Own Up, Doc

I can deal with people making mistakes that negatively impact me: mistakes happen. However, there is one thing that I simply cannot tolerate: people not owning up to their mistakes and shifting the blame onto others. In the context of medicine, I just can’t believe that this would happen, but it does.

The Cyst Saga or How I Learned to Stop Worrying and Love the Remains of the Abscess on the Side of My Head

For more than a month, I have been trying to schedule an appointment with a dermatologist. At the beginning of this time period, I spoke with the dermatologist’s nurse, and after discussing a few dates, we agreed to schedule an appointment at the end of August. When I called in shortly before the appointment, I was told that I had no appointment: rather, I had an appointment in the middle of August, and I had missed it. I was told that the nurse would call me back to reschedule. She didn’t. I sent an e-mail to the doctor explaining that there had been some miscommunication because I was told the appointment was for the end of August, and that I’d like to reschedule. I called back a week later since no one had contacted me. The receptionist said the nurse would call me back that afternoon. She did this time, and claimed that the dermatologist didn’t want to reschedule my appointment, implying that since I had “missed my appointment,” I didn’t deserve to receive care from him, a busy physician with a full schedule with other patients who do show up for their appointments. (EXCUSE ME? said a voice screaming in my head.) I tend not to complain, but this was just ridiculous. After finding out the name of the person with whom I was speaking (who happened to be the nurse who was supposed to have scheduled my appointment), I insisted that there had been some miscommunication or mistake since I had been told that my appointment was for the end of August. In fact, the date my “appointment” was scheduled for would have been the best date possible for me (since I had nothing scheduled for that afternoon), but she had never even offered that date as a possibility (leaving me to choose between possibly having surgery the day before an exam or the day before I flew out of town for a weekend trip). She then discovered that I had not received an appointment (reminder) slip, which seems to imply that she (or someone else between her and the appointment schedule) seriously dropped the ball. With an enormous THUD. She subsequently rescheduled my appointment for a month from now. I don’t like getting people in trouble, but the fact that the blame was shifted onto me and would have removed my ability to seek treatment from this dermatologist is a serious breach of responsible conduct. I’d like to think that she simply didn’t remember making a mistake when the dermatologist discovered that his patient (me) was a no-show for my mid-August “appointment”: that would suggest incompetence rather than gross negligence due to dishonest irresponsibility.

I Must Not Tell Lies

I used to be somewhat self-conscious about my teeth. My lower incisors are somewhat crooked: my jaw just doesn’t have quite enough space for them. When I was a teenager, like so many others, I had braces for a couple of years. However, mine didn’t work. Rather, the braces worked fine, but the retainers didn’t. When I went to see my orthodontist, he took a look at my teeth and very quickly jumped to his conclusion. “Why aren’t you wearing your retainer?” (Excuse me? – I was too timid to talk back in ALL CAPS at that point in my life.) The thing is, I had been wearing my retainer, exactly as he had instructed. I explained such. He looked at me condescendingly and said, “You need to wear your retainer as I instructed.” As one might imagine, I was quite angry that I was being accused of being a liar when I wasn’t. He seemed completely incapable of adapting to an unfamiliar situation or an outcome he didn’t expect. He was unable to believe that the treatment he provided didn’t work. Of course, it had to be my fault.

I kept wearing my retainer after that, but I was very disenchanted by the condescension bestowed upon me by this person with the initials “Dr.” in front of his name. Months later, I was fairly negligent with my retainer use, partly because it was clear that the retainers were not strong enough to hold my teeth in place. However, it was mostly because he had destroyed my trust in him. Ironically, as I watched him with some degree of defiance in my eyes, the orthodontist examined my teeth and said, “I see you’re wearing your retainers. Good.” I said nothing.

Today, it remains as my scar, my reminder of honesty as I continue on my road to becoming a healer: in order to treat others well, I must be honest with myself, particularly about my mistakes. I must not tell lies – especially to myself.

Fall Guy

Without going into too much detail about the case of Dr. Anna Pou and the deaths of a number of patients at Memorial Hospital in the chaotic days following Hurricane Katrina, there is one thing that I found meaningful about the case. Despite the dreadful consequences and the end of her career, Dr. Pou did at least one thing quite admirable that no one can deny: she took responsibility for the deaths of the patients under her care. Ironically, she was getting nailed for taking responsibility, exactly what we want our doctors to be doing. By pursuing so doggedly in trying to put Dr. Pou behind bars, Louisana Attorney General Charles Foti publicly, nationally, and severely damaged the patient-physician relationship by making it harmful for doctors to take responsibility, admit mistakes, or show signs of remorse for undesired patient outcomes. At one point, the Attorney General even convinced the other two defendants, both nurses working with Dr. Pou, to testify against her in exchange for having the murder charges against them dropped.

I found this quote (from the Wikipedia article on Dr. Pou) remarkable:

The investigation apparently began after Dr. Bryant King, a physician working at Memorial following the hurricane, publicly charged that one or more health care workers had killed patients. King told CNN that when he believed, based on conversations with other health care workers, that a doctor was about to kill patients, he boarded a boat and left the hospital. King explained his actions in terms of his opposition to Pou’s alleged actions, arguing “I’d rather be considered a person who abandoned patients than someone who aided in eliminating patients.”

In the midst of the chaos, with no sign of rescue or aid, with everyone trying to adapt to an unfamiliar situation with unfamiliar needs, this doctor thus justifies his decision to abandon patients. Way to give up the responsibility to save lives and ease suffering.

Concluding Thoughts

Responsibility is an incredibly important component of the medical profession. As far as I have witnessed and heard, it seems that physicians often feel or take greater responsibility for conduct and outcomes than other health care professionals, or perhaps just other people in general. At least in my case, orthodontists and nurses. Don’t get me wrong, I love nurses and have worked extremely well with many, but the buck stops with the physician. The physician is the team leader, and upon the shoulder of leaders, we place the responsibility and the blame. If anything, our society should make it easier for physicians to take responsibility, learn from mistakes, and improve care rather than continue in its punishment of one of the few groups of people that actually feels compulsion to be responsible and act on that internalized moral code.

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