We may only interact with our physicians a few times a year, but they hold enormous insight into the most intimate details of our lives. We're okay with this lopsided relationship because of an implicit trust. Yet while every doctor takes an oath to continually earn that trust, some physicians, even heroic ones, fail to live up to their pledge.
In a disturbing essay titled “Our Family Secrets,” published Tuesday in the Annals of Internal Medicine, a journal of the American College of Physicians, a doctor reveals in vivid detail what it looks like when that trust is violated—specifically, through completely indecent treatment of female patients under general anesthesia. Writing anonymously, the author declares: "I know this is my silence to break."
It's probably safe to say that most doctors would be horrified by the behavior described in the essay, which you can find here. But its publisher hopes the piece will also embolden some to call out inappropriate behavior, even when the offenders are superiors.
In an accompanying note, Dr. Christine Laine, editor-in-chief of the journal, says she and her editorial team initially debated publishing the accounts. “We all agreed that the piece was disgusting and scandalous and could damage the profession's reputation,” she wrote. “Some believed that this was reason not to publish the story. Others believed that it was precisely why we should publish it.”
Laine elaborated on her own emotional reaction over the phone. "The first time I read it, it made my stomach churn," she told me. "Every time I’ve read it since, I’ve had the same reaction. It makes me angry for all the patients, angry for all the young physicians, and angry at myself—angry for all the physicians who were too timid to speak up.”
Just how pervasive is this brand of unethical behavior? Should we, as patients, be more concerned about the conduct of those with whom we entrust our lives? Do doctors need to start wearing body cams?
No national governing body tracks the kind of transgressions recounted in the essay—but Barron Lerner, a physician and medical ethics professor at New York University's Langone Medical School, said he believes they aren't common. “I would say the sorts of things being described in that piece are very rare, especially now,” Lerner told me. “Ten, twenty years ago, they were more commonplace.”
Lerner explained that before women started entering medicine in large numbers, medical school and residency programs were chock full of “frat boy behavior.”
“I think that to the degree that the medical profession was male, it was an old boys network," he said. "There was a lot of inappropriate behavior and patients were the victims.”
Lerner said the medical community has made progress in teaching young physicians to treat patients with respect. Students today study ethics and professionalism and are encouraged to develop a sophisticated understanding of patient needs.
“To the degree that this article reveals that some of it is still happening, I think it’s a good opportunity to make sure that medical schools and residency programs are doubling down and trying to come up with mechanisms for people who witness this sort of behavior to take action,” he said.
And yet, the medical hierarchy still doesn't make it easy for junior physicians to speak up. “When a student does something unprofessional or unethical, there’s apt to be more formal policies in place,” Lerner said. But when it comes to supervising physicians, the policies are less specific and rely more on the general concept of professionalism.
On top of that, some doctors would argue that there is a place for gallows humor in the profession. But cracking jokes while treating patients can be dangerous territory.
"If someone makes an off-color joke—that’s not nearly as bad as [what's described in the essay]—at 3:00 in the morning when everyone is stressed out, I don’t think that should get reported to the dean the next day," Lerner said. "Part of the challenge here is judging how bad something is and paying attention to the context in which it’s happening."
The physicians called out in "Our Family Secrets" probably thought they were just being funny. But when they degrade a patient in the process, they've clearly crossed an ethical line.
Laine told Fusion she and her team have received emails from colleagues and strangers alike commending them for publishing the essay. But she's also received indignant feedback, particularly from some OBGYNs who mistook the piece—which focuses on incidents within their speciality—as an attack on their field.
“It’s not an OBGYN problem. It’s not a male physician problem or a female patient problem,” Laine told me. “In our minds, we didn’t publish this to malign OBGYNs.”
Laine explained that the point of the essay was simply to remind physicians of the responsibility they have. “We all have, on occasion, witnessed some actions by our colleagues that are cringeworthy,” Laine said. “The issue is—and the message is—that if it ever happens, physicians need to report it.”
For Laine, it’s crucial that students internalize that accountability early in their careers. “A lot of what we learn in medical school comes not only from books, but from watching how our colleagues behave,” she said. “I just hope that physicians who read the essay will have the courage to speak up and do the right thing when they see their colleagues misbehave.”