Dr. 101: “If I see something that I don't agree with, I say something”
dr. 101.
“I would say that I always did what I thought was right, and I wasn’t afraid of the consequences, because if I was right, there should be no consequences”.
Dr. 101 is a specialty department chief at an urban community hospital. The events of this story took place during the 1970s. This interview has been edited and condensed to create the following story. EnduringCaduceus commentary immediately follows.
Medicine is my seventh career. It’s probably the career I always wanted but never had the academic discipline to do. That turned out to be a function of the fact that I’m dyslexic, and I never knew it.
I got by academically because I had total recall. If information was presented in a sentence structure, I couldn’t deal with it, but if it was presented in a graphic, pictorial, or outline form, I could memorize it almost instantaneously.
So, depending upon the subject matter, I could do ridiculously well or ridiculously poorly. I developed all sorts of coping mechanisms to convince myself that I wasn’t stupid. Eventually, I figured out why I was different and I began to understand myself better. At that point, I realized that I wasn’t happy with my career and I decided to switch to medicine.
Medical school was the beginning of my understanding that medicine had nothing to do with what I believed about life and what I thought was right and wrong.
I just told this story to an obstetrician gynecologist friend who was really upset by something. I told him, “If we don’t all speak up when we see something that we know is wrong, then we are complicit and can’t complain about it.”
I was a third-year medical student doing a gynecology rotation with five other students—all men. And when I tell this story, I can still see it—the operating room, I see the whole picture.
“Medical school was the beginning of my understanding that medicine had nothing to do with what I believed about life and what I thought was right and wrong. ”
This Attending gynecologist was doing a surgery on a woman with the worst case of condyloma acuminatum I’ve ever seen. They were covering, you know, everything, and he was meticulously excising each one of the warts one by one.
The five of us were standing there, and then all of a sudden he turns around to us and he says, “I’m bored, this is going to take forever,“ and he did a total vulvectomy.
He just removed everything—everything. It was all covered with condyloma, but rather than trying to do something less invasive, he did a total vulvectomy and just took everything off.
It happened in a split second and then I started to walk out. When I got to the door, he looked up at me and said, “Where are you going?”
I said, “I’ve seen enough.” He said, “Well, I’m not finished.” And I said, “I’ve seen more than enough, and there’s nothing else in this room that I want to see or learn.” And I walked out.
My beeper goes off about an hour later, and it’s the Dean’s secretary. She said, “You are suspended from your duties as a medical student, and you are to be here at 7 o’clock in the morning to meet with the Dean.”
The next day, I walked in, and the Dean was sitting behind his desk. He said, “What you've done was gross insubordination in front of other medical students, nursing staff, and colleagues of Dr. P.
You can either resign without prejudice or go through a disciplinary process, where you'll have a written record of what you've done".
I said, “I’ll tell you why I walked out of the room and said what I did. If you think what I did was inappropriate, then I do not want to be a doctor.” I told him the whole story and walked out.
At 1 or 2 o’clock in the afternoon my beeper goes off, and it’s the secretary again saying I had been reinstated, but that my rotation would be someplace else with a different Attending.
The Dean never talked about it again. Never said a word. Never explained why I was reinstated. I think the possible explanation was that they realized I had good grounds for doing what I did.
If they kicked me out of medical school, it would be uglier than if they kept me because what this guy did might came to light. Not only was it unjustified, but he totally mutilated a woman, a young woman—just incredible.
The reason for the story is medicine is sort of a kangaroo quirk that silences people who disagree. Their voices are often limited by the ego of another human being.
“The reason for the story is medicine is sort of a kangaroo quirk that silences people who disagree. Their voices are often limited by the ego of another human being. ”
It’s not about the patients, it’s often about the ego of the individual who has gotten a place of authority—it’s a feudalistic society. In our environment, we see horrendous behavior all the time, but when you see it happen over and over, it doesn’t seem so horrendous anymore.
Even I’m not without sin. I’ll walk into a patient’s room, and I won’t introduce myself. I won’t even realize it because, well it’s me, and I know I’ll be good and nice to this patient. But I catch myself at times.
As for a mantra, I would say that I always did what I thought was right, and I wasn’t afraid of the consequences, because if I was right, there should be no consequences.
Enduring Caduceus Commentary
During our interview, Dr. 101 told me several examples where, as a medical student and intern, he spoke up against authority after witnessing things he thought were wrong.
In this narrative, I included only the story about the gynecology patient. The agony and horror of this decades-old experience showed in his face as he told me what happened.
For those who need a refresher, condyloma acuminatum are genital warts and a complete vulvectomy is the entire removal of the external female genitalia. The procedure is reserved for cases of vulvar cancer. This type of cancer occurs at a higher rate in women with a history of genital warts or human papillomavirus-related disease.
However, based on the events described, we can conclude that performing a complete vulvectomy for genital warts, even though they were extensive, was inappropriate.
Out of curiosity, I asked about the patient’s ethnicity. Dr. 101 said, “She was Hispanic. He [the physician] was not.” We both paused for a moment after this answer, I suspect because neither of us knew the best way to address it further.
It is apparent that depersonalization played a role in what happened to this patient, but my biggest takeaway from this interview can be summed up in one word—courage.
It may not be easy, but finding the courage to stand up for yourself and the patient can build your confidence and inspire others. And maybe we can start to steer our culture away from silence and fear.