Medicine Surgery

One surgeon behaving badly as an excuse to bash surgeons

You know, it really annoys me when I see idiocy as idiotic as the idiocy of this surgeon in New Jersey:

In a lawsuit filed yesterday, a Camden County woman accused her orthopedic surgeon of “rubbing a temporary tattoo of a red rose” on her belly while she was under anesthesia.

The patient discovered the tattoo below the panty line the next morning, when her husband was helping her get dressed to go home after the operation for a herniated disc, her attorney, Gregg A. Shivers, said in a phone interview yesterday.

“She was extremely emotionally upset by it,” said Shivers. The suit, filed on behalf of Elizabeth Mateo in Camden County Superior Court, seeks punitive and compensatory damages from Steven Kirshner, a board-certified orthopedic surgeon with offices in Marlton and Lumberton, both in Burlington County.

Kirshner does not deny placing the tattoo – and has left washable marks on patients before to improve their spirits, his lawyer, Robert Agre of Haddonfield, said last night. He said none has complained.

“What’s offensive about this complaint is that it suggests something he did was intended to be prurient, and nothing could be further from the truth,” said Agre. “It was intended just to make the patient feel better.”

Let me just say: Dr. Kirshner is a twit. A surgeon can’t ethically do something like this. He just can’t. It’s a violation of trust and of the doctor-patient relationship. Worse, it was placed on what is considered private anatomy, which is normally covered by panties, a place that would heighten the sense of violation, especially in a female patient. That many patients apparently didn’t mind or were even amused by Dr. Kirshner’s warped sense of humor is irrelevant. He deserves whatever he gets.

Unfortunately, a fellow ScienceBlogger has, in a blast of ridiculously overblown rhetoric, decided to use this particular incident as a convenient springboard from which to generalize Dr. Kirshner’s apparent attitude towards his patients to all doctors and indulge in that favorite pastime among all too many, doctor bashing, and in particular surgeon-bashing (warning: this particular SBer loves exuberant profanity; don’t continue reading if you don’t want to see it–that’s why I put it below the fold). Let’s start with the doctor-bashing:

As someone who spends a substantial portion of his professional time teaching medical students, I can tell you that this kind of attitude-that physicians are gods, not mere mortals, and wield power over other human beings that no one dare question-is inculcated in them from the very beginning of medical training. It is an ugly secret of our medical training system. And the more prestigious the institutions where physicians receive their training, the more overweening is this attitude.

Anything that a physician calls a “joke” or “for the patient’s benefit” simply is that, and how dare anyone question that judgment!

My response will certainly not be as polite and restrained as that of Dr. Bates, and it may not even be as restrained as that of my much more sarcastic bud PalMD. PalMD may want to try to restrain his justified anger. On the other hand, I don’t know that I’ll manage to reach the stridency of condemnation that Mark Hoofnagle has.

I don’t know what medical school PhysioProf teaches at. Well, actually, I think I do, although I don’t know his name. What I definitely know, though, is that PP doesn’t have clue one about clinical medicine or the training of physicians outside of his narrow area of basic science classes. If he does, he’s never shown it. Moreover, his contempt for physicians is legendary. Everything he says is skewed by that, and what he describes does not resemble any medical school I’ve ever attended or been faculty at. Of course, my fellow SBer will probably retort with something as moronic as his generalization above, such as “You can’t handle the truth!” or “You’re a doctor and a surgeon; of course you would never see it.”

Such responses would be just as much bullshit as his careless and ignorant generalizations about physicians and his use of the bad behavior of one surgeon as an excuse to bash surgeons and physicians in general.

As an M.D./Ph.D. I’ve straddled both worlds, spending long periods of time exclusively in the world of basic scientists. Indeed, there were times when I seriously considered quitting surgery residency or clinical medicine to pursue nothing more than basic science. I know PP’s world. I’ve lived it. Maybe not as long as he has, but long enough. I still straddle both worlds and live his world to some extent, only now at the same time as being in the clinical world. And, having done so, I can with great confidence tell you that PhysioProf’s claim that “this kind of attitude-that physicians are gods, not mere mortals, and wield power over other human beings that no one dare question-is inculcated in them from the very beginning of medical training. It is an ugly secret of our medical training system” is a hot, steaming, stinky, drippy turd laid on the blogosphere–rather just like PP himself, come to think of it.

In fact, the opposite has until recently traditionally been true. If anything, before the last decade or so, medical training has resembled the military to some extent, especially internship, with the apparent goal being to show trainees that that they are stupid and worthless, the lowest form of life–scum not worthy of the great responsibility of taking care of patients. I exaggerate a bit, of course, but certainly the attitude that physicians–or even surgeons–are gods is not one that is inculcated in anyone who didn’t already have that attitude before going into medical school. And, sure, certain specialties probably attract certain personalities, but such fact-free, biased, and brain dead generalizations do not even try to describe this. They exist only as an expression of extreme contempt, and deserve nothing but contempt in return.

Yes, as a profession, we physicians and surgeons have our share of arrogant morons. So do Ph.D.’s in the medical schools where I’ve worked, and I’ve seen no evidence that such people are any less prevalent among our basic science colleagues, the nasty, arrogant “gods” among whom abuse graduate students and postdocs instead of residents and the hospital staff. I think I can guess what’s going on here with PP too. I’ve seen his type before: Big time researchers with multiple R01s who consider it so very far, far beneath them to be required by their medical school to lower their golden selves to teach medical students basic science and ultimately come to resent it and them, particularly infuriated that medical students tend not to perceive the utility of science that they won’t ultimately need for patient care. Another thing that might be going on here is that perhaps PP is faculty at too high and mighty of a prestigious medical school, and, if he really is observing a sense of entitlement in the medical students to whom he deigns lower himself to give scraps of his great and awesome scientific knowledge, perhaps–just perhaps–it’s a class issue rather than a medical student issue. Perhaps if he’d come slumming with me and PalMD at the mid-tier medical schools where we’ve been faculty he’d get a different picture. Certainly we have.

But then we’re doctors, and no doubt PP will simply dismiss our retorts simply because of that. It will never occur to him–not for even a second–that he is the one who has no clue. Here’s one last observation for PP: If you give off the attitude that you think medical students are arrogant twits with attitudes of entitlement, not only will you interpret all their behavior through the lens of your own bias (ever hear the term confirmation bias?), but you’ll probably unknowingly provoke the very behavior that you anticipate based on your bias. Listen up. You probably don’t realize this but clinical faculty have exactly the same sorts of issues to deal with, but we don’t decide that all medical students must be twits. For example, the vast majority of students who rotate on the surgery service will not go into surgery. Some of them make it very clear that they don’t have any interest in surgery and are just doing their time because they have to, just as I’m sure that some of them make it clear that they don’t care about your precious physiology lectures any more than to learn what they need to pass their boards. Instead of viewing them as being parasitic arrogant wonders with a sense of entitlement, we accept that when we took our jobs as faculty at a medical school it became our responsibility to train all medical students, not just the ones going into surgery, with the surgical knowledge that is considered necessary to being a good general physician, and we do just that.

Now, as I’m just warming up, here’s where PP really shows my profession the love and brings home the stupid:

Surgeons are the worst, they cut people’s fucking asses open with sharp knives, and they are basically used to functioning as dictators in the operating room. These leads to the development of attitudes which makes perfect sense in light of the practical demands of surgery. But they do not work well in other areas of life. Put a surgeon in charge of any enterprise that requires leadership through persuasion or consensus, and you are totally fucking fucked.

PP is so utterly clueless about this that I can’t even work up any anger anymore. Instead, I’m laughing at him. Yes, in the O.R. surgeons are the “captains of the ship.” It has to be that way. If a patient’s condition goes south in a hurry and something needs to be done immediately, we expect and need to have the O.R. staff do what we need them to do when we need them to do it. The patient deserves no less. However, emergencies aside, that power is not dictatorial. Perhaps it was in the past, but no longer and not for some time. Indeed, I highly doubt PP has ever actually hung out in an O.R. for any length of time. These days it’s a highly collaborative effort between surgeon, anaesthesiologist, techs, nurses, residents, and sometimes many others. Here’s another clue: Surgeons aren’t in the O.R. all the time. In fact, we’re in the O.R. less than half the time, if that. The rest of the time we’re in the clinic seeing patients, rounding on patients in the hospital, serving on committees, and doing a variety of administrative jobs. For most surgeons, time spent in the O.R. is nowhere near the majority of their time. There’s a lot more to being a surgeon than just operating.

As for surgeons not being able to lead through persuasion or consensus, give me a break? Where does PP get his ideas of surgeons? Scrubs? House of God? The guy can’t seem to spout anything other than the most simplistic stereotypes about doctors and surgeons. Rare is the department chair or division chief these days who doesn’t have to lead through consensus. The days of the dictatorial department chair are long, long gone.

You know, the really sad thing about my having seen PP’s rant is that his other posts about grantsmanship, running a lab, and writing papers are generally really quite good. I recognize this precisely because I straddle both worlds, basic science and clinical surgery. The guy could be a lot better than his idiotic rant on Feministe and his own blog. Sadly, he chooses not to be. More’s the pity. That leaves me with this question: If PP has such utter contempt for physicians and the medical students who will ultimately become physicians, why on earth does he continue to have anything to do with them?

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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