I will never forget a conversation I had with one attending physician, supervising me as I fumbled my way through my first medical history and physical examination. "Never forget," he began, "human beings are at their most vulnerable when they go to the doctor."
He urged me to think about what happens when patients seek medical help: They disrobe in front of a perfect stranger, attempt to give the doctor clues as to what ails them, all the while being scared to death they will be told something that will forever change their life. When the patient is under anesthesia, this vulnerability is taken to an even higher level, as all control is ceded to the surgical and anesthesia team. He reiterated that there is no other profession in the world like this. That which is told you in private is the most serious of trusts. "You betray it at your own peril — and your patient’s," he warned that day.
His words rushed back to me recently as I read on the Internet of two headline-grabbing instances where doctors appeared to have deeply violated patient trust. Last week, a Philippine hospital recommended possible dismissal of a group of surgeons and a nurse whose rowdy, unprofessional behavior while removing an object from the rectum of a patient was posted on a video on YouTube. The video, seen by millions, showed doctors and nurses laughing and cheering, and someone shouting "Baby out!" And back in December, a Phoenix surgeon photographed a patient's tattooed penis with a cell phone while the patient was undergoing gallbladder surgery.
These were not cases of doctors “snapping” from pressure or exhaustion. These episodes were careless and stupid, may have been illegal, and at the very least reflected a blatant and cruel disregard for patient privacy.
More than 3,000 years ago, Hippocrates, the father of modern medicine, penned an oath, a variation of which virtually all medical students take upon completing their studies, which established patient privacy as essential to medical practice. "What I may see or hear in the course of the treatment ... I will keep to myself, holding such things shameful to be spoken about.”
While most patients, as part of their operative consent, grant permission to have their pathology photographed as part of the medical record, these photographs had nothing to do with record-keeping, and everything to do with humiliation.
Each step was an outrage: from photographing or filming the patients' body parts to distributing the shots to others (in one instance, around the world via the Internet). Both were a fundamental betrayal of the right to privacy each of us assumes when we go to the doctor.
Betrayal always hurts. But the violation of personal privacy by our doctor when we are at most vulnerable is especially egregious. These events were probably not premeditated, and may not even have been intended as malicious, but they were cruel. They were unethical. And they were so avoidable.
How could this have happened? The operating room environment is unique. To maintain sterility, the exposed part to be “worked on” is isolated by a series of drapes from the rest of the body. This may have the effect of temporarily depersonalizing the patient. In fact, to get done what we need to get done, temporarily depersonalization may be advantageous, permitting the surgeon to concentrate on the task at hand. The pressures of surgery are felt by everyone in the room, and there's often a collective levity when the operation is over.
This environment and some doctor's desire to show off may have combined to result in such flagrantly thoughtless behavior. This does not excuse it. It just may explain how such a painful violation of the patient-doctor trust could happen.
Offensive episodes such as these, when bracketed by stories of physicians prescribing illegal drugs such as steroids, have the potential to contribute to public cynicism about physician behavior. But episodes of “doctors behaving badly,” are not on the increase.
There have always been people who, without stopping to consider consequences, do dumb and even harmful things. Yes, these events were awful. Yes, the doctors should be punished. But the vast majority of the doctors I know greatly respect and value the trust you have placed in our hands.
Dr. Edward V. Craig is Attending Surgeon at the Hospital for Special Surgery in New York City and Professor of Clinical Orthopedic Surgery at Cornell Medical School.