What is the worst ethical lapse you’ve seen?
Dr. Heart1: I was in medical school, and there was a new surgeon. This doctor was going to perform a new and difficult procedure—a minimally invasive way to do a cancer surgery that usually required cutting the patient wide open.
Dr. Baby: Big operation!
Dr. Virus: Big f-ing operation!
Dr. Heart1: The patient was on Medicaid, of low socioeconomic class, and not educated. I scrubbed in on the case, and a bunch of the hospital’s doctors were there. We did the upper-chest part laparoscopically (using cameras and smaller incisions). Usually, it takes about 45 minutes to an hour; laparoscopically, it took four hours. Not a big deal, it’s a learning curve. But when they start the most complicated part of the operation, the problems begin. There’s bleeding, bleeding, bleeding, but they can’t figure it out. At this point, she’s been under anesthetic for twelve hours, and they decide not to finish laparoscopically but to open her up. The second that decision was made, all the attending physicians left the room and the fellows—the people who are finishing their training—came in.
Dr. Virus: The junior varsity.
Dr. Heart1: It just felt really, really unethical.
Dr. Baby: Well, it’s like the big coronary surgeons. They have their fellows come in—they open the chest, they set it up, they have the vein from the leg, it’s all ready to go … He comes in, he makes one stitch, and then the fellows close him up. So, he did the procedure, but the fellows did all the major stuff that really counts.
Bogus Malpractice Suits
“I just sat in on my friend’s trial, and it was all theatrics. The expert witness brought in an EKG complex, which is usually three to four millimeters long. He magnified it to four feet long and kept on saying, ‘The doctor missed this!’ No doctor would have seen that.”
Dr. Heart2: I think the lesson here is that doctors are self-serving. I know of a patient whose doctor wanted him to enroll in a study. In order to enroll, the patient has to say that he’s short of breath. This patient had heart problems—and the doctor went through every possible maneuver you are taught not to do on a patient with his condition in order to get this patient to say that he was short of breath so that he could enroll him in the study. The doctor proceeded to lie him completely flat, do all the things you’re not supposed to do. This poor son of a gun would not yield. He wouldn’t confess to shortness of breath! The doctor finally gave up.
Dr. Lung: Research is a real problem. Doctors just make up the data. They don’t report negative side effects, no question about it. I used to write the results on my reports that were negative and nobody printed them. Only if it’s positive does it get published in a journal. A doctor I know used to publish papers like nobody’s business, and all the doctors who came and left told me he made up data to satisfy NIH grants and pharmaceutical grants. He was and still is very popular.
Is doctor training better or worse than it used to be?
Dr. Heart1: Worse. The way we used to train physicians is that you worked all the time. You were on call all the time. Medicine was holy work—a calling. It was a privilege and an honor—you should sacrifice everything. Everything else came second. It didn’t matter if you didn’t eat during the day, it didn’t matter if you didn’t sleep. Now, the thinking is, if people don’t sleep they make mistakes, and if they make mistakes it’s bad for the hospital. So residents are being taught medicine as a career choice as opposed to a profession, a calling. They’re being taught as shift workers, which I think is a huge problem. When that clock hits a certain time, they have to leave the hospital. They can’t go to the library and read about the patient. They cannot go to the pathology lab and look up their patient’s pathology on microscope.
Dr. Lung: They look at the clock even as I’m teaching them. They’re looking at their watch three times thinking, This is too long: I can go and find it on the Web. They really cannot find things on the Web, and that is a huge problem.
Dr. Baby: Residents used to have a lot more independence. Now they have to be supervised when they give out a prescription for an anti-yeast cream. Or they have to be double-checked, in every clinic with every patient, by an attending, so that they’ve lost the decision-making, the feeling that this is my patient, I’m a doctor, and I’m taking care of this patient.
Dr. Heart1: That’s important, because these days we have zero tolerance for mistakes. Twenty years ago, that was not the case, and that’s a good thing.