Ethics in medicine – real life experiences

I haven’t been posting very regularly on this blog since starting my third year of medical school because I’ve been a bit busy adjusting to the new routine of seeing patients every day. I must say that although the hours required during the clinical years of med school are worse than the classroom years (overnight calls, long shifts of standing, etc), it is also much more interesting seeing patients every day and applying everything we’ve learned up to this point (hello steep learning curve!). With this intense clinical exposure comes a lot of scrutiny of my future colleagues – I look at each of the doctors I work with and see traits I would like to possess, and also those I do not. While I can say that most of the doctor’s I’ve worked with have been fantastic both with their patients and with their interest in teaching us students, a few have been downright awful and possibly unethical. Here is a sample of the worst that I’ve encountered these past few months:

The first is a doctor that takes no interest in the students and barely listens to what we have to say after we interview her patient and give a report before she examines them. I have to wonder why someone like this doc is working for a teaching hospital if she obviously despises the students. To make matters worse, a few of the students who have worked with her more frequently have commented on how she treats patients differently depending on their race. While I haven’t witnessed this first-hand (I’ve only been with her on a few occasions), I can’t say it would come as much surprise…I understand everyone has personal biases, but when you care for such a diverse patient population as ours it is necessary to work extra hard not to let your biases influence care. I hope I don’t turn out like her.

The second involved a primary care physician who was treating a morbidly obese patient with osteoarthritis of both knees. This patient’s insurance would not cover a particular injection the doctor wanted to give to alleviate the pain/inflammation of her joints, so the doctor was in the process of setting up a situation where she would order the injection for another patient whose insurance would pay for it, but give it to the first patient. I’m pretty sure that counts as some form of insurance fraud, but my guess is a lot of people would look the other way because of the general public perception of the “evil insurance company.” While I certainly sympathized with the pain this patient must be going through with her knees and the impact it has on her quality of life, I couldn’t help but think that if she would lose even a little weight she would feel a lot better all around. Perhaps the insurance company wouldn’t cover the shot because it likely wouldn’t make much difference given the severity of her obesity and arthritis. But what do I know?

The third doctor was a specialist performing an endoscopy-type procedure on a middle-aged woman. If you’re not familiar with how those procedures work, you are basically putting the patient under partial anesthesia so that they are awake but heavily sedated. Most people don’t remember much afterwards, though their eyes are open and they can talk a bit throughout the entire thing. This doc was chatting with his fellow nurses and technicians when politics came up. I was always raised never to bring up “religion and politics” while at work, but I figured since these people worked together for so long they must be comfortable discussing their views. The doctor was a republican, while most of his coworkers in the room were democrats…to be honest I think they were all a bit stupid when it came to understanding federal policy, as none of them sounded very educated on the issues (but I digress…). Of course Barack Obama comes up, to which the doctor makes some remark about how “Obama’s a muslim, and I just don’t think it’s right to have a muslim in office with terrorism being such a issue” etc. I’m probably wording things a bit more eloquently than what came out of this guy’s mouth. I am not an Obama fan for various reasons, but I couldn’t stand by quietly while this doc was spouting lies. I made some comment about how Obama is actually a christian, but how some keep trying to spread the rumor that he is a muslim because they think it will deter people from voting for him. Then the doc starts rambling about muslims, saying what essentially amounts to “muslim = terrorist”. Suddenly he becomes aware of what he’s saying, and he looks down at the patient and asks, “are you a muslim, ma’am?”. This poor woman, in her drugged state shakes her head “yes” and says something unintelligible. The doc’s face loses a bit of color, and then he turns to one of his nurses and asks if she would please administer more of the drug that produces amnesia (so the patient won’t be able to remember the offensive things he said). The nurse looks at him thinking he’s joking, but the doc is entirely serious, so she administers more of the drug. Would the extra dose of this drug harm the patient? Probably not, though it is still plausible that it might have. I guess “first do no harm” goes out the window for this guy when you say something offensive to your patient who is completely incapacitated. It made me really sick to my stomach to witness the entire thing, and I hope I’m never paired with this doctor in the future.

I still think most doctors are good people, and this has been confirmed numerous times for me in the past couple of months as I’ve worked with a variety of different practitioners, but it’s hard to look at them the same way when there are a few rotten apples spoiling the perception. I may not know what kind of doctor I want to be at this point, but I’m starting to get a good idea of what kind I don’t want to be. From your perspective, what are traits that make a doctor good or bad? Any comments are appreciated!