KevinMD: Hospital fires MD for standing up for his beliefs

[drusso]

This is happening every day...

A physician was fired for standing up for his beliefs

"Here’s what is controversial: Physicians are silenced. They are incapable of expressing their views from within the system, even when those views pertain to public health advocacy. Physicians are expected to be assembly-line workers who keep their mouths closed, who do as they are told, who do not rock the boat. Individuality is removed piece-by-piece from brilliant young minds until they are reduced to machinelike robots operating under fear-mongering tactics like “professionalism.”

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[hyperalgesia]

This is happening every day...

A physician was fired for standing up for his beliefs

"Here’s what is controversial: Physicians are silenced. They are incapable of expressing their views from within the system, even when those views pertain to public health advocacy. Physicians are expected to be assembly-line workers who keep their mouths closed, who do as they are told, who do not rock the boat. Individuality is removed piece-by-piece from brilliant young minds until they are reduced to machinelike robots operating under fear-mongering tactics like “professionalism.”

I don't know if residency is the best place for political activism...

Vanderbilt puts Duke Med alum on leave after complaint about kneeling to protest white supremacy

 

[emd123]

I've seen plenty of this guy's stuff pop up on twitter. It doesn't surprise me his mouth got him fired. We are not rappers, cable news hosts, or political campaign staff, for whom controversy is currency. It rarely pays to be controversial in Medicine, in fact non-conformity is almost always punished. For someone who claims to be so much smarter than everyone else, this guy sure seemed to miss that very elementary point.

 

[Aether2000]

While his points may have been well taken, the unmasked identity delivery of his ponderings cost him his job, just as the same would probably get many of us fired who work for corporate America. If you disagree with corporate decisions made by your employer and do so publicly in any profession, you are not protected from being sacked.

 

[emd123]

After reading more about this story, it looks like there were job performance issues. Regardless, it's pretty damn hard to get fired from residency, especially surgery where the call is extensive and no one in their right mind wants to thin out the coverage even more. But somehow this genius managed to do it. One of the things I read, was that a patient refused to give him consent to operate on him, and so as a response he went online and blew up the internet, ranting about it, criticizing his employers, which made them nervous about a potential HIPAA violation. Likely they've documented plenty of severe fireable offenses to protect themselves from the inevitable lawsuit they know is coming, since this guy is a known litigator, having already sued President Trump (and won!) for blocking him on twitter.

 

[Ducttape]

1. he is still a "physician-in-training". he is still in school, as it were.
2. while I do agree with some of his political opinions (by that I specifically am referencing his lawsuit and generally being opposed to the policies espoused by Trump), there is a time and place for these activities. generally speaking, on hospital grounds is not one of them.
3. racism is still alive and well in certain parts of the country. many like to think differently. or, in the writings of doctodd, all conservatives know that no racism exists at all...
4. the author of the report is, of all occupations, a medical student. she has no inkling of what it takes to be a real physician.

if he wants to be politically active, fine, but it should only be on his own time, and not at the cost of his professional calling.

 

[emd123]

3. racism is still alive and well in certain parts of the country. many like to think differently. or, in the writings of doctodd, all conservatives know that no racism exists at all...

Yes, racism is alive and well and it's abhorrent. However, informed consent is another issue at play here. Take the example the doctor in question gave on twitter. He recounts an example of a patient who refused to let him operate on him due to "his race." He then says a supervising resident "didn't allow him to operate on the patient." Then he responded by blowing up his employer on twitter as racist, throwing HIPAA to the wind and ignoring the fact that the patient didn't give informed consent to be operated on by him. Now let's assume the patient's reason for refusing consent for this to operate on him was entirely racist (and not due to competency issues as the university alleges or poor bedside manner). If so, that's abhorrent on the patient's part without justification. Regardless, you cannot force, and no chief surgical resident can or should force a patient, against his will and without informed consent to be operated on by someone he's not given consent to, whether the reason is abhorrent or not. I've had patients cuss at me, threaten me, call me names, and otherwise act abusively, sometimes in states of psychosis or intoxication (mostly in ED settings), but that never gave me the right to operate on them against their will. But from what it sounds like, this physican tried to turn that around on his employer and blame them, publicly on twitter, for the racism of a patient claiming that they should have allowed him to violate a patient's informed consent. No matter what names a patient calls me, that does not allow me the ability to perform surgery or procedures on them, against their consent. Nor does it justify trying to settle a score with your employer over something like this, potentially violating HIPAA, on twitter. It's no surprise he'd get fired after this. It sounds like he was expecting his chief to allow him to operate on a patient who specifically refused consent for this specific surgeon to operate on him. No matter how racist and unjustified the patient was, that's nuts. If a (legally competent) patient says, "Don't operate on me," you can't operate on them, period.

1. he is still a "physician-in-training". he is still in school, as it were.

Correct. In other words, not an expert in anything yet.

2. while I do agree with some of his political opinions (by that I specifically am referencing his lawsuit and generally being opposed to the policies espoused by Trump), there is a time and place for these activities. generally speaking, on hospital grounds is not one of them.

Exactly. We all have opinion on everything. I can only imagine how painful my work day would be if I had to hear about and argue the most deep seated political and religious points of everyone in my office, every day. Most people with common sense seem to get this. Apparently this guy didn't. It seems he values grandstanding for political points (ie suing Trump for blocking him on twitter) above his own career. Now as a 3rd year resident with no program, he's in a real tough spot. To me, that shows extremely poor judgement for someone who in his twitter bio claims he's going to "cure heart and kidney disease in babies." I'm not sure how he's going to cure "all heart and kidney disease in babies" as a 3rd year resident, with no program and no board certification in anything. How about start with learning how not to get fired while learning basic appy's and chole's first? It seems there's a big issue with maturity, here.

4. the author of the report is, of all occupations, a medical student. she has no inkling of what it takes to be a real physician.

.

Correct. The article was mostly virtue signaling without much understanding of how medical training and physician practice works in the real world.

 

[Ducttape]

I've had patients cuss at me, threaten me, call me names, and otherwise act abusively, sometimes in states of psychosis or intoxication (mostly in ED settings), but that never gave me the right to operate on them against their will.

only critique on your comments above - you actually do have the right to operate on intoxicated or psychotic patients. if the patient is not of sound mind and lacks capacity and it is in the patient's best interest, you do have the right to perform treatments against their will.

 

[pastafan]

only critique on your comments above - you actually do have the right to operate on intoxicated or psychotic patients. if the patient is not of sound mind and lacks capacity and it is in the patient's best interest, you do have the right to perform treatments against their will.

If you have a court order or permission from their legal guardian. Life threatening emergency and you're taking a chance.

 

[drrosenrosen]

You can absolutely perform medical treatments in the event of a life threatening emergency without consent. That's the whole idea behind trauma surgery. It's not "taking a chance". Now, anything not immediately life threatening, I agree with you, you have to get their conservator or guardian on the phone and get an informed consent.

 

[BigRedBeta]

There are a significant number of conversations circulating widely that suggest Dr. Gu was a poor resident whose performance was not progressing to same degree as his co-residents. That was the larger issue relating to his dismissal and why you don't see any colleagues or faculty members rushing to comment on the "unjust" actions of Vanderbilt.

It's pretty common in medicine that you can keep your job if you are an a*shole but good at your job. Likewise, people will let you slide if you are enjoyable to be around even if you aren't a particularly good doctor. But if you are dangerous to patients AND unpleasant or a distraction? Yeah good luck with that.

 

[pastafan]

You can absolutely perform medical treatments in the event of a life threatening emergency without consent. That's the whole idea behind trauma surgery. It's not "taking a chance". Now, anything not immediately life threatening, I agree with you, you have to get their conservator or guardian on the phone and get an informed consent.

To clarify my caution. Is it truly an emergent life threatening emergency, GSW, major trauma or a surgeon who wants to cut and urgency is questionable?

 

[Ducttape]

yes pastafan, you are wrong.

you have to determine if there is a life threatening emergency, then determine patient capacity (minors cannot self-determine capacity - that is where you need to contact a guardian) and whether treatment would pose an undue burden to the patient.

patients refusing EMS care: https://www.jems.com/articles/1969/12/patient-refusal-what-do-when-m.html?c=1

patients refusing MD care: autonomy vs. duty to treat: VM -- Does Patient Autonomy Outweigh Duty to Treat?, Feb 03 ... Virtual Mentor

 

[emd123]

only critique on your comments above - you actually do have the right to operate on intoxicated or psychotic patients. if the patient is not of sound mind and lacks capacity and it is in the patient's best interest, you do have the right to perform treatments against their will.

Sometimes yes, and sometimes, no. If a patient is intoxicated or psychotic, and a harm to themself or others then yes, you can override their consent or refusal of consent. But if they're happily drunk, or psychotic/depressed without suicidal ideations and have the decision making ability to give or refuse consent, you absolutely cannot override their wishes, especially a 3rd year resident, when there are other surgeons around the patient consents to.

There are chronically psychotic patients that hallucinate all day long, but still have their own right to legal consent and are their own power of attorney. You can't just start doing elective operations and procedures on them without consent. Same goes with people that are happily drunk. Just because someone is drunk, in your office or ED, that doesn't mean you can slap them down on the procedure table and do elective procedures or operations on them. Only if they're homicidal or suicidal, an immediate life threat to self or others due to their psychosis or drunkenness, can you override their consent (or lack of) for life and limb saving procedures. For elective procedures and surgeries, you can't do so, whether patients are drunk, or psychotic at all.

So, back to the example above. Unless the patient above, was suicidal, homicidal or so drunk he was unable to know the risks/benefits of agreeing to or refusing the surgery from that specific surgeon, then the surgeon had no right to force the patient to submit to surgery by him. Considering that the surgeon was an underling 3rd year resident with a superior that the patient did want to operate on him, there's no legal or ethical way for this 3rd year resident to claim he can override the patient's refusal of consent, no matter how 'racist' the patient's reasoning. Maybe if the patient was imminently dying, so drunk (or psychotic) he couldn't make his own decisions, was refusing life saving emergency surgery, AND the 3rd year resident was the only surgeon in house, then maybe the surgeon could operate under the principle of "implied consent" in an emergency situation. But other than that, Mr 3rd year resident can't force himself on a patient, no matter how appalled his is (rightfully so) about the patient's racism.

 

[emd123]

You can absolutely perform medical treatments in the event of a life threatening emergency without consent. That's the whole idea behind trauma surgery. It's not "taking a chance". Now, anything not immediately life threatening, I agree with you, you have to get their conservator or guardian on the phone and get an informed consent.

It's a common misconception that in an unconscious trauma or medical emergency patient that you're acting without consent. You're not.

You still need consent to perform life/limb saving treatments. In the unconscious emergency patient it's a type of consent called, "implied consent." But if someone is awake, alert and legally competent, they absolutely can refuse consent and you cannot perform the life saving treatment, without consent. Example; Jehovah's witness is shot. Comes in to ED bleeding to death, awake but going to die in 5 minutes without a blood transfusion and surgery. The surgeon is 10 minutes away. Patient clearly says, "I'm a Jehovah's witness. Do not give me a blood transfusion. I refuse, even if that means I'll die."

Guess what?

You cannot perform the life saving treatment without consent.

 

[Ducttape]

Sometimes yes, and sometimes, no. If a patient is intoxicated or psychotic, and a harm to themself or others then yes, you can override their consent or refusal of consent. But if they're happily drunk, or psychotic/depressed without suicidal ideations and have the decision making ability to give or refuse consent, you absolutely cannot override their wishes, especially a 3rd year resident, when there are other surgeons around the patient consents to.

There are chronically psychotic patients that hallucinate all day long, but still have their own right to legal consent and are their own power of attorney. You can't just start doing elective operations and procedures on them without consent. Same goes with people that are happily drunk. Just because someone is drunk, in your office or ED, that doesn't mean you can slap them down on the procedure table and do elective procedures or operations on them. Only if they're homicidal or suicidal, an immediate life threat to self or others due to their psychosis or drunkenness, can you override their consent (or lack of) for life and limb saving procedures. For elective procedures and surgeries, you can't do so, whether patients are drunk, or psychotic at all.

So, back to the example above. Unless the patient above, was suicidal, homicidal or so drunk he was unable to know the risks/benefits of agreeing to or refusing the surgery from that specific surgeon, then the surgeon had no right to force the patient to submit to surgery by him. Considering that the surgeon was an underling 3rd year resident with a superior that the patient did want to operate on him, there's no legal or ethical way for this 3rd year resident to claim he can override the patient's refusal of consent, no matter how 'racist' the patient's reasoning. Maybe if the patient was imminently dying, so drunk (or psychotic) he couldn't make his own decisions, was refusing life saving emergency surgery, AND the 3rd year resident was the only surgeon in house, then maybe the surgeon could operate under the principle of "implied consent" in an emergency situation. But other than that, Mr 3rd year resident can't force himself on a patient, no matter how appalled his is (rightfully so) about the patient's racism.

don't try to confabulate and make this even more complicated that it already is.


your assessment of their competence determines the likelihood that you should override their consent.
your assessment of the critical nature of their condition determines if you should consider overriding their consent.
your assessment of the potential harm from doing a procedure or transfusion determines whether it is worth it to overriding their consent.
thus, elective procedures should never be discussed in the context of overriding consent and including it in this discussion will just confuse people.

it is not a hedging kind of thing. drrosen is right, assuming the patient lacks capacity.

if you determine the 3 conditions are met, then you are ethically required to override their consent - critical nature of their injury, incapacity to make decision, and harm that comes from doing the procedure.

 

[lobelsteve]

This has not come up in my practice.

 

[emd123]

There are a significant number of conversations circulating widely that suggest Dr. Gu was a poor resident whose performance was not progressing to same degree as his co-residents. That was the larger issue relating to his dismissal and why you don't see any colleagues or faculty members rushing to comment on the "unjust" actions of Vanderbilt.

It's pretty common in medicine that you can keep your job if you are an a*shole but good at your job. Likewise, people will let you slide if you are enjoyable to be around even if you aren't a particularly good doctor. But if you are dangerous to patients AND unpleasant or a distraction? Yeah good luck with that.

Exactly. When a resident is fired or quits it's devastating to the people around them, residents and attendings included, to have to cover the extra call. You have to be really, really, really bad, either in competence or interpersonal skills, to get fired mid residency. Nobody, I mean NOBODY, wants to suck up part of a 3rd year resident's surgical call unless it's absolutely dire. They must have decided that it would be a much greater sh-- show to keep him around, then to fire him and pick up the pieces

 

[emd123]

This has not come up in my practice.

This type of thing rarely does come up in a chronic pain setting, since what we do is elective. They are interesting ethical dilemmas, though. I faced them more often than I'd like, in the ED. The worst is when it's a parent attempting to refuse a test or treatment for a kid, who might or might not have a life threatening issue, and the test you need to determine that, the parent is refusing to allow you to do. Had a kid once, who I was on the fence about possibly having early meningitis. I thought the kid needed a lumbar puncture. The parent refused. If it's bacterial meningitis, the kid has a life threatening emergency and it's child abuse for the parent to refuse parental consent for treatment for the kid. If it's a viral meningitis or other non-life threatening cause, they don't have a life threatening issue at all. But you need to test (the lumbar puncture) to know which it is. Do allow the parent to refuse, let the kid go home, hope it's viral and risk him dying of treatable bacterial meningitis? Do you call child protective services, tell them the parent is willing to let their kid die of untreated bacterial meningitis which is treatable, and see if they seize custody of the kid from the parent and allow you to do the LP and save the kids life? What if you do that and it turns out you were wrong and it was viral and the parents try to sue you? If you're right and the kid had bacterial meningitis, you saved a life and are a hero. If you're wrong and it's viral, you get sued. If you blow it off, let the kid go and he dies, you have that on your conscience forever, that you didn't do more. If you blow it off and it turns out to be viral, it turns out to be much ado about nothing.

Combine diagnostic uncertainty, with potential life threatening illness, mixed in with an uneducated population prone to poor decision-making, and vulnerable patients, and you have some tough, tough, tough situations.