Surgeons reflect on 'disgusting' scandals in OP room

[summer]

LA Times


A man stroked the inner thighs and genitals of a woman who lay unconscious on a table. “I bet she's enjoying this,” he said with a wink and a laugh.



The scenario would be disturbing under any circumstances, but even more so when you know this: The man was a surgeon, and the woman was the patient he was prepping for a vaginal hysterectomy.



Though the doctor's actions were a necessary part of prepping for the procedure — cleansing and scrubbing with cotton balls — his astonishing comment while doing so was seared into the brain of a medical student who was in the operating room.



The student's recounting of the event appeared this week in the pages of the prestigious Annals of Internal Medicine, in an article written by his medical school instructor.



Why would the journal's editors choose to publicize this unsavory view into the secret lives of doctors?




At first, they weren't sure they should. When the essay describing the incident came before them, the debate about whether to publish it became so heated that they had to table their decision for a week until emotions had cooled.



“We all agreed that the piece was disgusting and scandalous and could damage the profession's reputation,” they explained in an editorial that accompanied the provocative essay. “Some believed that this was reason not to publish the story. Others believed that it was precisely why we should publish it.”



The tale of the woman who came in for a hysterectomy and wound up being victimized by her surgeon is only the start of the essay, titled “Our Family Secrets.”





The anonymous author — who changed the names of everyone he described — said the issue came up while he was leading a medical humanities class. The topic had been the “virtue of forgiveness,” he explained, and he had asked his fourth-year medical students whether their training had exposed them to anything unforgivable.



After the student's painful admission that he felt pressured to laugh at the surgeon's crude behavior — “What was I supposed to do?” he asked — the author decided to come clean about an event from his own med school days.



The author was on an OB-GYN rotation and had just delivered a baby girl. Then the mother, a Latina, began bleeding uncontrollably.



A resident dubbed “Dr. Canby” took charge and diagnosed the condition as uterine atony, a complication in which the muscles of the uterus fail to contract after delivery.



After an anesthesiologist arrived and administered ketamine, the resident massaged the patient's uterus with his right hand on her abdomen and his left hand inside her body. A few minutes later, the bleeding stopped.



See the most-read stories in Science this hour >>

“The guy saved her life,” the essay author told his students. “I was blown away.”



Here's what happened next, as he recounted in his essay:



“Dr. Canby raises his right hand into the air. He starts to sing ‘La Cucaracha.' He sings, ‘La cucaracha, la cucaracha, dada, dada, dada-daaa.' It looks like he is dancing with her. He stomps his feet, twists his body, and waves his right arm above his head.



“All the while, he holds her, his whole hand still inside her vagina. He starts laughing. He keeps dancing. And then he looks at me. I begin to sway to his beat. My feet shuffle. I hum and laugh along with him. Moments later, the anesthesiologist yells, ‘Knock it off, assholes!' And we stop.”




The journal editors said they had no idea how frequently physicians treat their patients this way, or how often young doctors or medical students feel compelled to go along with the boorish behavior of their superiors. But they said most doctors catch a colleague behaving disrespectfully toward a patient at least once in their career.



Their hope is that after reading the essay, more doctors will find the strength to do the right thing — for themselves and their patients.



“We all need the strength to act like the anesthesiologist in this story and call our colleagues ‘assholes' when that label is appropriate,” the editors wrote.



Doctors and patients have responded with a range of emotions.



Some have praised the journal for bringing an uncomfortable issue out of the shadows and into the light. They said the anecdotes — while extreme — fit a troubling pattern of doctors failing to take their female patients seriously.


“As a family physician, I hear stories weekly of physicians who discount the lived experiences of women,” Dr. Elizabeth Allemann, who has a practice in Columbia, Mo., wrote on the Annals website. “We can do better. This will help. Thank you.”



Another commenter, who said she was a retired primary care physician, said she was surprised that people still buy into the “myth” that doctors are tantamount to saints.



“Why is it so shocking that doctors are just as prone to sociopathy and criminality as any other group in which vulnerable people are forced to place their trust?” wrote Dr. Munita Singh. “Perhaps the era of protecting the ‘profession's reputation' is over. After all, doctors are now being rated alongside restaurant food on marketing apps.”



One person defended the doctors described in the essay who, in his view, were merely trying to defuse high-pressure situations by injecting some levity into the operating room.





“The stress on these professionals is SO great that once in awhile, a little steam MUST be released in order to bring themselves and their teams back into some logical perspective,” wrote Robert J. Pegritz, who described himself as a medical/legal consultant. “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.”



Pegritz continued:



“Respect and integrity are not lost when a surgeon or P.A. [physician assistant] 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.”

[aurora]

A victory dance is one thing. A very sexual one, with racist tones, is quite another.

[AJL]

“The stress on these professionals is SO great that once in awhile, a little steam MUST be released in order to bring themselves and their teams back into some logical perspective,” wrote Robert J. Pegritz, who described himself as a medical/legal consultant. “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.”


“Respect and integrity are not lost when a surgeon or P.A. [physician assistant] 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.”

[IIOY]

Aug 24, 2015 6:49:29 GMT -5 summer said:

They said the anecdotes — while extreme — fit a troubling pattern of doctors failing to take their female patients seriously.


“As a family physician, I hear stories weekly of physicians who discount the lived experiences of women,” Dr. Elizabeth Allemann, who has a practice in Columbia, Mo., wrote on the Annals website. “We can do better. This will help. Thank you.”



Another commenter, who said she was a retired primary care physician, said she was surprised that people still buy into the “myth” that doctors are tantamount to saints.



“Why is it so shocking that doctors are just as prone to sociopathy and criminality as any other group in which vulnerable people are forced to place their trust?” wrote Dr. Munita Singh. “Perhaps the era of protecting the ‘profession's reputation' is over. 

Yes and yes.

[Deleted]

Aug 24, 2015 7:59:03 GMT -5 kevin arnold said:

Aug 24, 2015 7:51:03 GMT -5 aurora said:

A victory dance is one thing. A very sexual one, with racist tones, is quite another.

A victory dance with his whole hand still inside her vagina, acting like she was a puppet?

No.

Exactly. There are plenty of ways to let loose and be fun natured with your patients in a way that isn't disrespectful or demeaning.

[AJL]

There are plenty of ways to let loose and be fun natured with your patients in a way that isn't disrespectful or demeaning.

Or a complete violation of their body. What he did was more than demeaning. It was abusive. He stripped his patient completely of her humanity. I don't care how hard it is to be a doctor. I don't care how stressful it is to be a surgeon. I'm not expecting saintly behavior. I'm expecting behavior befitting a person with just a shred of humanity and kindness. We're not talking about snooty or cold or indifferent bedside manner. These stories are clearly about surgeons demonstrating a complete lack of acknowledgement that they are treating real, living, feeling HUMAN BEINGS.

I am so angry that anyone can defend this kind of behavior.

[NewOrleans]

Aug 24, 2015 6:49:29 GMT -5 summer said:

“Respect and integrity are not lost when a surgeon or P.A. [physician assistant] 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.”

Look, I am good with the doctor dancing like Uma Thurman or even doing the motherfucking ChaCha Slide in the OR. He just needs to take his hand out of the vagina while he does it.  

[NewOrleans]

“The stress on these professionals is SO great that once in awhile, a little steam MUST be released in order to bring themselves and their teams back into some logical perspective,” wrote Robert J. Pegritz, who described himself as a medical/legal consultant. “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.”

And what is this shit?  No, really, what the living fuck is this? And the patient would be singing with him?  The hell?

[Deleted]

Aug 24, 2015 8:23:51 GMT -5 AJL said:

There are plenty of ways to let loose and be fun natured with your patients in a way that isn't disrespectful or demeaning.

Or a complete violation of their body. What he did was more than demeaning. It was abusive. He stripped his patient completely of her humanity. I don't care how hard it is to be a doctor. I don't care how stressful it is to be a surgeon. I'm not expecting saintly behavior. I'm expecting behavior befitting a person with just a shred of humanity and kindness. We're not talking about snooty or cold or indifferent bedside manner. These stories are clearly about surgeons demonstrating a complete lack of acknowledgement that they are treating real, living, feeling HUMAN BEINGS.

I am so angry that anyone can defend this kind of behavior.

Agreed. Why would anyone go on record to defend this?

[aurora]

Aug 24, 2015 7:59:03 GMT -5 kevin arnold said:

Aug 24, 2015 7:51:03 GMT -5 aurora said:

A victory dance is one thing. A very sexual one, with racist tones, is quite another.

A victory dance with his whole hand still inside her vagina, acting like she was a puppet?

No.

Right. That's exactly my point.

[ESF]

One person defended the doctors described in the essay who, in his view, were merely trying to defuse high-pressure situations by injecting some levity into the operating room.

 If committing an act of sexual assault is your idea of "levity", you are a sick fuck.

[NewOrleans]

Aug 24, 2015 13:36:50 GMT -5 ESF said:

One person defended the doctors described in the essay who, in his view, were merely trying to defuse high-pressure situations by injecting some levity into the operating room.

 If committing an act of sexual assault is your idea of "levity", you are a sick fuck.

Yeah, who was it the other day who said this isn't sexual assault?  Let's get  him/her back in here to explain.

[StrawberryBlondie]

I really really wonder what my BIL and SIL would say in response to this. They've both intimated that they think doctors should never be able to be sued unless they really really intentionally fuck something up. And have made comments about regulars not understanding the pressure of being a doctor.

However, since both are generally not insane and are good people, I like to think they'd be aghast.

[AJL]

Aug 24, 2015 13:38:34 GMT -5 NewOrleans said:

Aug 24, 2015 13:36:50 GMT -5 ESF said:

One person defended the doctors described in the essay who, in his view, were merely trying to defuse high-pressure situations by injecting some levity into the operating room.

 If committing an act of sexual assault is your idea of "levity", you are a sick fuck.

Yeah, who was it the other day who said this isn't sexual assault?  Let's get  him/her back in here to explain.

I wonder if it's the same person who trotted out the old "compassion fatigue" excuse.

[NewOrleans]

Aug 24, 2015 13:43:23 GMT -5 AJL said:

Aug 24, 2015 13:38:34 GMT -5 NewOrleans said:

Yeah, who was it the other day who said this isn't sexual assault?  Let's get  him/her back in here to explain.

I wonder if it's the same person who trotted out the old "compassion fatigue" excuse.

No, I just checked. nikki25, why did you feel these cases are not sexual assault?

[nikki25]

Aug 24, 2015 13:46:10 GMT -5 NewOrleans said:

Aug 24, 2015 13:43:23 GMT -5 AJL said:

I wonder if it's the same person who trotted out the old "compassion fatigue" excuse.

No, I just checked. nikki25, why did you feel these cases are not sexual assault?

To the bolded; no that was definitely not me. 

I don't have enough time to type out in full detail why I believe this is not sexual assault but I will do my best to explain my position.

To be clear, I am making a distinction on why it is not a sexual assault as in a criminal offense with potential significant jail time. Not to be confused with me defending their actions and being accused compassion fatigue defender. Their behavior was fucking disgusting and feel horribly for these women.

Sexual assault in this case wouldn't even apply as defined by the PA Statute as no sexual intercourse was involved:

Subchapter B. Definitions of Offenses



back to top3124.1. Sexual assault



Except as provided in section 3121 (relating to rape) or 3123 (relating to involuntary deviate sexual intercourse), a person commits a felony of the second degree when that person engages in sexual intercourse or deviate sexual intercourse with a complainant without the complainant's consent.

The next closest potential offense would be indecent assault which is defined under the PA Statute as such:

3126. Indecent assault



(a) Offense defined.--A person is guilty of indecent assault if the person has indecent contact with the complainant, causes the complainant to have indecent contact with the person or intentionally causes the complainant to come into contact with seminal fluid, urine or feces for the purpose of arousing sexual desire in the person or the complainant and:

(1) the person does so without the complainant's consent;



(2) the person does so by forcible compulsion;



(3) the person does so by threat of forcible compulsion that would prevent resistance by a person of reasonable resolution;



(4) the complainant is unconscious or the person knows that the complainant is unaware that the indecent contact is occurring;



(5) the person has substantially impaired the complainant's power to appraise or control his or her conduct by administering or employing, without the knowledge of the complainant, drugs, intoxicants or other means for the purpose of preventing resistance;



(6) the complainant suffers from a mental disability which renders the complainant incapable of consent;



(7) the complainant is less than 13 years of age; or



(8) the complainant is less than 16 years of age and the person is four or more years older than the complainant and the complainant and the person are not married to each other.


www.womenslaw.org/statutes_detail.php?statute_id=4205#statute-top

I would argue that both cases are not and should not be defined as indecent sexual assault as there was no sexual element to either case nor did either case have any purpose of obtaining sexual arousal for themselves or the victim.


First, the situation leading up to said assault was a legitimate procedure conducted by a legitimate OBGYN during the course of a consented medical procedure. In the first instance, the doctor was shaving the vagina which is in the course of procedure was necessary to the medical act. Him rubbing her legs while making a rude, extremely inappropriate statement in and of itself does not hold up to the statute and IMO his behavior was completely reprehensible but tactless 'jokes' does not equal sexual assault. 

In the second case, again, the doctor was acting in their medical capacity and the initial insertion was for the purpose of a medical procedure and again, in the capacity of his job. I guess the strongest and really only argument for indecent assault is after the bleeding had ceased and him waving his hand and singing fucked up song. Now, obvs I am no doctor, and as an anecdote I had a very similar bleeding issues with my twins where I hemorrhaged where I needed a blood transfusion and immediate surgery directly after my emergency c-section. My doctor did something similar regarding attempting to contract my uterus until I could return to the ER. The doctor remained, ahem, in there until we reached the ER so from MY experience I didn't find it odd that the doctor didn't immediately retract his hand. 

But, to return to the statute, again, I would argue it does not meet the criteria as again there was no purpose of any sexual gratification involved and he was working a medical capacity and in the correct medical capacity for his professional. 

Listen, many won't agree with my position, that is fine. In the legal terms, this doesn't meet the criteria. Was it fucking inappropriate in every way, absol-fucking-lutely. Should they be reprimanded by the hospital, absol-fucking-lutely. But, making lewd, inappropriate 'jokes' in a course of a valid medical procedure is a far cry from the criminal act of sexual assault or indecent assault. 

This is probably why people hate lawyers. Okay, I am done. 

[ESF]

OMFG.

[cville]

Hey, guess what? I'm a lawyer and I think you're full of it!

[cville]

Aug 25, 2015 21:54:13 GMT -5 toledo said:

And jesus, what would you do to us if you DID "have time to type out in full detail"?

Probably cut and pasted three or four more statutes and then drawn further conclusions based on scant facts, conjecture, and cotton candy. I mean, after three years of law school who ISN'T qualified to make or break a case based on the facts included in an article written about another article.

[NewOrleans]

How do you know his motivations?

[Deleted]

I wonder what consequences these doctors will face legally and professionally? Does anyone work in this area of the law?

I just reviewed some medical ethical legal board review questions yesterday and it reminded me of this article. There were no questions in regards to anything sexual in nature done by a physician with explanations in legal terms, so that made me wonder about the legal ramifications. 

Hopefully they face some consequences. 

[NewOrleans]

asdfjkl would be shitting walls o' text if she were here!

[ESF]

Aug 25, 2015 22:03:31 GMT -5 NewOrleans said:

How do you know his motivations?

Seriously.

It's kind of Law 101 that you will never *know* anyone's subjective motivations, but you infer those things using circumstantial evidence.

And how the fuck can you conclude from this anything other than the fact that he was intending to assault her? Just because he laughed while doing it doesn't convert it into a joke. Normal people should infer from that that he's depraved, not a comedian. I mean really.

[downtoearth]

This is not just morally wrong, but it's unethical for a licensed health professional sworn to knowingly "do know harm". It's way worse than malpractice where something goes wrong that the surgeon/doctor was trying to get right. Plus it's BS that this wasn't sexual assault. nikki25 might be a lawyer, but I also think (as a non lawyer) that the definition of sexual intercourse has been extended from just a penis in a vagina - I'll have to go look, but I'm sure we had this discussion before about the legal definitions being up for interpretation and more encompassing now.

You know who did right by the patients in this article... the anesthesiologist who called the surgeon and student assholes, but I still don't think that was far enough. Can you imagine the lawsuit if he would have let the patient know what happened?! It would have ended that surgeon's career, rightfully.

[NewOrleans]

Aug 25, 2015 22:31:40 GMT -5 downtoearth said:

This is not just morally wrong, but it's unethical for a licensed health professional sworn to knowingly "do know harm". It's way worse than malpractice where something goes wrong that the surgeon/doctor was trying to get right. Plus it's BS that this wasn't sexual assault. nikki25 might be a lawyer, but I also think (as a non lawyer) that the definition of sexual intercourse has been extended from just a penis in a vagina - 

Megan Heimer was a lawyer, too, if you recall. 

At the very least, this is sexual battery.

and "I bet she's enjoying this" sure sounds the hell to me like trying to arouse the victim.

did I miss that these cases were in PA? Because otherwise, how is PA statute relevant?

[tacosforlife]

Aug 26, 2015 5:25:13 GMT -5 NewOrleans said:

Aug 25, 2015 22:31:40 GMT -5 downtoearth said:

This is not just morally wrong, but it's unethical for a licensed health professional sworn to knowingly "do know harm". It's way worse than malpractice where something goes wrong that the surgeon/doctor was trying to get right. Plus it's BS that this wasn't sexual assault. nikki25 might be a lawyer, but I also think (as a non lawyer) that the definition of sexual intercourse has been extended from just a penis in a vagina - 

Megan Heimer was a lawyer, too, if you recall. 

At the very least, this is sexual battery.

and "I bet she's enjoying this" sure sounds the hell to me like trying to arouse the victim.

did I miss that these cases were in PA? Because otherwise, how is PA statute relevant?

I am also sure that is not the ONLY statute on the books in PA. I'm pretty sure every state has statutes that criminalize various forms of sexual assault, including those performed with hands rather than penises. It may be called something other than "sexual assault" in the statute, but we've all been using the term colloquially. Under this very tortured defense of this as not sexual assault, we are to believe that of intercourse is not involved, it is not a crime? So someone can forcibly fondle me and it's not sexual assault? Fuck no.

Yes, these instances began as legitimate medical procedures. But to dance around and sing La Cucaracha while your hand is in a patient's vagina? That is a form of assault, no question.

[StrawberryBlondie]

Why are we talking about a PA statute??

[asdfjkl]

Aug 25, 2015 22:10:30 GMT -5 NewOrleans said:

asdfjkl would be shitting walls o' text if she were here!

I haven't read all the responses, but I have read the article.  I don't have time for a WOT either (lucky you).

Here is what I will say:

"Gallows humor" is an absolutely essential part of a physician's protective coping mechanism for dealing consistently with stress and issues of death and dying.  I think most of us would be surprised at some of the things that are said or jokes that are made in ORs or outside of clinic time between doctors.  I don't begrudge them that.

That said, THIS was not "gallows humor" and I reject the attempt by the people involved to recast it as such.  This was sexual assault.  The end.  

Plug for the Humanities:  This is why physicians need to e thoroughly educated in the humanities.  The present curriculum of most medical schools divorces physicians from the humanity (identification with the centrally human shared qualities) of their patients.