns feel inside women’s vagina’s when anesthetized as a learning experience. Without the women consenting to it. I remember my mentor (I was a student nurse at the time) being upset about it. (she had undergone surgery not to long ago). However fiction, there is a lot less fiction to it than to be comfortable with.
Raging Bee says
Amused: holy fucking shit what a horror story. This is something that needs to be relayed to both participants in the OP story, and whoever else might have read it. With apologies in advance in case it upsets them, of course…
Beatrice, an amateur cynic looking for a happy thought says
There is no indication the story is made up in the same article published as a blog post on her blog:
This exchange happened in the comments:
Josh, Official SpokesGay says
Wait– no one here actually believes that “this was fiction,” do they? Do you really, truly think that’s plausible? That she would write this in a way that clearly and intentionally frames it as a first-person narrative, and simply forgot to say it was a joke until later? This is really convincing enough to folks that you’re saying, “Well, it was in bad taste.”
Raging Bee says
In court, you never get to proving causality if there has been no harm.
Uh, yeah, and cutting a major vein, without medical necessity, is “harm,” pretty much by definition. Just like cutting the wrong body part to remove a tumor that’s somewhere else is “harm,” even if the wound heals quickly.
Don’t get me wrong: I am not advocating that surgeons go around cutting things they don’t need to, just because they can.
Yeah, she’s not advocating such things, she’s just tying herself in knots justifying and excusing them. Big difference. *Eyeroll*
Like, for example, graduating a surgical resident that cannot stop a simple bleed. Now THAT would be malpractice, by proxy.
So the guy who induced the simple bleed would not be guilty of malpractice, but the institution that let the student graduate, after he’d failed to stop it, would be guilty. This person’s concept of medical ethics needs work.
This Hope Amantine person sounds like a twisted mess who’s been conditioned to accept gross sadistic actions by authority-figures as normal or necessary.
How about not intentionally causing a bleed in the first place, huh? Because every bleed is a simple thing and will always be stopped according to schedule, with no ensuing complications, right.
Judging from Beatrice‘s excerpt from the blog, I would say Hope Amantine needs to brush up on her legal terminology.
No, not really. I entertain the notion for the sake of argument, but I strongly favor the conclusion that the story was actually true and she’s only retracting it now because it has received more backlash than expected.
I do not believe for one femtosecond that it is a fiction. This does not read as a real apology, it reads as backpedalling. In any case – if fiction or not, I would not let the doctor who wrote this to touch me with three meter long broomstick, let alone cut into my body. I sure as hell would rather die.
The doctor who wrote this is a terrible person. If true, then because she did not report this and subsequently thought this was a good thing to happen. If fiction, then because she obviously thought that it would be OK if it were true. The article does not in the slightest conwey the message, that she dissaproves of this scenario, or feels the need to prevent it from happening or anything like this.
At least not to me. Phuy. I generally do not wish ill on anyone, but she should get her licence revoked, because no matter how good a surgeon she might be, she is not ethical and moral enought to be trusted with other people’s lives.
Having both been, and trained, surgery residents, I can say that there should have been plenty of volume of cases available to teach your residents how to stop simple bleeds without having to create any on your own.
And if your centre doesn’t have a big enough volume of case load to do that, then it would be malpractice to even have a residency program there.
You can also conduct that training on cadaveric and animal models. There are pigs bred specifically to be suitable for that purpose.
Regarding malpractice and the issue of harm.
There is a no harm no foul rule for malpractice. So if, say, you ACCIDENTALLY cut that vena cava, then repaired it and the patient did well, you would be protected if the patient found out about it later and tried to sue you.
But deliberately cutting something that does not need to be cut, and something that if cut by accident would be universally regarded as a complication/adverse event? Well that probably isn’t malpractice either, but only because it’s much worse. It would be assault – a medically unnecessary maneuver performed without obtaining informed consent, since I suspect the patient did not consent to having healthy tissue unnecessarily cut to serve as a lesson for some trainee.
Fiction? I doubt it. Not with the comments she makes both on KevinMD and on her own blog. It looks to me like a simple country surgeon talked to a less simple country lawyer about the blog post republished on KevinMD.
Right, it’s not malpractice, it’s assault and battery. Depending on the state there would be various specific labels for it, but basically, he’s using a deadly weapon, there is no provocation or extenuating circumstance, the victim is helpless. It could be worth a very substantial prison term. And all the people in the room are accessories after the fact.
Esteleth, RN's job is to save your ass, not kiss it says
So, as a nurse, and a nurse who’s spent some time in the OR, let me say two things:
(1) I’ve known surgeons who are assholes enough to pull a stunt like this. I’ve also seen patients where the best explanations for WTF is going on is a tie between “the surgeon decided to have some fun” and “the surgeon was drunk.”
(2) The aforementioned culture of arrogant, domineering surgeons who are flat-out vindictive and cruel harms – including killing – patients.
Incidentally, I call bullshit on any claims that if the junior hadn’t been able to repair it the attending would have stepped in and the patient would have been fine. Taken at face value, the patient has been left with an unnecessary inch-long scar in their vena cava. One reason vascular surgery is so fraught is because scar tissue, including scar tissue along vasculature, behaves differently from unscarred tissue (this is the reason why the rise of laparoscopic surgery has been so amazing – the scars are tiny and thus patients do vastly better). Because some asshole attending decided to “test” a junior, a patient has been left with a lifelong increased risk of aneurysm (in case you were curious, an aneurysm of the vena cava that ruptures would be deadly in seconds). This patient, of course, is someone who was having an un-ruptured aneurysm repaired, meaning that the vasculature in the area is already damaged and fragile. As the probability that the attending’s stunt would have been disclosed to the patient is about zero (hello, malpractice), you now have a patient who’s following standard post-repair precautions, unaware that there’s at ticking time bomb in their vena cava. And then one day, they feel a little funny and note that their abdomen feels a little warm to the touch. And that’s the last thing they know before their brain shuts down from blood loss as they hemorrhage.
Incidentally, comments at the post have now been closed. The only comments made by the author was before the story changed to “it was fictional” and treat the story as if it really happened.
As a physician, let me say this. Surgeons are cut (no pun intended) from the same cloth as lawyers, politicians, engineers, etc… and yes even developmental biologists. In any field you are going to find assholes. And yes, I agree that when a patient’s life is at stake, the behaviors of a physician/surgeon do take exception. That is why the medical profession from the first year of medical school on up, takes great pains in insuring that the final product is a decent doctor. It is an expectation that physicians and surgeons will adhere to well defined core competencies that places the welfare of the patient first and foremost.
What should you really be worried about? It is not the few rotten apples out there that should keep you up at night. Rather, errors in medical decision making among otherwise empathetic doctors should give you tachycardia. An ER physician correctly sutures a dozen folks with superficial cuts, astutely diagnosed an atypical coronary event in a diabetic, fabulously made the call on an acute appendicitis with periumbilical rather than right lower quadrant pain but sadly misdiagnosed the subarachnoid bleed towards the end of his/her shift. That ER doctor was not malicious as the surgeon described in the opening thread. Physician mistakes happen all the time. A sleep deprived Radiologist who has to read a 100+ chest X-rays may miss that one film with that faint apical lung mass. He/she wasn’t purposely missing the diagnosis. Our goal for trainees is to prevent these sorts of mistakes including during extenuating circumstances. But, we live in an age when bean counters mandate that physicians see an inhumanly number of patients per day or who value procedures over patient care. Physicians these days fill out more forms and are forced to spend less and less time with each patient. And this is all in the name of satisfying a bureaucrat in Medicare or at BlueCross/BlueShield. Is it any wonder that Beverly Crusher will make a mistake or two these days?
Leaving aside the question of whether or the story was or was not a fiction, it is clear that the author regarded the patient subject to this “test” as a thing. The patient was a in the eyes of the writer a mere object to be worked whose consent or lack thereof is an irrelevancy compared to being used as a object to perform a test on.
Thus the author of the piece is blithely unconcerned about the patient except in so far as the patient serves as a thing to use for a test. Has this person heard about basic medical ethics. It is a absolutely standard rule that a Doctor only performs medical procedures on a patient that the patient gives informed consent to. This is called informed consent. The only exception to this is procedures that are necessary to save a patients life and even there a patient can refuse ahead of time certain life saving procedures.
A “cut” designed to test a trainee Doctor is not an emergency and would require the informed consent of the patient ahead of time. Otherwise it is indeed assault. It is obvious that this person has a highly instrumental attitude towards her patients and does not see them as fully sapient beings whose consent is required before such “tests” can be allowed.
The Vicar (via Freethoughtblogs) says
Incidentally: there really is pressure on doctors not to whistleblow on other doctors. It’s not just a thing that is impressed into them in medical school. In the late Harold Klawans’ autobiographical book Trials of an Expert Witness (highly recommended, by the way), he agreed to appear against a doctor who put a pregnant patient with hyperemesis gravidarum (severe vomiting during pregnancy) on a non-saline IV, instructed the nurses to keep it going, and then went out to play golf and went home without ever updating the orders. The patient developed brain damage because of the lack of electrolytes and ended up with locked-in syndrome.
Sound like a Mafia-style proceeding? A friend of mine in college was the son of a chemist who worked for one of the Great Big Drug Companies doing research on new drugs. When he was in junior high, their most profitable patent was about to expire and they were desperately seeking new drugs to patent. His parent was involved in this search, and one day their team discovered a potentially-fatal flaw in the major candidate for Next Big Thing. The company sent a bunch of thugs to keep them at the company until they signed, basically, a gag order. This went on for 18 hours. My friend’s family had actually been calling around in a panic to see if they had been in an accident when they called home at last after giving in and signing.
(The book, incidentally, also goes on to reveal that American hospitals, at least at that time, were not required to and generally did not notify anyone if a surgeon was refused surgical privileges on the grounds of repeated mayhem. Surgeons would get sued repeatedly over botched surgery until the hospital would kick ’em out, and then go on to another hospital and repeat.)
I have to agree with Josh, Official SpokesGay at #56: I don’t believe in the slightest that this was a fiction. It seems much more probable that either the author realized the implications of what she had written, or else was contacted by someone in the field and told to shut up.
The Vicar (via Freethoughtblogs) says
@44, Raging Bee
It can be backed up — to an extent. Which is to say: there are apparently many more psychopaths among surgeons than the population at large, but they do not make up the “worst” group and the percentage of psychopathic surgeons is still very much a minority. Both lawyers and salespeople are more likely to be psychopaths, and CEOs — frequently being drawn from the ranks of lawyers and salespeople — are unsurprisingly the most likely.
Yeah, she is obviously lying about the “fiction”. Exhibit 1097: Watch her Twitter feed over the last day!
Hope Amantine @HopeAmantine
Retyped, in Chronological order. My notes are in brackets.
See the trajectory?
1. Justify the actions and the use of a human subject.
2. Adamantly clarify that she wasn’t the one who made the cut, subtly acknowledging that it wasn’t something she wouldn’t to take the blame for.
3. Begins to emphasize more that she does not condone what the other surgeon did and at the same time still dismisses any possible dangers that could have arisen, because nothing bad happened so therefore everything was justified.
4. Nevermind, it was all fake, sorry you were all offended, you uppity, credulous peoples.
Obvious backtracking is obvious. I hope someone is taking screenshots in the event that she tries to flush all of this down the memory hole.
Per that article, CEO is the most sociopathic profession, and the rate is 4%. So 24/25 CEO’s are not sociopaths, and all the other top 10 have even more non sociopaths than that.
Not to mention, the change in tenor. The author (book and/or Twitter post) goes from making robust, first person statements to those putting the act at arms length:
…and having passive verbs; the story devolving to “it”:
apologizes for your bad reaction!
All the markers of a lie. Maybe someone realized a certain level of culpability would be coming down the road.
It was bullshit from start to finish but she was hoping to pass it off as genuine (just for the shock effect) but when the shit hit the fan she admitted it was fiction and pretended it was never meant to be taken seriously in the first place. Egotistical dickheads often get themselves into these situations and the escape route is always the same: “I was only joking. You didn’t think I was serious did you?“
Jim Etchison says
Am I the only person who sees the word “dissection” and thus assumes this is not attempted murder?
I get the feeling that the reason she’s now backpedaling and claiming it’s all fiction is that somebody pointed out that she has opened herself up to an ethics violation at least. If the patient was not informed of this “teachable moment” afterward, he now has (as mentioned in #65) a scar in his vena cava that will need to be monitored but the patient knows nothing about.
Plus, anybody who had surgery at the hospital she was at during the time that she was an intern will now have cause to investigate if any other such “teachable moments” were carried out on them.
This has “massive lawsuit” written all over it from the doctors to the hospital to her. No wonder she’s trying to say it didn’t really happen.
To that end, given the informed consent paperwork that must be signed before surgery, I wonder how difficult it would be to have an addendum added that explicitly calls out liability should someone try this. That is, having served on a medical malpractice jury, you want the surgeon to have the freedom to do the expected job, take care of any complications that arise, and be able to alter the predicted plan when they get in there and see that things aren’t quite what was expected, but directly introducing a complication such as turning off the oxygen to see if the anesthesiologist is paying attention or cutting something that isn’t part of the procedure will be cause for damages.
That’d require that the procedure be recorded from beginning to end and made available immediately to the patient with no delay.
And I don’t doubt for a minute that no hospital would allow it.
Nate Carr says
Rowan Vet-Tech pointed out at #22 that “dissection” here is a term of art.
@75, Jim Etchison: As other posters have pointed out, “dissection” in surgery doesn’t refer to the alive/dead state of the person being operated on but rather to the process of separating one tissue from another. That is, in order to get to the vena cava, you have to get through all the other tissue surrounding it. That process is known as “dissection.” You often practice dissection on dead organisms because any mistakes you make in your dissection will not be fatal since the organism is already dead. But dissection, for example, is separating the skin from the muscle.
This in another bit of data to add to my contention that most doctors are not terribly brilliant, they are just willing to work harder than anyone else. Medical school is designed to push so much information on the students that it is physically impossible to learn it all. So the students have a choice, figure out what is really important and concentrate on that or work more than most people would consider possible (roughly 20 hours a day, every single day classes are in session). The ones who take the latter course (a majority, I am sorry to say) are often rather odd people who are pretty damned naive.
This doctor told a story that described the assault of a helpless patient by a surgeon and didn’t seem to expect that people would be outraged both by the event itself and the failure of everyone there to report it. In some ways, it almost doesn’t matter which time she was lying, the original story or the claim that it was fiction. How could she not have known how people would view such a story? Her reaction to the reaction is pitiful. And as others have said, whether the original story was true or not, I would not want her to be my doctor. She might possibly be a technically competent surgeon, but she is most definitely not a competent human being.
I’m not saying it’s likely true but I think this is quite plausible. Someone may simply make up a story because it’s just a good story and this is definitely a good story (horrifying, but a good tale). It is very troubling for two reasons, however:
Because every indication is that she is passing the story as true. This was never portrayed as a mere fiction(not at her blog and not at KevinMD three weeks later). The other reason this is extremely troubling is that her writing (as well as her comments) is clearly portraying this incident as exemplifying how a surgeon should be and what should be entailed in surgical pedagogy.
It would be a little bit as if someone wrote about some incident that one time at this neonazi meeting they once attended and then defended neonazi ideals in the comments. If this person later claimed that the account about the incident at the neonazi meeting was fictional I would still be troubled about their defense of neonazi ideals.
Yeah, this never happened. All the people saying it’s plausible have clearly never worked in a teaching hospital.
To expand, every single thing that happened in surgery has to be charted. There’s no way this would happen because there’s now way an unnecessary cut to a major artery would be charted without triggering major institutional review. And if it intentionally *wasn’t* charted, that’s the type of fraud/malpractice that ends careers- remember there are 8-10 people in the room for this type of surgery, not just the surgeon and the attending.
I think the other wrote this to get attention and shock people, then realized just *how* bad it was, and then added the ‘fiction all along’ disclaimer. But this simply did not and could not have happened.
Excluded Layman says
Just because it says that on the tin, amblingon, doesn’t mean that’s what’s inside. Rules on paper are meaningless, it’s the culture of the enforcers that defines the system.
Not to mention the gaslighting effect of authority on ethical choices; but that’s okay, please continue.
Rowan vet-tech says
Saying that couldn’t happen at a teaching hospital is like saying that cops couldn’t rape someone because of procedures, which is patently untrue. Or to be less hyperbolic, that’s like saying cops would never falsify a report. The surgeon might also try modifying the story of the situation and what happened (“It was an accident”, “It was very very small”), or putting the blame on someone else (“The student did it”, “Someone bumped me while I was in there”)…
I tried to post a comment earlier today on the author’s blog.
I got a notice saying that the comment would appear after approval (which is perfectly reasonable).
Just a few minute ago, I checked back, and the blog (not just that post, but the whole blog) has been removed:
(I’m not suggesting my comment had anything to do with it.)
And the apology at kevinmd.com has been re-worded:
Rowan vet-tech says
That disclaimer needs to be at the top. And the title of the article needs to be changed.
I cry bullshit. She’s gotten herself into deep shit, which is why she’s removed her blog entirely.
Tony! The Queer Shoop says
Sooo, I was going to Google screaming rabbits, but I think I’ll just not.
One inch ~ 2.5cm, yes? I find it very hard to believe that a surgeon, in an OT full of nurses, trainees, students, anaesthetists etc. would be able, or allowed, to purposefully cut a 2.5cm hole into the major abdominal vein. That’s not a small nick, and it is not something you can stitch up in a hurry. It would need a patch being sutured in, clamping of the vessel on both ends, it would be 1-2 hours of operating time to remedy this. A very unlikely scenario at best.
Yup, it’s happened already as keiththompson just discovered.
I made sure the Wayback machine would make a capture earlier today (including comments). However, if one really wants it gone, they can request removal (I believe the Food Babe has resorted to this before –unless Archive.org enforces robots.txt retroactively). Someone should make a capture.
I forgot to link the capture:
Leo T. says
I made a secondary capture of the Archive.org one, just in case. (And yes, Archive.org does enforce robots.txt instructions retroactively.)
Beatrice, an amateur cynic looking for a happy thought says
Thank you for your perspective. It’s scary that people who hold others’ health and lives in their hands are forced to work far beyond exhaustion.
This sounds plausible. Especially with rorschach’s comment about what would happen with a cut of such size. (although, the cut could have gotten a bit bigger in her retelling no matter if the story was fictional or not. Big fish can get bigger no matter if you caught a sardine or nothing.)
This surgeon has been hilariously regaling medical colleagues for years with this story. And they’ve been swapping their own team-bonding stories of “how we all survived training”.
And now, conveniently and suddenly, it’s a fiction with no teachable point at all.
I have no doubt that her gender played a part in being subjected to this potentially-lethal prank. But regardless of that, this surgeon’s moral compass has gone unchallenged for years. And she’s actively writing an article to perpetuate this shitty set of ethics.
I have no sympathy if Hope Amantine loses her license for protecting this oh-so-fictional surgeon. She’s not the only one who should, but even one scalp would be a warning to other sociopath med students.
The story is fictional.
It says so at the bottom of the article.
Thumper: Who Presents Boxes Which Are Not Opened says
The word “dissection” is throwing me a bit. Are we sure this was a live patient? I suppose technically it merely refers to cutting something open to see the inside, but I always associate the word with dead bodies.
Assuming it was a live patient, I haven’t really got anything more coherent than a massive “What the fuck?!”, shouted at full volume. That is so incredibly irresponsible I can’t even words.
I’m not sure psychopathy is the right word. I imagine that being a surgeon necessarily involves some level of dehumanizing the patient, else most people would have real difficulty cutting them up, but I’m not sure that necessarily entails an inability to empathise.
And not only has the blog vanished, but so has the twitter handle.
#96: that was only added after people on Twitter started discussing the possibility of finding out who did this, when and where. Before that, the author was defending the perpetrator, talking about how it was a defining moment in her surgical training, and giving no indication that it wasn’t true. She’s also now deleted her twitter account and the original blog. This looks like fear of consequences, not embarrassment about being caught lying.
throwaway, butcher of tongues, mauler of metaphor says
I positively believe that you believe that’s the case.
Update 9/7/2015: Previous credulity about the believable nature of the credulity of another person was not meant to be taken as an actual belief. I apologize if anyone interpreted my clear remarks otherwise and took offense.
One tweet, with some comments, can be found here. Sadly, I didn’t think to archive any of the earlier tweets, where she was discussing the story as if completely genuine. One of the comments at the link quote an earlier tweet, though.
@62 (Amphiox): I think you are mistaken in several respects. (BTW, “no harm no foul” is a rule I’ve never heard of, and I’ve been doing med mal cases for a long time. Perhaps it is in certain parts of the country where people do law with their left foot, but it certainly isn’t a hornbook principle.)
To begin with, what the attending did was absolutely a departure. The extent of the plaintiff’s subsequent recovery does not affect that part of the malpractice formula. The second the doctor does something that falls outside the standard of care — boom, departure. The only thing that’s left is to assess the damages proximally caused by it. And that’s just it — the “rule” you refer to, even if it exists somewhere, goes only to the issue of damages — but you are mistaken on that point as well.
Note that medical malpractice law doesn’t require permanency. The patient’s good recovery should certainly be exploited by the defense attorney to minimize exposure — but it won’t eliminate the damages altogether. Having to undergo an unnecessary surgical procedure counts as harm. Having to have subsequent treatment for resulting complications is also harm, even if the patient makes a spectacular recovery in the end.
The only time the whole “no damages” argument holds any water is when you can show that the horrible outcome at issue — death, amputation, brain damage, bed sores, loss of pregnancy, etc — was unavoidable in any event. But that’s more of a causation issue rather than a true “no harm” situation. Theoretically, there is also the idea that the physician may “correct” or reverse his malpractice, but I’ve never seen this in real life without additional pain and suffering for the patient, which, of course, gives rise to liability. The argument is a total non-starter, in any event, if what you are trying to say is that, because the patient is okay NOW, the past harm doesn’t count.
Quick totally off-topic note to Amused: I just clicked on your blog and am loving your writing! Only read the Scalia and hateful humor ones so far but they’re both great, especially the Scalia one. And I like your inclusion of art.
However, malpractice is actually a very specific legal term
General advice to doctors, from a lawyer: Doctors should not try to play lawyer. Most of you are very bad at it. The events described were not only malpractice, they were potentially criminal battery. The fact that the doctor reporting the battery didn’t actually cut the patient’s vena cava is not really much of a defense. Helping cover the battery up is being an accessory after the fact, which is also a crime.
Doctors: At the very least go talk to actual lawyers before you opine on legal matters. Better yet, don’t opine on legal matters and reveal on the internet that you have engaged in a criminal conspiracy.
“That’s not a small nick, and it is not something you can stitch up in a hurry. It would need a patch being sutured in, clamping of the vessel on both ends, it would be 1-2 hours of operating time to remedy this. A very unlikely scenario at best.”
Holy fucking shit. With my “memory hole” prediction I wasn’t quite anticipating Hope Amantine to take the “DELETE FUCKING EVERYTHING!!!!” route. Damn. As if the things she said weren’t enough, the piss poor backtrack and then the frantic, ridiculous coverup really does make this all even more suspicious. I believe that these tactics will mean that Streisand will soon be in Effect. Twitter and blog are gone, I imagine she will try to get the post removed from KevinMD.
As of right now:
The major google results I am finding about Hope Amantine show that Forbes has covered the story and chastised Hope regarding honesty. Orac has also covered the story.
And as I find this and follow links on another article in the google results, I find that I continue to be psychic:
Hope Amantine had previously contributed several posts from her personal blog to the KevinMD website: http://www.kevinmd.com/blog/post-author/hope-amantine
I found that the comment thread via disqus is still available for the KevinMD post. (I then checked to see if the article was still there, and it looks like it hasn’t actually been removed yet)
So, before that is baleeted too, here is MOAR quotes of Hope Amantine, singing the praises of her allegedly fictional scenario:
The disheartening thing is that KevinMD, several commenters on that site, and the Forbes article seem to at least somewhat buy the “it was fictional” account and seem largely focused with the dishonesty of that. Which is in an issue, if the fiction story were true. But….really. Every piece of evidence seems to simply scream out against that excuse. It is just infinitely more plausible that she is simply lying about lying. Deleting articles for her in the name of your credibility is just helping her wipe away evidence. I don’t get it.
@103 (Saad): Thanks! :)
Here in the northeastern US (I forget just where, but I think in Connecticut), far fewer than 10 years ago, the same thing happened. I have no doubt it still does. —Okay, my first hit with a Google search for “Yale”, “hospital”, and “pelvic examinations” turned up this from the Women’s Health Collective (the page and the first, visible, page of the pay-walled linked article don’t have “Yale” in them; I wish I could set Google so that ‘verbatim’ would be the default). Yes, it still does. “Consent”? What’s that supposed to mean?
Thanks for the clarification. I should have been more clear when I wrote “protected from malpractice” that this referred to the size of the settlement – ie the amount of the settlement is determined based on harm done to the patient, and if harm was minimal then the settlement amount would be minimal. It has no bearing on findings or admissions of fault.
What I wrote in #62 was my interpretation of what was directly told to me by a malpractice attorney, but it is likely that I did not fully understand everything that was said, or the context in which it was said.
Dark Jaguar says
PZ, I’ve heard a rabbit scream. It was my fault. As a kid we were playing with a rabbit and it fell down the stairs. I never even knew they could scream until that moment when it broke it’s back. It died a few days later. You’re right, I never want to hear that sound again.
Some other bloggers have written about it as well. Orac is a surgeon, and said that the story “rang true “to him and he could see an arrogant surgeon doing exactly that.
John Horstman says
I don’t know that her (possibly fictional) teacher is a psychopath, but the author of that story sure sounds like one, especially given the Twitter responses.
That said, I would very much prefer that anyone operating on my insides not be at all burdened by empathy – I imagine that would be very distracting, as empathizing with someone with an injury or illness lying unconscious and being sliced up would cause the empathizer to mirror pain and anguish (which would probably dissuade people with strong senses of empathy from ever becoming surgeons in the first place – I would expect a substantial overrepresentation of people with below-average empathy responses to be working in fields like surgery, forensic pathology, and mortuary services). I would hope that they would still be dedicated to a professional code of ethics that would appropriately bound their behavior; empathy is not the only basis for ethics.