A surgery resident at the Mayo Clinic is under fire for taking a photo of his patient’s genitals during surgery for a gallbladder problem. A concerned surgical staff member took it upon themselves to contact the press about the incident, and so now the entire country knows what this poor guy has tatooed you- know- where.
It seems to me there’s a bigger problem here than the photo – and that’s the violation of this patient’s privacy by the staff member who took the story to the media. Since when is calling the local paper the appropriate way to handle a hospital incident involving a patient?
In fact, I’d argue that the “whistle blower” to the media committed an even bigger violation of the patient’s rights than did the resident who snapped the photo. What could have been a private matter between the patient and the Mayo Clinic (and the lawyers for both sides) has now become national news.
(Hat tip to Kevin, MD for the story, the latest addition to his “Doctors Gone Wild” post series.)
Wow. One can only guess why the staff member went to the press (anonymously) rather than to the hospital administration, perhaps because there’s a power differential that made the staff member think a complaint wouldn’t be addressed by the administration?
And we don’t know that the staff member leaked the patient’s name or details, though they’re in the paper now.
Would the Clinic have followed up on an anonymous report without the press? Would the patient have ever heard about it without the imminent publication of the piece? (Yes, I distrust powerful organizations that protect their own when they can. I grew up during Watergate.)
What’s an appropriate response to such a lapse in judgment? If you were on the ethics board or whatever, what would you suggest?
You couldn’t be more right. Obviously the photograph should never have been taken, but ringing the paper rather than alerting the hospital management suggests to me that this is less about the breach of confidentiality and more about someone wanting to drop the surgeon in it by way of a highly publicised lawsuit.
It doesn’t in any way excuse the actions of the surgeon, of course, but nonetheless I find myself wondering just how “violated, betrayed and disgusted” this patient was, given that he (a) runs a topless bar and (b) is the sort of person who doesn’t mind a stranger tattooing “Hot Rod” on his dick.
I think the surgery resident should probably be fired.
There are all sorts of safeguards in a hospital to protect people who alert the powers that be to inappropriate conduct. I can understand why the whistleblower might not have gone straight to the resident, but surely there was an attending, a charge nurse, someone who that person could have gone to.
schruggling – I love that joke….But I don’t want to offend anyone, so I took it off. Hope you’re not mad at me…
XXOO
TBTAM
Bardiac –
I can’t figure out how the media could have gotten the patient’s name unless someone gave it to them. The other possibility is that they asked the hospiptal to ask the patient if he would be willing to speak to them and then he said yes.
But according to the story, he heard about it the same day the story hit.
Part of the problem is the medical culture. In medical training, residents talk freely about cases, and tend to complain about patients openly. They forget that not everyone is part of the medical circle, and those who are not don’t understand privacy ethics.
It’s too bad something like this has to happen for medical people to pay attention.
And my question is, why did the newspaper print the guy’s name? They didn’t have to.
Doc McHebert –
You’re right. The HIPAA regs should apply to newspapers as well. It seems that if a hospital employee violates HIPAA, the info becomes fair game for anyone, and that’s just not right…
“The HIPAA regs should apply to newspapers as well.”
This is what’s known as prior restraint. Trust me, as a nation we don’t want to go there. There’s a reason why we have a free press in the United States. At times it may be inconvenient and intrusive and distasteful, but the alternative is worse.
I know this point may be hard to understand for people who come from a medical culture, where confidentiality is prized. News culture is about openness. Neither the one nor the other is necessarily good or bad; they’re just different because they each have a different public mission.
The fact that the patient owns a strip club and has a tattoo on his johnson is neither here nor there. We’re all vulnerable when we enter the doors of a hospital. Even if someone is, uh, flamboyant, it doesn’t mean they enjoy being treated in this manner or that it’s OK to blame them on the grounds that they somehow brought it on themselves.
To Hebert:
Everyone present in the operating room was part of the HIPAA “circle”, and none of them had any business going to the press. Calling a newspaper was just as much a violation of that patient’s privacy as would taking the photos and displaying them in public. The caller did as much a disservice as if she repeated what a patient said while under the effect of sedative. Pretending that personal outrage justifies the call is no excuse.
If the doctor violated professional ethics, the venue is the training program director, the hospital medical staff director or the state board of medicine, any or all of them would have been better than calling some reporter.
I would rather see the tattletale anonymous caller get the axe than the resident. She clearly did more harm.
To those of you calling for the staff member to get fired/punished: what makes you think your reaction wouldn’t be the reaction of the top dogs at the Clinic if s/he had tried to handle it internally? Maybe s/he tried to handle it internally? We don’t have a whole story here, and never will.
When I read the article, it sounds like the victim got a call from the Clinic, saying something was wrong, and then the resident got on the phone to explain and apologize, because the administration didn’t want him finding out in the newspaper. Tell me, honestly, do you think he would’ve gotten that call if the Clinic could have handled it internally, with a “tsk tsk” to the resident and no negative publicity or chance of a nasty lawsuit?
It’s not like the resident told him the next day, “gosh, I made a mistake, and thought you’d want to know that I showed a picture of your tattoo to some of my pals.” He waited until the paper was about to put out the article. (It’s not clear that the article linked is the threatened article; I wonder if things didn’t get moved around, because the victim sounds like he’s going to take advantage of the stupidity, doesn’t he?)
Is there no harm done so long as the victim doesn’t learn about it? (This is an honest question, but an important one. I think some people mistrust doctors because of the sense that doctors protect other doctors at the expense of patients.)
I’m curious what an appropriate response to the resident is. (I don’t know; it seems like a horrible thing if he loses his license for something so stupid. On the other hand, I sure don’t want him anywhere near me.)
Rumor has it the resident has been fired.
I sense an oblique reproach aimed in my direction. I’m a lawyer; I don’t need lessons in the importance of confidentiality. I said quite clearly that the fact that the man owned a strip club and had a tattoo didn’t excuse the breach.
However, I also recognise a plaintiff eyeing up a lawsuit when I see one. The lawsuit is inevitable, will be costly for the hospital, and will divert funds away from treating patients. That is something that could have been avoided if an attempt had been made to deal with this quietly in-house – as could any embarrassment suffered by the patient himself.
I could understand going to the press if the person who leaked this story had attempted to deal with it in house and been rebuffed or not taken seriously, but I see nothing in any of the reporting of this incident to suggest that, and as from the media’s point of view the hospital’s failure to take a complaint from the surgeon’s colleagues seriously would have been at least as much of a story as the original incident, I assume that no such attempt was in fact made, and I find that very odd.
Forgive my slight stroppiness. I am in a bad mood about something unrelated and it appears to be colouring all of my social interactions both on and offline. I stand by my point (which is basically that I agree that there was a terrible breach of confidentiality, but I’m entitled to add that I don’t have as much sympathy for this patient as I might in other circumstances) but let’s all pretend that I expressed myself less tetchily…
Apology accepted.
The irony of a strip club owner being upset about an invasion of his privacy has not escaped my notice.
I guess what resonated with me was that the patient told the newspaper he had been really apprehensive about his surgery, and this particular surgeon helped reassure him. These are the kinds of things that help form bonds between patients and physicians. It means something to the patient.
And then look what happened. I may loathe the guy’s choice of occupation, but I think he’s entitled to feel just a little bit betrayed.
Several years ago I wrote a letter of complaint to a clinic’s patient relations office after one of its surgeons (from whom I was in treatment) forwarded an e-mail I’d written to him to an individual who worked at the clinic but was not in any way involved in my care. The subject of the e-mail was complaints I’d received from my referring doctor about the surgeon’s apparent unwillingness to keep him in the loop. I attempted to explain that I felt some anxiety about their interactions. From my perspective, it was a personal communication between myself and the surgeon only.
To my knowledge, the patient relations office never discussed the matter with the surgeon — I certainly never heard from him — but I did receive a termination letter followed by a series of surprisingly rude and condescending letters from their risk management attorney after I pointed out that HIPPA promises patients will not be “penalized” for filing a privacy complaint. Said the risk manager in one letter, “We do not consider termination a penalty.” I wonder what they DO consider a penalty?
Thus, I can about imagine what a clinic or hospital might do if one of its own tried to shine a light on a questionable act by one of its doctors. Going to the press seems a bit extreme, but I certainly don’t believe that the medical culture recognizes the importance of monitoring and disciplining its own.
For those who think that this incident could have been properly resolved without reporting the incident to outside sources, the following study by the AMA challenges that assumption.
The AMA study found out that:
“more than half of doctors told investigators that they failed to report a serious medical error they observed, or a colleague who was impaired or incompetent, to authorities in the last three years.”
“Turning in your buddies is the hardest thing to do.” “There is an ethics of loyalty to your peers that is very deep.”
“This raises serious questions about the ability of the medical profession to regulate itself.”
The whole study can be found here:
http://www.ama-assn.org/amednews/2007/12/24/prsc1224.htm
To All –
This is a fabulous discussion on this issue, thanks to all for your thoughtful comments.
I am struck by just how much distrust there is in the medical profession’s ability to police itself. I do think that at the attending level, some of the concerns are founded. But at the resident level, where this incident occurred, I can’t imagine any residency program I know of that would not have taken this incident with the utmost seriousness and disciplined the resident involved. My experience as a resident and now as an attending in an academic institiution is that residents don’t hesitate to report problems with their fellow residents – the group works as a team, and shortcomings in one member affect everyone, and residents know this.
I do not believe that the media needs to become involved in this kind of incident. The violation, while egregious, was limited in scope. Had had the incident stayed internally, the damage to the patient would have been limited. Would he have been notified and had the opportunity to sue? Perhaps not. But since the images were destroyed, and only seen by several members of a surgical team, his privacy would have been protected much more than it has been by going to the media.
I maintain my stance that the larger damage to this patient’s privacy was done by the person who went to the media.
Now, if a patient really does not care about his privacy, this incident creates an opportunity to gain a bit of fame as well as fortune, and the more publicity around it, the better the economic outcome to a lawsuit.
And that’s another discussion….
My personal concern wasn’t the damage done to this particular patient’s privacy, but rather the depressing realization that any patient’s naked body under anesthesia can be taken so easily as eminent domain, then disrespected for a few cheap laughs. All without conscience. Also, it’s not too much of a leap to suspect that this doctor deleted the images from his phone only after getting wind that he was reported. Why did he take photos if not to show his buddies who weren’t in the OR at the time.
Just a patient –
You are right – It is depressing to think that such a thing could happen. The power differential between patient and doctor is enormous, and especially when anesthesia is involved, the patient is comepltely powerless. The trust they give us as their physicians is a holy one, and to violate that is nothing short of a sin.