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Confronting Scandalous Physician Behavior: The Annals Of Internal Medicine Takes The First Step

If you have not read the latest essay and editorial about scandalous physician behavior published in the Annals of Internal Medicine (AIM), you must do so now. They describe horrific racist and sexist remarks made about patients by senior male physicians in front of their young peers. The physicians-in-training are scarred by the experience, partially because the behavior itself was so disgusting, but also because they felt powerless to stop it.

It is important for the medical community to come together over the sad reality that there are still some physicians and surgeons out there who are wildly inappropriate in their patient care. In my lifetime I have seen a noticeable decrease in misogyny and behaviors of the sort described in the Annals essay. I have written about racism in the Ob/Gyn arena on my blog previously (note that the perpetrators of those scandalous acts were women – so both genders are guilty). But there is one story that I always believed was too vile to tell. Not on this blog, and probably not anywhere. I will speak out now because the editors at AIM have opened the conversation.

When I was a third-year medical student I was assigned to tag along with an ophthalmology resident serving his first year of residency as an intern in general surgery. We were to cover the ER consult service one night, and our first patient was a young Hispanic girl with abdominal pain. It was suspected that she may have had appendicitis. Part of the physical exam required that we rule out a gynecologic cause of the pain. And so a pelvic exam was planned for this young girl of about 12 or 13. She was frightened and clinging to her grandmother. She had never seen a gynecologist before and had explained through her grandmother that she was a virgin – making a gynecologic cause of her abdominal pain less likely. I offered her some reassurance with my broken Spanish and held her hand as we wheeled her on a stretcher to a private examining room. The resident whispered in my ear, “This is going to be fun.”

The resident was creepy at every stage of the exam. He was clearly relishing the process, slowly instructing the poor girl to position herself correctly on the table. He held her knees apart as she whimpered and cried. He pretended to have difficulty positioning the speculum, inserting and reinserting it an unconscionable number of times. All-in-all it probably took ten minutes for him to get a cervical sample (this usually takes under 60 seconds). He performed the bi-manual portion of the exam in a bizarre, sexualized manner. I was furious and nauseated.

The patient was finally returned to her grandmother and the resident took me aside to ask how I thought he did. The perverted expression on his face was not lost on me. I looked at him with daggers in my eyes, but I knew that if I confronted him head-on it could trigger an investigation and in the end I had no hard evidence to prove that he had done anything wrong. It would wind up being a “he said, she said” scenario. I mustered the courage to say, “I think you were slow.”

For a fleeting moment he was taken aback by my insubordinate criticism and then he said the sentence that still haunts me today, “Well it was her first time.”

Each time I think of this interaction I feel sick to my stomach. I wonder what more I could have done.*  I wonder if he is still out there violating his patients, and if anyone has ever confronted him. My only consolation, I suppose, is that he did not go on to become an Ob/Gyn. As an ophthalmologist one would hope that he had fewer opportunities for sexual abuse of patients.

I guess you could say that in my medical training, I witnessed a child rape. I don’t think it gets much worse than that… and I don’t know what to do with this horrific memory. I am forever changed.

It is my hope that these sorts of situations become true “never events” and that we create a protective environment where there are no career consequences for medical students thrust into the unfortunate position of whistle blower. Maybe the courageous AIM editorial is the first step towards redemption and healing.

*Note that I never saw this resident again. Our paths did not cross after the incident, and it was only at the end of the exam that I fully recognized the evil of his intent.


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26 Responses to “Confronting Scandalous Physician Behavior: The Annals Of Internal Medicine Takes The First Step”

  1. Sara says:

    It’s encouraging that the writer wrote about this experience. As someone on the outside of the medical field, I certainly can’t speak to or say I understand the hierarchy that is in place in these environments. While the misogyny and racism may be less prevalent in the field, the hierarchy still appears to be a important feature in medicine (again, I’m going off of what I have seen, not experienced, as I am not a doctor).

    I can only go off what is written here, but it sickens me that this hierarchy would come in the way of someone speaking up when they see something being done that is wrong. Listen to your gut, this sounds like all types of wrong.

    I can’t imagine being in the position that the writer was in, especially when you are in school and you are in an educational environment. It would have been difficult for her to speak up. There’s also the shock that you may feel viewing something like this. But it almost seems like in the end she is coaxing herself out of guilt for not speaking up. He may have become an ophthalmologist, but how many other patients did he see to while he was in his residency? How many could have been affected like this little girl? How many others said nothing?

    With so many of these stories coming out of doctors behaving badly, it seems to be an issue that is not only covered up by the medical field, but implicitly encouraged by young trainees. Let’s be clear, doing anything other than speaking up when such behavior is taking place is being complicit in it.

  2. Jeremy Maxwell says:

    Thank you for sharing this, but do the world another favor and tell us who this guy is, so that we can all avoid him. I don’t want my future daughters anywhere near him. That poor, poor girl! She was raped and she probably doesn’t even realize it.

  3. I understand your perspectives, Sara and Jeremy. Unfortunately I had no hard evidence to support my account – no video, no other witnesses. The “rape” as I believe was the resident’s intent, was with a surgical instrument and gloved hands used in the expected location for the exam being performed. As Jeremy mentions, it is likely that the child did not realize what his intent was, which may have minimized the psychological harm.

    The point of this post is that horrible things can happen without sufficient evidence to convict – which puts everyone in a very difficult position, and where justice is unlikely to be served. As a profession we need to talk about this – and figure out a fair process for stopping it. As a frightened 20-something year old student, I did not have the knowledge or skills to manage this alone. It is tragic all around.

  4. Louise says:

    Thank you for sharing this!
    What a disgusting creep! I am myself in academia and I certainly do understand the difficulty for a young student to speak up, don’t feel bad about that. Also, the guy asking you how he did, makes it seem that he knew very well that you saw it and that you were in no position to speak up. He was on a vile power trip using two girls in his personal pleasure game. What a pig, what a loser.

  5. Thank you, Louise. The layers of complexity were not lost on you… :-)

  6. Whitney says:

    Thank you for writing this post. It leaves me both depressed and hopeful. Depressed because it feels as though not much (if anything) can be done in the situation described; hopeful in that even while you were in a no-win situation, given the position of student that you were in, it was not lost on you what was going on. The resident was quite clear in his actions & comments – if he continued that behavior (which I think is very likely), he continued to place himself in a position to have his actions called on for what they were.

  7. Lax says:

    Our family gyn, after examining me, at 18 years old, began to ask me bizarre questions, all about sexual preferences, which I avoided. He went on to go into great detail about his own (which I had never heard of, which were, I know now, voyeuristic and s/m type things. My boyfriend was in the waiting room, I was extremely embarrassed, and managed to end the “conversation”. My sister, years later, told my (unbelieving) mother that she awoke from anesthesia unexpectedly, after a DNC type procedure in his office, no nurse was present, and he was performing a sex act on her. He quickly reseated her. No one believed her except for me. My mother sent all my sisters to this man. He was finally caught, his medical license taken away. I believe this goes on all the time. Thank you for your posts. They are important.

  8. Katie says:

    Hello,
    In my life, I believe this is the first time I have ever left a comment on any article. I will keep this short. I strongly believe that you should report this doctor, even if time has passed. You may not be able to prove anything, but you know it is the right thing to do. A person like that who is disturbed enough to act like that and say those things in front of another person will only get worse with time. He learned that he can do what he wants and get away with it. Please do report him. (I do understand the nuances of being a medical student working with a resident, as I also went to medical school.)

  9. Warthog says:

    The fact that you did not SAY anything makes you as guilty, if not more guilty than he was.
    I hope that OUR paths never cross.
    You and many, many Doctors keep many a secret.
    You say it is nauseating? You nauseate me.
    YOU are in the wrong.

  10. MARY says:

    I am outraged but not surprised….. and it needs to be stopped. I had an encounter with a mail nurse when I was just out of a coma. Barely conscious, he came in to wash me. He made comments like “this is what we call Bush Washing, or something similar. He as there to take care of me but spent most of his time on the phone checking out the statis of his applications he’d put in at different locations, hospitals, — don’t know. He would spend his whole time each day talking on the phone when we was in my room. I was young and scared…he made my experience worse. Wish I had had the courage that I do now to confront this sub-human…..thanks for the article.

  11. Thank you, Lax and Mary for sharing your stories. I have been thinking a lot about what we could do to stop this behavior. Perhaps a professional society like ACOG (American Congress of Obstetricians and Gynecologists) could lead the way with a reporting process? Any patient (or colleague) who felt that a physician was behaving inappropriately (but the interaction did not reach a level of legal intervention) could submit a complaint. If a pattern of complaints arose, an investigation could begin. That way the medical profession could intervene with doctors who are behaving badly even if there wasn’t sufficient evidence (potentially) to convict them of anything in court.

    ACOG would probably want to test out this reporting system with a smaller group of physicians first, to make sure that the reporting process wasn’t abused by disgruntled patients/colleagues who might not have true grievances beyond a dislike of personality quirks or billing issues. I think that even if there were a few of those, patterns of misconduct (especially sexual) could emerge, and something could be done with the problem physicians. I hope that professional societies will strongly consider this idea. Any other thoughts?

  12. Molly Webster says:

    During the Obstetrics rotation of my nursing program, I witnessed multiple instances in which male obstetricians behaved inappropriately. Standing at the nurses’ station one morning, an OB made mention of the fact that one of our patients, a beautiful Tahitian woman, was on the board for a procedure. “Oh,” he breathed, “I can’t wait to get my fingers inside her!” He laughed.

    This same OB also “helped” women experiencing inability to achieve orgasm by using manual dilators and stimulating the women to climax while on the exam room table. He was “very proud of [his] success rate.” All this in the name of health education.

    Another OB was known for “rocking the delivery table” during second stage. The nurses were disgusted with his behavior but he was never formally sanctioned for it.

    Sad, sad situations. By saying nothing, we assent to these misuses of medical power.

  13. Laurie says:

    In nursing school during one of my surgical rotations I witnessed extremely shocking comments made about my patient during surgery by the anesthesiologist. It was not sexual in nature, but I was appalled and felt so very bad for my patient. She was a terribly scared young woman who had been through a great deal and lost a lot of weight- over 100 pounds. She had lots of loose skin causing a lot of issues and was having it removed. The man kept making disparaging comments about whales and blubber- basically “fat” jokes while this woman was asleep. It was so completely unbelievable to me.

  14. Jen says:

    You are a physician, not a district attorney, so stop making assumptions about how to deal with crimes committed by people in the medical profession. The idea of a medical society complaint log is ludicrous.

    Since you never saw this guy again, you have no idea if he continues to violate patients or if his pedophilic crimes are continuing in his private life. It’s apparent that this man has an anti-social personality disorder and that is not going to change.

    One way YOU can deal with this memory is to report it now. Give the police, the hospital that this occurred in and any appropriate medical licensing boards the details and let them determine how to proceed.

  15. nk says:

    Please, as other commenters have advised, report this physician immediately. What you describe is a crime and the criminal is still able to harm others. The victim should also receive assistance for her suffering. It is not true that her supposed lack of awareness that she was being victimized minimizes her suffering. This is a rape of a minor and must be reported.

  16. Tmunk says:

    I find your story less than genuine. I think your declarations of not knowing where this colleague ended up is meant to scare all of us who rely on doctors for our care. Crazy that I found this link from NYT. Cannot believe everything you read.

  17. Amelia says:

    Give me a break! “The physicians-in-training are scarred by the experience, partially because the behavior itself was so disgusting, but also because they felt powerless to stop it.”

    If we are scarred by witnessing or hearing about emotional or physical cruelty (and the prolonged gynecological exam was emotional cruelty), then you just scarred me and every other compassionate person whose eyes scanned your silly little essay. According to your logic, if we read about Nazi concentration camps, we are scarred. ISIS’ horrific executions–forever scarred. Stain and the Kulaks–scarred. Mao & the Cultural Revolution. Darfur. Guantanamo. Executions by Mexican drug lords.

    The essential part of this story is that when you had a chance to do something, you did nothing, because it might have affected your career adversely. You were the other adult and the other medical professional in the exam room, yet you didn’t bother to ask to take over or ask him if he didn’t have the sample or “couldn’t finish soon?”–you didn’t even INTERRUPT!!!–because you were worried it might slow YOU down. That’s what i get out of your story. And that’s what you should get out of it, too.

    The girl is probably o.k., because she probably thought it was just a bad medical experience, the way so many medical experiences are.

    Don’t try to play the big crusader for women’s rights with this story. Don’t act as if you’re brave, because you’re not. You’re just getting mileage out of the abuse you witnessed and made not the slightest effort to stop. You’re just another voice in the chorus in an era of moral panic.

  18. Vanessa says:

    I am a physician, mother and staff in a male-dominated field. My advice is: ifyou don’t speak up as a trainee, you will certainly not do so as faculty, so do it. Even if it turns out to be a “she said, he said” scenario, if for no other reason perhaps others will be paying more attention to his behavior. A little reputation goes a long way in medicine. If he behaves, great. If not, a pattern may be established. Silence is enabling. And, while a trainee, residents/fellows at least are (or should be) protect by the ACGME; your DIO should be your advocate if needed be. Our patients rely on us to be their advocates, never forget that.

  19. Vanessa, unfortunately this happened ~20 years ago. I never saw the resident again and I don’t know his name.

    I think the comments like those of Amelia are not helpful in this dialog. Other women who bravely describe the things they’ve witnessed (but did not report for one reason or the other as we read above) are learning from her that they will be quickly vilified.

    This kind of bullying is part of what keeps us from facing the problem – those who do speak out are shamed and silenced. In the spirit of not judging and presuming “guilt” on the part of those who did not know how to stop what they saw, or who did not respond in the way we personally think may have been best, I am asking for commenters to refrain from ad hominem attacks. All civil discourse and opinions are welcome.

  20. Rose says:

    Thank you for this insightful post. During my years as a clinical psychotherapist, I worked with many women who had experienced some form of sexual violation by a family member, acquaintance or professional in their lives. I think the professional violations (by another therapist, clergy, physician, etc.) were as much or more traumatic because of the trust they had placed in the professional, who then tricked and exploited them. I have also talked to people who shared memories about being under sedation, and do believe that on some level, people are aware when such violations happen. I believe it is important for peers to have a way to report unethical behavior on the part of colleagues – it is part of our code of ethics. I also believe professionals have an obligation to inform their patients about appropriate professional behavior. For a number of years, I was part of a team of women who taught pelvic exams to 3rd year medical students – my primary motivation was to assure that other women did not have to experience the rude, insensitive exams that many of my friends had had, which led them to avoid seeking routine gynecological care. We can all do something to speak out about inappropriate professional behavior and to support people’s rights to dignity as patients.

  21. Susan says:

    My mother grew up in Nazi Germany, and she has often said that if people had spoken up for what they believed was right, the Nazi’s would never have gotten into power. I admire my mother for speaking up even when the situation is uncomfortable for her. This story is a case where you too could have spoken up and should have. If not during the exam, then afterwards so that at least the doctor’s superiors would be aware of the doctor’s poor behavior and so he would know that his conduct was not condoned. This is a hard thing to do, I realize, but if we stand by silently, then nothing improves. I hope that if you and all of us encounter anything close to this situation, we will stand up for what we believe is right.

  22. Alan says:

    Several years ago a medical school classmate called me out of the blue to “catch-up.” I hadn’t heard from him for over twenty years. Later that day I asked my wife,” You’ll never guess what “so and so” specialized in?” She had met him several times during my medical school years. Without hesitation she said “Ob-Gyn.”
    Twenty-five years later he still works and has a 5 star rating in Healthgrades and other reviews.
    Thanks for your story, It’s brave to let out a story that most people would not be willing to expose.
    There are experiences that develop into black and white over time, but most humans get paralyzed by reactions and emotions that sees lots of gray too. I hope that this physician too is 5 star rated and contributed positively to our profession and to many individuals’ lives.

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