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Clarification Of Comments On Medical Battery

PhysioProf

My blog post the other day about the surgeon who committed battery by placing a temporary tattoo on an unconscious patient has generated quite a bit of, shall we say, consternation among some physicians and surgeons. In re-reading the post, I see that it was written in a way that was overly hyperbolic and generalized even for PhysioProf.

And for that, I am genuinely sorry. As bloggers, we always try to create controversy and argument, but I see that in this case I went too far.

Although I am not an MD, I love being a peripheral part of the medical profession, love being a basic science faculty member at a medical school, and love teaching medical students. I care very deeply for my medical students, and spend a lot of time and effort on effective teaching. I also have great affection for them, and wish them only the best in their future medical careers.

And that is why I am so concerned about the behavior of the “tattoo surgeon”. I do see an issue with paternalism, arrogance, and omnipotence in the profession, and I do not see the behavior of this surgeon as being solely attributable to a “lone bad actor”. Bad acts occur in a context, and I believe that to at least some extent, the medical profession includes a context that makes bad acts like this one more likely.

Accordingly, I disagree strenuously with something PalMD posted today about this issue:

The days of systematic pathologic paternalism on the part of doctors is long gone. It may linger in places, but it’s just not part of the culture anymore.

I believe this is not true, and it harms the medical profession to pretend that there is no longer an issue to be addressed.

28 thoughts on Clarification Of Comments On Medical Battery

  1. The days of systematic pathologic paternalism on the part of doctors is long gone. It may linger in places, but it’s just not part of the culture anymore.

    Riiiggghhht. So I can go to any OB/GYN right now and have them tie my tubes? I didn’t know that the medical profession could change so rapidly. I’ve seen 4 specialists in the last 3 months. One wanted my HUSBAND’S PERMISSION. Three said I was too young.

    Brilliant.

  2. “One wanted my HUSBAND’S PERMISSION.”

    Wow. May I suggest filing a complaint against that one, at least, if you haven’t already?

  3. Kristen,

    I’m not trying to make the case that what you’ve experienced is right, but for the record when I wanted my vasectomy I had to get my wife’s permission. I also thought this was weird.

  4. Erik – when my partner got his vasectomy, he didn’t have to get my permission. I think it’s a case-by-case thing.

  5. Sorry, this still doesn’t cut it with me. I agree that arrogance is a professional hazard of medicine – but every profession has its hazards, and as the anecdata on your previous post indicates, doctors run the gamut from brilliant to atrocious, with most somewhere in between.

    What really bothers me, though, is your attitude as an educator, something at which I’m apprenticing at the moment. (Post-secondary education, too, so I know at least something of the challenges of students who are grown-ups.) You condemn doctors as evil because they “cut unconscious people’s asses up with scalpels” – yes, that’s what surgery involves, and it has saved many people’s lives. And you attribute not only arrogance but, essentially, actively malevolent motives to the entire profession you’re entrusted with training. I’m sure some of your students are legitimately problematic and will be bad doctors, but plenty will probably good-but-not-perfect students/people who will be good-but-not-perfect doctors one day. Your attitude makes me wonder whether their other instructors have the same impression of them. My guess is that most of the shortcomings you claim they exhibit are a perfectly natural defensive reaction to the attitude that you, a professional who is in a position of authority and power, so evidently hold toward them.

  6. I read the earlier comments and responses to PhysioProf’s posts and style of writing and sympathized with both sides but this post and particularly the following quote finally put me over the edge…

    “As bloggers, we always try to create controversy and argument…”

    First, is this really the intent of ALL bloggers? Or is this one person universalizing his intent onto all bloggers?

    Secondly, is this fundamentally feminist strategy for change? I’m really asking this question. What purpose does controversy serve here? On this issue? On this blog? For women, trans people and queers accessing healthcare?

    Most importantly, is this a useful strategy for change within your chosen profession and on this issue? Might it be more helpful to use your position within the profession to work on concrete strategies for change?

    I’d love to see you put some of your controversy starting energy, PhysioProf, towards working on ways that physicians, medical students, basic science instructors, clinical preceptors, patients, healthcare advocates, lay healthcare providers, etc. could all work together to advance change in medicine.

  7. I care very deeply for my medical students,

    If so, it is in the same way that abusers “care” about their partners/victims. Your post radiated contempt, not of the system or of the abuser (and I have yet to see anyone, MD or otherwise, defend the asshole who did the tattoo) but of the students. No arrogance on your part, eh, Highly Prestigious Professor?

  8. No pathologic paternalism in medicine? Or it’s a non issue?

    Oh, freaking please. Just tell that to any woman who had a hospital childbirth. In my time as a midwife/doula I have seen doctors preform procedures that weren’t medically necessary, that patients had specifically asked to not have done(as in, I would rather tear than have an episiotomy at an office visit) lie to the laboring mothers, doctors who when asked about all the complications of a procedure such breaking the bag of waters, pat the mother on the shoulder and say, “you just let us worry about that, you just sit back and wait for the epidural to kick in dear”.

    When I very gently ask the mother such things like, “it looks like the doctor is about to do an episiotomy is there something you want to ask him before he does?” I get asked by either the doctor or the nurse when I finished medical school and “how dare I tell my client all the side effects of a drug or procedure because that almost never ever happens ever, so we don’t even mention that particular side effect. ”

    I need to scoff mightily and bitterly at the idea that there is no paternalism in medicine.

  9. In a separate point, I semi-agree with you about paternalism: it’s decreased from, say, 50 years ago, but it sure as heck isn’t gone. Trivial example: a professor I had to deal with during med school (a PhD, as it happens, though I think that a coincidence, not a sign that PhDs are all sexist jerks), used to refer to female med students as Firstname, male med students as Dr. Lastname.

    I suppose there are some doctors who think that they are gods, but given the way that any given therapy can flop, any procedure go wrong, even the simplest intervention backfire, no matter how good you are…I’d have to conclude that any doctor who thinks that he or she is god is either very, very inexperienced or too dumb to live.

  10. You’re the worst poster in the history of this blog and your continued posting detracts from the contributions of your coauthors. I don’t know what Jill saw in you to grant you this opportunity, but I can’t wait until you’re gone. How many submissions have you made now, and in all of them I haven’t seen a single redeeming word or thought. One walks away from your musings with the overwhelming impression that you are a bitterly disappointed individual. Just hang it up.

  11. Enfamil, indeed, you fucking whiny ass titty baby. You’re banned for the stupid, and for violating a repeated request to respect the contributions of the guestbloggers. Done.

  12. You’re the worst poster in the history of this blog[.]

    That kicks total fucking ass!!! I am historical and shit!!! w00t!!!!

  13. Pingback: w00t!! « PhysioProf

  14. Well, PP, you try and provide actual content for the blog and end up as worst poster ever, whereas I provide nothing but fluff and nobody calls me out. What gives? Where’s my goddamned title?

  17. “The days of systematic pathologic paternalism on the part of doctors is long gone. It may linger in places, but it’s just not part of the culture anymore.”

    Yeah, right. A week ago I went for a surgical consult and the sugeon literally yanked my panties off without warning, because they were “in the way” (his words) of him inspecting a lump on my leg. I asked for the other surgeon in the group, who kept touching me – hand on my shoulder, or my ankle, etc – the whole time. Even after I told him I was uncomfortable.

    The kicker is that one of them will be performing surgery on me in a week. I cna’t go elsewhere because I can’t afford to because of my insurance. I am seriously considering not having the surgery and dealing with the consequences. I don’t need this trigger bullshit.

    Not all doctors are like those two, but I can see where an institution, in this case a medical group, can perpetuate that sort of behavior just by letting it happen. Or denying that it does.

  18. why is it that doctors are this way

    PP, i have a favor to ask of you. its a huge, nay HUUUUUUUUUUUGE favor.

    i would like to please, at least once a quarter/semster/whatever, remind your med students that they are being taught sexism. that they are being taught that all women are hysterical, that if a woman complains the first answer is that she’s making it up for attention and the second is that she is crazy, and only after those are both eliminated does the posibility that there may actually be something wrong recieve attention.

    i have had over 20 years of this, and i am only 31. see when i was 9 i got sick and had a lot lot lot lot of pain that made me scream. i was eventually diagnosed with acute intermident porphyria and sent to Children’s Hospital at Stanford to learn to “deal with my pain” – i.e., no annoy anyone else with it, and to hide it from everyone. in the mean time i was born with displasia of the right hip… and i JUST NOW got home from the surgery to fix it.
    the surgery that could have been performed at ANY POINT in the past 22 year, giving me a better, less painful, more productive, less suicidal (and on and one) life. except, i was a girl and i was making it up and NOT ONCE did ANY DOCTOR EVER bother to take a simple fucking x-ray of my hips!!!!!!! it was “in my head” or it was a “female issue” or a “side affect of the porphyria” or (and this is my favorite, because the causality is backwards) MY “fault for being 40 pounds over weight” – conveintly ignoring the fact that the AGONIZING CHRONIC PAIN IN MY LEGS IS WHAT MADE ME GAIN WEIGHT.

    men do NOT get treated this way by doctors. unless someone thinks a guy is an addict, he gets real and total care. women? are hysterical. i think i might sue USCF and Stanford. i am really really considering it. not for money (would i even get anything, after the lawyers?) but to try and fix this issue.

    so PLEASE remind your students that they are being taught this, and this is WRONG

    also, on that tube tied issue – what is that??? i have porphyria, pregnancy has something like an 80% chance of killing me, i am 31 and i STILL cannot get anyone to tie my tubes!!!!!! the FUCK!?!?!?!?!?

  19. i would like to please, at least once a quarter/semster/whatever, remind your med students that they are being taught sexism.

    I concur. You could also point out that they are being taught racism and homophobia while you’re at it. If you’re interested and don’t already have this data, I could point you to several articles demonstrating that outcomes are worse in women and minorities, even after accounting for differences in socio-economic group, etc. That’s straight racism/sexism. Since you’re an NIH researcher, you might also go into some of the history from Tuskeegee to the historical lack of trials that include women (especially women of childbearing age.) It’d probably be more convincing than random foaming a the mouth about teh evil doctors.

    While we’re on the subject, has anyone ever systematically examined this question of who can and can’t get a tubal ligation easily? My last conversation with my gyn on the subject went like this: “What are you using for birth control?” “Condoms, but I think I’m done with having children so I’m considering tubal ligation.” “If you want to go with it, call me and we can discuss timing.” No fuss, no muss, no demand that my partner agree. What’s different about me versus denelian (for example)? Age (I’m 40)? Race (I’m mixed race though appear white)? Socio-economic status/insurance (I have a really very good insurance and would go elsewhere if my doctor pissed me off)? Is there a given group that is systematically being denied control of their bodies or is it individual assholes taking advantage of people in vulnerable situations? (It’s not acceptable either way, of course, but the remedies are different.)

  20. Medical students are generally not deep thinkers about social arrangements, and have the same degree of sexism, racism, homophobia as their peers of comparable SES origin. Few have had an academic or personal background in political or social analysis or action. Once they hit medical school, life goes on hold for a while, and finding time to read the news becomes an accomplishment. My estimate is that the “humanities” course in the first two years is pretty much a waste of time for them, as they don’t have the first hand experience on the floors that makes dealing with ethical issues concrete. Yes, they get the history, Nuremberg Trials, Tuskegee experiment, etc, but it doesn’t sink in.

    The real chance to influence medical students comes in the clinical years, where the students model themselves after skilled and respected faculty and residents. A senior faculty member addressing a “non-standard”* patient with respect, and correcting house staff for rudeness, is a powerful example.

    The culture change in medicine is as slow as the culture change in the outside world – and this should be no surprise, since there are a lot of older physicians out there. Attitudes of the recently graduated cohort are more liberal on average than those of the class of 1970. On the other hand, age sometimes imparts some wisdom and understanding of people as they are rather than as we wish they would be.

    To those who consider PP to be condescending towards students – if you have taught for a while, you will identify certain cohorts of students as “getting on your last nerve” for apathy, whinyness, and so on. Much has to do with the pre-med-school curriculum changes and other experiences – everything has a single correct answer, problems should be easy to solve, everything should be on the intranet with no need to come to class. I like the students, but drat it takes a long time for them to lose the test orientation and gain the patient orientation.

    * (black, hispanic, poor, female, gay, transgender, uneducated, or any other type of characteristic that isn’t similar to the typical doctor)

  21. i would like to please, at least once a quarter/semster/whatever, remind your med students that they are being taught sexism.

    I concur. You could also point out that they are being taught racism and homophobia while you’re at it.

    While this sounds like a generally good idea, I would actually beg PhysioProf not to do this. To have your exposure to such important but often ignored (at best) issues come from a professor who radiates this much contempt and hostility toward his students, and this much arrogance and taste for hot-tempered hyperbole, runs too much risk of being counterproductive. I would honestly rather hope the students get this message elsewhere than have the lot of them get in the form of a semi-coherent rant by an instructor who doesn’t seem any too inclined to hide the fact that he despises them from day one.

  22. Medical students are generally not deep thinkers about social arrangements,

    Do you have any evidence to back this statement or should one take it in the same was as one would take the statement “Women are generally not good at math”?

  23. black, hispanic, poor, female, gay, transgender, uneducated, or any other type of characteristic that isn’t similar to the typical doctor)

    Many medical school classes are now more than 50% female, so the “typical doctor” of the future, if not quite yet of the present, is female. However, universities and medical schools are still slow to hire women as professors. So you get mostly male professors like PP lecturing mostly female medical students about how arrogant they are. Very feminist, I’m sure.

  24. Pingback: Feministe » Thanks, And Farewell!

  25. Dianne –

    really, except for age, we probably look pretty much the same (and we are less than a decade apart). down to the multi-racial-but-looks-white.

    well, age and i have never had kids. which seems to be the reason no one wants to tie my tubes. porphyria or not, i haven’t popped out a couple of parasites, so i can’t get my tubes tied.

    no, not bitter. sigh

  26. Reading the comments to this post and the previous post is really disheartening…especially in light of the fact that I have a med school interview Thursday.

  28. NancyP, can you provide any evidence for your claim that “medical students are generally not deep thinkers about social arrangements”?

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