Surgeon admits to branding initials on patients' livers • Hacker News Board

Re: Surgeon admits to branding initials on patients' livers

#61

Post by saiya-jin » Mon, Dec 18, 2017, 9:46 AM UTC

theprotocol wrote: post #37

simplyfantast wrote: post #31

Earlier quoted context omitted.

I've been a physician for about 16 years. I won't defend the guy, it's just that I routinely see things that I would consider worse: doctors drunk at work, doctors who sleep with medical students in exchange for good evaluations, rampant cheating in medical school, rampant stimulant abuse, and the list goes on and on... It's unethical for sure, but I guess my gut reaction is that it's not necessarily an offense that…

>it's not necessarily an offense that demands termination. Someone murdered someone near my workplace. This surgeon branding his initials on someone's liver isn't so bad in comparison. Therefore, it isn't so bad in the absolute. You set up the slope yourself and then proceeded to slip on it.

Reality is, tons of doctors have all kinds of issues (my fiancee is a doctor in one of the biggest hospital in Switzerland). As mentioned - substance abuse, tremendous pressures at work and massive overtimes (suicides aren't that rare, some just quit profession or downgrade to become a nurse).

Ever thought that when you are admitted, doctor will quickly check youtube to look FOR THE FIRST TIME how to perform some minor (or not) procedure? Ever thought that patients would die or get seriously, permanently injured just because somebody forgot to do some checks? You thought that most senior surgeons are just workoholic egomaniacs, dependant on various legal or illegal substances that healthy person shuldn't touch, ever? And this is Switzerland.

In ideal world, you're completely right. In real world out there, where ALL OF US make mistakes all the time, including doctors, this is really 'meh' category that I wouldn't mind at all on me, as long as doctor's performance is consistently solid.

Maybe slap on the wrist in form of demotion / ban of practice for a year or two. Put a mandatory psychological treatment for true reason of this behaviour (we're society after all and should help each other, not banish them to hell for any mistake). Otherwise, if your would apply super high standards consistently across all staff, you would see plenty of people dying due to no staff in hospitals. Sad but real.

Re: Surgeon admits to branding initials on patients' livers

#62

Post by theprotocol » Mon, Dec 18, 2017, 9:52 AM UTC

hycaria wrote: post #59

dvt wrote: post #23

The fact that people are defending this guy, or treating it as "no big deal" blows my mind. Just off the top of my head, a few ethical issues: - Breach of patient-doctor trust -- a very asymmetric relationship - Breach of the Hippocratic Oath (you don't *burn* healthy tissue without good reason) - Permanent bodily modification without consent - *Multiple* offenses Should he have been terminated? Does the punishment f…

To me this is really no big deal. Honestly I think people are overreacting because they have absolutely no idea of anything about everything that's inside bodies. Having used coagulators and seen hundreds of livers (pathologist) and the eventual macroscopical but benign scars they get because of ("naturally occurring") small infarctii or such, this has really no consequences whatsoever. I don't know how it worked in…

>Honestly I think people are overreacting because they have absolutely no idea of anything about everything that's inside bodies. Having used coagulators and seen hundreds of livers (pathologist) and the eventual macroscopical but benign scars they get because of ("naturally occurring") small infarctii or such, this has really no consequences whatsoever. I don't know how it worked in this case, but there's a reason doctors are disciplinally judged by their peers in some countries.

You must be Dr. Manhattan. It's a big deal to us uneducated ants but you're enlightened so you can see it for what it is, is that right?

Actually, you are simply too arrogant to see it.

Re: Surgeon admits to branding initials on patients' livers

#63

Post by giomasce » Mon, Dec 18, 2017, 9:59 AM UTC

whiddershins wrote: post #42

Argh I don't know enough abut medical ethics to know where the line is but for all the people rejoicing in the guy resigning, losing his license, being convicted of a crime, or any other horrible outcome ... Please, please, really consider what it means to ruin someone's life when advocating for a certain punishment. There's a whole range of reactions between "eh, no big deal" and "destroy his career!" Whatever the m…

It seems to me that this form of "public spanking" would really earn the opposite of what you claim for: when you leave the judgement to the crowd, you are basically fomenting hatred and revenge (because for some psychological reason in such a case every one feels entitled to have a revenge, even when they are not involved in the case), which in turns leads to a punishment that cannot be controlled any more. This is why judgement should be left to professionals that (should) take the appropriate time to listen to both parties, review the legal basis and take a well-thought decision, trying to not put too much feeling in it. I'm not claiming this works perfectly, but it is definitely better that leaving the matter to the crowd. There are many cases of people whose guilty-appearing position was overexposed, for example by media, later proving innocent or less culpable that the initial situation might have suggested, but condemned forever to unjust public shaming.

On the act itself, I am in the number of those who think this should be taken extremely seriously and it is good ground for losing the license and criminal charges. Scarring someone's body (against their own will) has been for long (and until a few decades ago) a sign of property and slavery, and although I do not think this was what this surgeon intended, it still must be considered an extreme humiliation. Also, a surgeon's professional position usually entails an important amount of responsibilities and power, so violation of the public's trust in them are very important matter.

Re: Surgeon admits to branding initials on patients' livers

#64

Post by firstplacelast » Mon, Dec 18, 2017, 10:33 AM UTC

simplyfantast wrote: post #31

dvt wrote: post #23

The fact that people are defending this guy, or treating it as "no big deal" blows my mind. Just off the top of my head, a few ethical issues: - Breach of patient-doctor trust -- a very asymmetric relationship - Breach of the Hippocratic Oath (you don't *burn* healthy tissue without good reason) - Permanent bodily modification without consent - *Multiple* offenses Should he have been terminated? Does the punishment f…

I've been a physician for about 16 years. I won't defend the guy, it's just that I routinely see things that I would consider worse: doctors drunk at work, doctors who sleep with medical students in exchange for good evaluations, rampant cheating in medical school, rampant stimulant abuse, and the list goes on and on... It's unethical for sure, but I guess my gut reaction is that it's not necessarily an offense that…

That opinion stems from a place of privilege and over-entitlement. UPS drivers would get fired for ALL of that behavior, to not hold yourself to that standard at a minimum is shameful.

If it is a question of 'not having enough doctors' so we need to keep bad physicians around, then that's another reason that we need to drastically increase our enrollments for medical school. We certainly have enough willing and able Americans that would be ecstatic for the opportunity.

I assume physicians have something like law-enforcement's 'blue line', but it's pretty imperative that professionals like you hold each other accountable.

Re: Surgeon admits to branding initials on patients' livers

#65

Post by hycaria » Mon, Dec 18, 2017, 10:41 AM UTC

theprotocol wrote: post #62

hycaria wrote: post #59

Earlier quoted context omitted.

To me this is really no big deal. Honestly I think people are overreacting because they have absolutely no idea of anything about everything that's inside bodies. Having used coagulators and seen hundreds of livers (pathologist) and the eventual macroscopical but benign scars they get because of ("naturally occurring") small infarctii or such, this has really no consequences whatsoever. I don't know how it worked in…

>Honestly I think people are overreacting because they have absolutely no idea of anything about everything that's inside bodies. Having used coagulators and seen hundreds of livers (pathologist) and the eventual macroscopical but benign scars they get because of ("naturally occurring") small infarctii or such, this has really no consequences whatsoever. I don't know how it worked in this case, but there's a reason d…

It's important, just not for the reason most commonly accepted ie risk for the patient yada yada.

Easy question : do you know what it looks like ? I think no picture has been published, I infer what it probably looks like out of what I've seen and my experience which is relevant in this case, but most people are probably not able to do so (this is arrogant I guess ?).

BUT it is indeed bad and damaging for the doctor/patient relationship, which is today even more prevalent than the care one.

Re: Surgeon admits to branding initials on patients' livers

#66

Post by chesimov » Mon, Dec 18, 2017, 11:06 AM UTC

jacquesm wrote: post #58

chesimov wrote: post #49

Earlier quoted context omitted.

To me, a doctor drunk at work is far, far worse. I would much rather have a doctor initial my liver but still do a good job of fixing my problem, than have a drunk doctor operate on me (or treat me in any sense actually). I suspect a lot of the outrage is to do with the insult to human dignity that initialing someone's organs brings. But look at the outcomes.

What if your liver developed a problem due to getting initialed? What if every doctor operating on you felt that carving their name in you was their right? How about the entire team? After all, the outcomes are what matters right... Really, this is improper , it's nothing to do with human dignity, it's got everything to do with trust and consent. And consent is - in case you didn't know it - a rather large plank in o…

Yes, it is definitely improper to say the least. It also brings the profession into disrepute. I agree that it breaks trust as well as insulting dignity; and I should also clarify that my aim was not to defend the actions of the surgeon. I'm not a doctor but I don't find the complications argument convincing in this case though (unless it took a long time and resulted in prolonged anaesthesia; then I believe there are added risks). I still maintain that something like being drunk at work, especially as a doctor, is significantly more dangerous and reprehensible - lives are put at risk. By contrast, I think having initials on my liver, especially if I don't know about it, is less of a hardship.

Re: Surgeon admits to branding initials on patients' livers

#67

Post by chesimov » Mon, Dec 18, 2017, 11:15 AM UTC

chesimov wrote: post #66

jacquesm wrote: post #58

Earlier quoted context omitted.

What if your liver developed a problem due to getting initialed? What if every doctor operating on you felt that carving their name in you was their right? How about the entire team? After all, the outcomes are what matters right... Really, this is improper , it's nothing to do with human dignity, it's got everything to do with trust and consent. And consent is - in case you didn't know it - a rather large plank in o…

Yes, it is definitely improper to say the least. It also brings the profession into disrepute. I agree that it breaks trust as well as insulting dignity; and I should also clarify that my aim was not to defend the actions of the surgeon. I'm not a doctor but I don't find the complications argument convincing in this case though (unless it took a long time and resulted in prolonged anaesthesia; then I believe there ar…

Edit: I haven't been able to clearly determine if the actual initial burning was harmful (in a significant way) or not.

Re: Surgeon admits to branding initials on patients' livers

#68

Post by gadders » Mon, Dec 18, 2017, 11:25 AM UTC

jacquesm wrote: post #60

gadders wrote: post #34

Earlier quoted context omitted.

If he'd done it to me, I'd have carved my name on his forehead. Completely unacceptable. //edit// I'm not sure why this evokes such a strong reaction in me. I think it's because it's like a claim of "ownership".

I would not have retaliated in kind but most likely would have retaliated in court, and I would have pulled out all the stops to inflict maximum damage. So I'm sympathetic to your response but to react to the point where the damage you do is worse than the damage that was done to you - in spite of the breach of trust - is probably not the best course of action. Also, I've seen that movie.

I'm exaggerating, but I do think sometimes when a physical wrong is done to your person it requires a physical response.

Re: Surgeon admits to branding initials on patients' livers

#69

Post by DanBC » Mon, Dec 18, 2017, 11:30 AM UTC

dvt wrote: post #23

The fact that people are defending this guy, or treating it as "no big deal" blows my mind. Just off the top of my head, a few ethical issues: - Breach of patient-doctor trust -- a very asymmetric relationship - Breach of the Hippocratic Oath (you don't *burn* healthy tissue without good reason) - Permanent bodily modification without consent - *Multiple* offenses Should he have been terminated? Does the punishment f…

A minor nit, but it's not a permanent body modification. The marking is supposed to heal. He was caught because he marked a liver and it didn't heal because that patient was ill and another surgeon found the mark.

He was prosecuted and convicted for a minor offence ("assault by battery" is almost the lowest level of this offence) and because he pled guilty the more serious charge ("assault causing actual bodily harm" (ABH)) was dropped.

Some doctors in UK have been convicted of manslaughter by gross negligence (a far more serious criminal charge) and were able to return to practice after a time of suspension, so he might be able to return to work.

He's been through a hearing at MPTS (the independent medical tribunal service) after a complaint to the GMC (the regulatory body for doctors in UK). I think it was an interim hearing, and they're waiting for the criminal trial to finish.

But here's the warning he got:

> In August 2013 and on more than one other occasion Mr Bramhall initialled patients’ livers using an argon beam coagulator. This conduct does not meet with the standards required of a doctor. It risks bringing the profession into disrepute and it must not be repeated. The required standards are set out in Good Medical Practice and associated guidance. In this case, paragraph 47 and 65 of Good Medical Practice are particularly relevant. 47. You must treat patients as individuals and respect their dignity and privacy. 65. You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession. Whilst this failing in itself is not so serious as to require any restriction on Mr Bramhall's registration, it is necessary in response to issue this formal warning.

They had several options: they could have prevented him from working; they could have required him to take action to prevent re-occurance.

Re: Surgeon admits to branding initials on patients' livers

#70

Post by DanBC » Mon, Dec 18, 2017, 11:31 AM UTC

c3534l wrote: post #39

simplyfantast wrote: post #31

Earlier quoted context omitted.

I've been a physician for about 16 years. I won't defend the guy, it's just that I routinely see things that I would consider worse: doctors drunk at work, doctors who sleep with medical students in exchange for good evaluations, rampant cheating in medical school, rampant stimulant abuse, and the list goes on and on... It's unethical for sure, but I guess my gut reaction is that it's not necessarily an offense that…

This seems way worse than those things. Relationship problems, nepotism, and drug and alcohol abuse are problems. But permanently vandalizing a living human body while the person is unconscious goes far beyond the pale. The person should do jail time in addition to being permanently barred from medicine. Defiling a patient's body for "fun" should be taken extremely seriously.

It's not a permanent modification in most cases.

He pled guilty to a criminal offence, but that offence is at the lower range. (Assault covers a range, from assault at the low end (doesn't require physical contact), then assault by battery (requires physical contact) to ABH then GBH.

I think he's going to get a suspended sentence.

He's got a warning from an interim hearing from MPTS, and you can see the warning on the GMC lists.

Does this work?

http://webcache.gmc-uk.org/gmclrmp_enu/start.swe?SWECmd=Goto...

Here's the text of the warning:

> In August 2013 and on more than one other occasion Mr Bramhall initialled patients’ livers using an argon beam coagulator. This conduct does not meet with the standards required of a doctor. It risks bringing the profession into disrepute and it must not be repeated. The required standards are set out in Good Medical Practice and associated guidance. In this case, paragraph 47 and 65 of Good Medical Practice are particularly relevant. 47. You must treat patients as individuals and respect their dignity and privacy. 65. You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession. Whilst this failing in itself is not so serious as to require any restriction on Mr Bramhall's registration, it is necessary in response to issue this formal warning.