* * Anonymous Doc: When doctors attack... patients... while students are watching... ?!

Thursday, January 26, 2012

When doctors attack... patients... while students are watching... ?!

I was planning on responding to one of the comments from yesterday's post. I was planning to say that, yes, we do have a system for reporting errors and other incidents, but it doesn't seem like anyone uses it, I have no idea where the information goes, and certainly no one ever talks about using it, or has ever encouraged us to use it. So, it's a great system.

For dramatic purposes, let's imagine I was writing that post, when one of my medical students interrupts me.

"Doctor, we're back from that test you had us accompany the patient to."

"Oh, great. I wanted you to get a chance to see an actual procedure done on one of our patients. Was it interesting to watch?"

"Uhhhh... sort of. It was awkward."


"Yeah, the doctor was kind of yelling at the nurses."

"That's unfortunate."

"And the patient."


"Yeah. She wasn't fully sedated, and she was struggling a little when he put the tube in, and he started calling her names--"

"Maybe he just wanted to make sure she didn't get hurt--?"

"He slammed her head down on the bed pretty hard."

"He did what??"

"Yeah, we were all looking at each other and felt really uncomfortable, because it definitely seemed like he crossed a line. Should he have been that rough with a patient?"

"Rough is really not a word you should ever be using to describe how a doctor is treating a patient."

"And we didn't want to say anything, because he's an attending and we're just students--"

"Of course. That's obviously a very awkward position to be in. And the other students felt the same way?"

"Yeah, we were talking about it the whole walk back here. We're not sure if there's something we should do, some way to report this. Oh, he also called her crazy, and then said she won't remember anything anyway because of the sedation."

"This seems like a setup for something they would use to test whether people use the incident reporting system."

"So you think we should report it?"


"How do we do that?"

"I don't know. But let me figure it out, and then later I can show you and we can definitely report this. I don't want you to think that's an appropriate way for doctors-- for anyone-- to behave. To anyone, let alone a patient. And you're sure this couldn't have been interpreted in some other way?"

"Uh, yeah. We were all pretty scandalized."

......So I find the incident reporting website, and it's broken. I call one of the administrators, who's never heard of the site. He refers me to another administrator, who tells me I have to sign up for a username and go to another site. He refers me to another administrator......

"Are you sure you want to report this?"

"Are you sure you want to ask me that? Why wouldn't I report this? I think it's a valuable lesson for my students, and definitely not an appropriate way to treat patients."

"But you want something to be in writing? Maybe you should talk to the attending first."

"I didn't see what happened. My students did. I don't think they should have to talk to the attending. There's a good reason something like this can be reported anonymously. It shouldn't be the responsibility of the students to have a conversation with an attending about how he treats patients. It needs to be reported, and investigated."

"Come on, it starts a whole process."

"Uh, yeah, that's the point."

"And you're sure you have all of your facts straight?"

"I have the facts of what my students-- three of them-- all agree they saw, and I think it rises to a level where there should be further investigation. I'd rather err on the side of patient safety."

"I'd rather you err on the side of not reporting things. I wouldn't want you to regret it down the road."

"Can you please just tell me how to log in to the system?"

.....So, yes, we have a wonderful incident reporting system, and it works tremendously well to protect our patients and our staff. My students filled out the form. The system shot them back an error message. They will be submitting it by hand tomorrow. And, I fear, and unfortunately expect, that no one will ever hear anything about it again. Excuse me while I go slam some patients' heads into the wall.


  1. If all else fails, perhaps they could talk to a clerkship director or someone else at the medical school. Med schools are at least supposed to be nominally invested in this sort of thing, even if the hospital seems to be primarily interested in covering its ass.

    Good for you for pushing back on these people. I'm seriously horrified that this happened.

  2. As an ICU RN, I have written MANY incident reports. Most on myself, but a few on others (RNs and MDs). The purpose for these is to protect the patient - period. I'm lucky enough to work in a place that tries very hard to fix the system that allowed someone to make a dangerous mistake without excessively blaming individuals. But what you describe - I would follow that all the way to the top. It is unacceptable on so many levels, and I would not let it go until I knew it was in the hands of someone who would act on it. That includes the incident reporting system, but also informing individuals in places of influence. I know enough of these folks that I can let go of whatever it is once they tell me they'll deal with it. Who do you have who can push this forward for your students? Teach them now how to effectively navigate systems, not to learn to be passive "because nothing ever changes." Also, talk to the nurses present during this - they may have other pathways to pursue this, too.

  3. Wow. That is like something out of some horror movie or House or something... Good for you for pushing to get it reported, the world needs more doctor like you!

  4. I think this is a case for the police. I don't know if you can stay anonymous, but you can just tell the patient to report it to the police so the attending won't know who you are.

    Reporting the incident to the hospital will amount to nothing. There's too much bureaucracy and nobody cares. When I have a question about something I witness, I talk to the police at my hospital to get a quick and honest answer.

    A lawyer from my university's hospital spoke to my class about incidents like this. The patient has every right to call the police on us if we assault them. Forunately for the hospital, patients usually don't speak up or know their rights.

  5. What you've described, beyond abhorrent physician behavior, is assault. I agree that the police should be called. This physician should be standing tall in front of both a judge (both civil and criminal) and a medical board. What a disgusting and sad story. We're supposed to be healers, ya know?

    Good for you for standing up to this a$$hat administrator and having the courage to do the right thing.

  6. Anon @8:15PM: I'm guessing the patient won't be able to report this, because she was probably given something like Fentanyl/Versed. Those drugs cause some degree of amnesia, so even though sedation was inadequate for the procedure, she won't be able to accurately describe what happened and the attending could credibly argue she was confused. Unfortunately, the students and the nurse are the only witnesses to the attending's unacceptable behavior. I'm guessing this wasn't the first incident, and the reporting situation Anonymous Doc describes is very common. Thus, people like this continue to practice without being disciplined, continue to teach young healthcare providers, and the cycle continues. Disgusting, but I've seen it over and over again.

  7. This is so wrong, I hope it gets addressed.

  8. Let us know what happens ... even if nothing ... down the road. Your reading public wants to know!

  9. I'm the original "Anonymous" above - people like this do NOT consistently continue to practice. I'd like others to know that it can be addressed and does actually impact what happens...but "the powers that be" need to be informed. That alone takes guts to report, but AnonDoc has already done that. Now he just needs to make sure it is heard. There are folks that no longer practice where I work because of me...a hard thing to say (it was their livelihood, etc), but nothing comes above a patient's wellbeing and safety.

  10. Academic doctors are often in academia for a reason: they don't interact well with patients or the "real world." This isn't shocking, to me at least.

  11. All that is necessary for evil to thrive is for good men to do nothing....


  12. I know a child who had a painful procedure take over an hour because a med student was learning. Everyone thought nothing of it because the kid had amnesic meds on board. If a parent had been present I don't think it would have happened. I just think this goes on all the time!