Teaching Unprofessionalism

Teaching Unprofessionalism August 23, 2015

For the second time this summer, those of us who have ever been patients under anesthesia cringed and hoped it hadn’t happened to us. An essay published this past week in the Annals of Internal Medicine highlighted one more danger we’d rather not worry about: the possibility that medical caregivers misbehave when patients are at their most vulnerable.

This is not actually news, and not just because we heard about just such an incident earlier this summer.

It’s not news because we’ve known for quite some time that residents of long-term medical and mental health facilities–that is, populations who are particularly vulnerable–are potentially subject to abuse and neglect precisely because they are all but invisible. The history of treatment for mental illnesses is particularly deplorable, but let us not practice chronological snobbery: it is not only in pre-modern insane asylums that patients have been dehumanized, physically abused, and forcibly sterilized.

Those are “them,” though, and we’re “us.”

That is, most of us in a position to read newspaper and internet accounts of such horrors are protected from them, to a degree, by not ourselves being in such an institution.

But anyone might find herself in an emergency room, or dental operating room, or little outpatient operating room in his doctor’s office. Any of us might find ourselves vulnerable to abuse, humiliation, or cruelty.

Image via Pixabay. Public Domain.
Image via Pixabay. Public Domain.

We are always just a bit vulnerable when we are in a medical setting. From the medical history (Do I tell them about my past drug use? I’ll round down, shall I, when they ask how much alcohol I drink per week? Is my mother’s bipolar disorder relevant? Does he really have to know about that abortion when I was sixteen?) to the operating table (Do you think they cleaned those instruments properly? She looks about twelve years old–how many spinal punctures has she actually done? Why are they talking about their vacations while I’m sitting here with my [random organ that’s supposed to be internal] on the outside of my body??), fears abound.

The greatest fear, after the fear of outright incompetence, is that the one supposed to be caring for us is not a caring person.

The two incidents described in the Annals both involved medical professionals behaving unprofessionally, even if they didn’t actually harm patients or break the law. They were, in the words of the anesthesiologist quoted, assholes, even if they were life-saving assholes. Both incidents involved unconscious women being mocked in sexual (and in the one case racist) ways by the very person charged with her safety and care.

The thing that struck me most about the essay, though, was that the people most upset by the behavior were the people least in a position to do anything about it. The stories were told by people who were, during the incidents themselves, medical students. Though not as vulnerable as the patients whose abuse they witnessed, they were themselves vulnerable to abuses of power by the doctors they might have considered reporting, and they would certainly have been socialized against objecting openly to their superiors’ behavior.

And if no one objected to it, they would have learned that it was unobjectionable.

Thank goodness for the anesthesiologist who cried foul, in the second story.

Thank goodness for the journal editors for publishing the stories–their way of, in essence, crying foul.

Thank goodness, even, for the essay writer, who recognized the moment, finally, to break his silence and confess his complicity–his willingness to “sway to the beat” the doctor is singing.

But mostly thank goodness for that anesthesiologist. But for her* willingness to call the assholes out, the essay writer might still be “swaying to the beat” he learned as a medical student.

*I cannot justify my assumption that the essay writer is male and the anesthesiologist female. But that is the casting in my head, when I imagine the scene.


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