That story about an arrogant surgeon? It’s gone. Totally deleted.
Of note, “Hope” has since deleted her blog and Twitter account.
After consideration of your feedback on Twitter, consultation with the MedPage Today editorial team, and analysis by “Orac” at Respectful Insolance, and Peter Lipson and Janet D. Stemwedel at Forbes, I have removed the story from the website.
Whoa. That’s not a good response to what ought to be a “teaching moment”.
I expect this will be covered at Retraction Watch (who actually have a budget, and an M.D. in the house, to boot).
According to the linked page, it was not clear that the story was fact or fiction, and the original author’s response did not clear up the confusion.
It was either fact or a lie. It was never intended as fiction. I think it was fact.
Ultimately, I don’t think it matters in the long run whether the story was fact or fiction. Both in the story itself and in the comments defending it, the author displayed an astounding lack of respect for patients’ autonomy, the delicate nature of the doctor-patient relationship and the inviolability of the patient’s body; as well as no understanding whatsoever of what constitutes medical malpractice or (even more disturbingly) a violent crime. Her mindset makes her dangerous to patients. I sincerely hope her doctorhood is fictional, too.
It is also disturbing that she clearly presented something that she later said was fiction as fact, and defended it as such in the comments. Whether this really happened and she later said it didn’t to cover her hide, or she invented the story from the beginning, she’s a liar.
As I just recently mentioned (among other things) in the original thread, the article is still actually accessible right now, for whatever reason: http://www.kevinmd.com/blog/2015/07/a-lesson-in-the-or-that-prepared-this-doctor-to-be-a-surgeon.html
Despite saying it was removed, it looks like it either hasn’t been removed yet, wasn’t removed successfully, or (unlikely) the removal was reversed.
Saad is right, and she was right on the other thread. It’s obvious “Hope Amantine” told that story as fact, meant to tell it as fact, used it as fact to illustrate a point about her training the real world of medicine, and then lied about it being fact. Spend exactly ZERO minutes trying to find a way that this could be a misunderstanding. It’s not. It’s plain old lying to cover up the fact that one got caught promoting something horrendous that one should have known better than to endorse.
Oh also? “Hope Amantine” can delete her Twitter and her blog, but her identity as a surgeon will be found out, and soon.
Saad@3:
The alacrity with which the story was removed suggests that the KevinMD editors were strongly motivated to remove it, which in turn suggests that they feared litigation, which in turn suggests that someone gave them reason to believe that the story’s felonious mentor-surgeon (surely gratuitously cutting a medically/surgically unnecessary hole anywhere in a patient, much less an inch-wide hole in a patient’s heart, is felony assault) exists and could be identified. That cascade of suggestions is enough to convince me that, indeed, “It was never intended as fiction.” Then I conclude (as you have, by whatever process) that it was more likely to be fact than a lie, because if it were a lie (about an identifiable person) then the author would have to be astoundingly reckless to publish it. I admit that there are many astoundingly reckless people, some of them authors; but I think that the proportion of authors who are astoundingly reckless is much smaller than the proportion of editors and publishers who are astoundingly pusillanimous. My money’s on “fact”.
I don’t think you guys understand what an inch-long cut in a major vein close to the heart would do. For one thing, it wouldn’t stay an inch long for even a second. As described, the story is just utterly implausible.
That’s not even addressing the scar tissue that would be left behind, which *absolutely would have to be charted.* Yes, I understand that institutional policy can be ignored and there are all kinds of examples of doctors behaving badly, but I think a lot of the commentators are vastly underestimating how massive a coverup this would have to be.
One plausible explanation is that this is a heavily exaggerated version of something that really did happen. But there’s simply no way someone made a 2.6 cm incision on the vena cava and kept it totally secret.
Another plausible explanation is that it *was* reported, but the doctor flagged it as an error. The problem is that an error of this magnitude would be a potential career-ruiner in a lot of cases, and even if it wasn’t would end up being reported to the patient and likely result in a lawsuit. Hospital administrators tend to be pretty risk-averse, and trying to cover things like this up is actually way riskier than the alternative.
Another plausible explanation is that it never happened, but its a story that’s been floating around her social circle for a long time and she formalized it. There are lots of similar apocryphal stories regarding insane attendings that get passed around my social circle, all of which happened to a friends-friends-friend.
amblingon, #10
Good points. My money is on your first explanation that it’s exaggerated. I find it impossible to believe that it was fictional based on many factors:
– the title makes it pretty clear it’s fact. It makes absolutely no sense to create a fictional scenario and titling it: “This event prepared me to be a surgeon” while admitting it’s fiction. It’s like if the real-life actor Mark Hamill reveals his hand is amputated but wants us to believe Darth Vader did it.
– when you read the whole thing, there isn’t even the slightest subtle hint that she intended it as fiction
– the fiction disclaimer only came after people started criticizing her
– her extreme overreaction of deleting and closing everything
Josh, #6
I’m actually a man. :)
…I sincerely hope her doctorhood is fictional, too.
I sincerely suspect that, like her original story, her doctorhood will BECOME fictional.
Despite saying it was removed, it looks like it either hasn’t been removed yet, wasn’t removed successfully, or (unlikely) the removal was reversed.
So now the story of the fact-that-became-fiction being removed is now fiction? The plot thickens…
It’s like if the real-life actor Mark Hamill reveals his hand is amputated but wants us to believe Darth Vader did it.
Well, there’s three more “Star Wars” movies coming up that need plots, so I guess that one will do…
Saad—thank you for correcting me:)
It’s like if the real-life actor Mark Hamill reveals his hand is amputated but wants us to believe Darth Vader did it.
Ha, that’s awesome. Gonna save this line for future use.
I’m not following here. It should’ve been reported, even if it was a 0.1 cm incision or if there was any incision at all, for any reason at all.
If that’s the case, it’s still presented as if the moral of the story is that this sort of thing is how surgeons should/need to learn their craft: keep them on their toes so they can save lives in circumstances when you’re not deliberately making things worse (also, don’t really give a fuck about the person under the knife). Any doctor presenting that, with not even a whiff of disapproval, is somebody who needs to be investigated anyway, whether or not the story is factual or autobiographical. The clearest message is that this is how they think things ought to work, which of course they’re free to simply express, but expressing such sentiments is a huge red flag that they’ve acted on this belief at some time, given that this is their job. (Perhaps not acting in exactly the way the story depicts, but that’s neither here nor there.) Then, the response we see, to less-than-mild criticisms that this isn’t good but is actually criminal … that doesn’t look like a very good sign either.
I’m not sure if the writer was using her real name, but if the writer’s real life identity is revealed (likely not difficult in either case), then it would be a trivial matter to find out her training history (a matter of public record) to find out where and when she did her residency, and who the attendings who would have been training her would have been.
This would not be a big community. It can probably be narrowed down to just a handful of surgeons, if not outright identified to a single one.
In which case her story constitutes a direct accusation of assault with deadly weapon. If a story or a lie, then this is defamation. Even if true, she may well have trouble proving it, if that attending launched a defamation suite against her.
The removal of the story may well be motivated by such concerns, if not outright legal advice she has since obtained.
Actually, there wouldn’t be much scar tissue left behind. The repair of a 2.5 cm laceration of the IVC would, when healed, be barely visible except for the vascular sutures and knots on the exterior of the vessel. That’s not to say it’s a benign thing to put a hole in a major vein and repair it. The interior surface would be left with some irregularity in the area of the repair or even a stenosis, which could serve as a nidus for clot formation and thus increase the risk of pulmonary embolus.
One correction. The area of the repair was nowhere near the heart. Dr. Amantine was discussing the repair of an abdominal aortic aneurysm, which is, of course, in the abdominal aorta. That means that everything being worked on is on the other side of the diaphragm. Also, just because a 2.5 cm laceration is in a large vein doesn’t mean that it will inevitably rapidly get bigger. Most don’t, actually, because veins are low pressure flow systems, particularly compared to arteries.
I’m glad to hear the story was fake. I should have taken the story with a grain of salt I suppose. I’m still angry about how it was portrayed, but I’ll know to question these things a bit more in the future.
Dark Jaguar. . . why do you believe that you’ve learned “the story is fake”?
As far as I’m concerned, the veracity of the story is still a big, fat question mark. I’m certainly not going to take the author’s word for it.
I can imagine two scenarios here:
1. The story as presented is more or less the author’s experience. She backed off of claiming it as real when she got the backlash.
2. The story is an urban legend from the hospital that she trained at that is passed from resident to resident over the years. “Did you hear what Attending Surgeon X did once? He ripped a hole in a patient’s IVC just to make the resident clean it up.” and the surgeon claimed it for her own personal experience but backed off when confronted with the backlash.
I see no way that this could be intentional fiction from the first. I am certain that it was intended to be taken as fact, whether it was or not.
I also found the claim that the act was justified or at least ok because residents need to learn bizarre. Just how low volume was the place she trained that she didn’t get lots of experience treating IVC tears (not to mention tears in every other organ known) without an artificially induced situation? If there really is a program where the surgical residents are in danger of getting that little experience then it needs to be shut down.
It’s not true unless there was a trial and conviction.
Orac is a surgeon, and in his comments about it he said that the story “rang true “to him and he could see an arrogant surgeon doing exactly that. (cross posted from the other thread about the same topic)
I don’t think the lesson was supposed to be treating IVC tears or even how to handle an emergency. I think it was to disabuse a student of the notion she can afford the luxury of assuming she can have control of a medical situation. Or in other words, a sadistic instructor knocking a student down a peg because … well, students get uppity if you don’t, don’t they?
I’m inclined to believe this is a big fish story. I can believe an instructor might do this, and I can believe a hospital would simply downplay or deny it. But I’d like to believe at least one student in shocked conversation in another might have mentioned concern of the ethics. Either way she’s a back-pedalling coward.
It seems to me that the surgeon in question was taking a leaf from the flight instructors’ book, where it is not only normal, but required that a learner pilot demonstrate that they can handle a plane when its engine is shut off by the instructor. The surgeon might even have a pilot’s licence and picked up the idea in training. Creating an emergency situation is an excellent safety training principle in many fields, but completely indefensible as a medical training using a live person. That’s what simulation centres are for.
Actually, I think this has turned into an excellent teaching moment — just not in the way the surgeon intended.
There is actually a third possibility, somewhere between ‘truth’ and ‘fiction’: it could be that it was a story that she heard, and claimed as ‘her own’. When I was training at CMA to be a marine engineer, there were a number of stories that were, in many ways, very similar. The most similar was a story about one of our faculty members who, frustrated with a lack of seriousness during our weekly drills, jumped overboard to force the students to respond correctly. I do not know if that story was true – if so, it violates a couple laws and a ton of ethical concerns – but it was told to me by several people who swore they were there. And I heard seniors who I knew where not there (for I had been with them on their training cruises) repeat the story to a fresh batch of freshmen, swearing they were there, themselves. It didn’t matter to them that they weren’t. They believed the story. That was enough to make it ‘true’ in their minds – true enough to claim as their own.
It sounds like an urban legend relevant to surgical residencies which she tried to pass off as personal experience.
My dad a million years ago told the military version of this kind of story, where everyone knew a crusty old sergeant who threw himself on a live hand-grenade that a nervous trainee had dropped.
Well of course I don’t need a trial and conviction to be convinced of something, but perhaps a little more than an already questionable writer isn’t too much to ask for, yes? Should we be SO quick to believe stories like this? Has snopes.com taught us nothing?