Virginia Case Raises Questions About Ethics Of Patient Care

Transcript

RACHEL MARTIN, HOST:

A case in Virginia is raising serious questions about what doctors can and cannot do when a patient is sedated. In this case, a man wanted to make sure he captured the doctors' instructions after a colonoscopy, so he started a recording on his smartphone before going under. Here's what the anesthesiologist said to him once he was out.

(SOUNDBITE OF PHONE RECORDING)

UNIDENTIFIED WOMAN: And, really, after five minutes of talking to you in pre-op, I wanted to punch you in the face and man you up a little bit.

MARTIN: But the patient didn't just record inappropriate comments - and there were many - the doctors were also accused of putting false information on his chart.

(SOUNDBITE OF PHONE RECORDING)

UNIDENTIFIED WOMAN: I'm going to mark him hemorrhoids, even though we don't see them and probably won't. I'm just going to take a shot in the dark.

MARTIN: A jury awarded the man $500,000 for defamation and medical malpractice. To talk about this story, we're joined by Katie Watson. She's a professor of medical ethics at the medical school at Northwestern University. Thanks so much for being with us.

KATIE WATSON: Hi.

MARTIN: You heard the tape of these doctors making these jokes. What was your reaction?

WATSON: I was surprised by the profoundly juvenile level of the joking. I was disappointed how the patient was the object not just of unflattering and demeaning descriptions, but also of what I would categorize as a junior high level of bullying, which, in junior high, might be called a prank and, as adults, is called falsification of medical records.

MARTIN: You know, there are certain industries, especially high-stress industries, like medicine, where it's common to hear examples of gallows humor - really dark jokes being told. And you've written about this, and you've said that that's not necessarily such a bad thing. Does this case fall under that category?

WATSON: No, I don't think it does. Gallows humor is when clinicians joke about things like death and dying - very emotionally difficult circumstances that are insurmountable obstacles and are really part and parcel of certain areas of medicine. So joking is a way to deal with these emotionally difficult parts of their job. And then another aspect sometimes is time pressure. So for example, in an emergency department, when you don't have time to do a different kind of processing of emotions, sometimes a joke is a way to just let it go and move on to the next patient, to give that next patient your best.

In this case, a colonoscopy is a routine procedure, and this patient - perhaps he was annoying in his initial presentation. Using ridiculing words like man up, joking about a rash on his genitals, putting that he had hemorrhoids on his chart as a prank does not appear to me to fit in the category of gallows humor or any kind of productive use of humor. Instead, it's a cheap excuse to have a laugh at a powerless person's expense.

MARTIN: From your vantage point, is there a larger lesson in this case? I mean, what's the takeaway here?

WATSON: I think the takeaway is that all professionals, not just in the - in medicine, have legitimate frustrations and complaints. And if you listen to the full excerpts that were captured and that were put on the Internet, the clinicians actually move to some legitimate complaints and frustrations they have not just with this individual, but with patients generally. But instead of dealing with those frustrations directly and trying to minimize them or change the circumstances, they took out their frustrations on the easy punching bag of a patient - and a patient when he was unconscious. So one takeaway is that we have to deal with these things directly. If a patient is bothering you or annoying you or not behaving appropriately, address that with the patient. But to do the end run of ridicule and bullying is below professionals.

MARTIN: Katie Watson is a professor of medical ethics at Northwestern University. Thanks so much.

WATSON: Thanks, Rachel. Transcript provided by NPR, Copyright NPR.