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

Re: Surgeon admits to branding initials on patients' livers

#71

Post by DanBC » Mon, Dec 18, 2017, 11:33 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…

> What if your liver developed a problem due to getting initialed?

He only initialed livers as part of a wider set of markings that surgeons normally make. If the initials are going to be a problem those other normal marks would also be a problem.

Re: Surgeon admits to branding initials on patients' livers

#72

Post by DanBC » Mon, Dec 18, 2017, 11:35 AM UTC

chesimov wrote: post #67

chesimov wrote: post #66

Earlier quoted context omitted.

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.

No, it wasn't. Surgeons have to mark livers to show areas they're going to work on. These are normally temporary markings and heal over time. When this surgeon made marks he also added his initials. He did this to one patient, and the marks did not heal, and another surgeon found the marks.

I'm not trying to defend him, but it wasn't intended to be a permanent marking.

Re: Surgeon admits to branding initials on patients' livers

#73

Post by corobo » Mon, Dec 18, 2017, 11:36 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…

> What if your liver developed a problem due to getting initialed?

I mean.. at least you know who to sue.

Re: Surgeon admits to branding initials on patients' livers

#74

Post by DanBC » Mon, Dec 18, 2017, 11:40 AM UTC

Aeolun wrote: post #55

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.

Yeah, if someone's initialing my liver, that's probably a good indication the operation went well :P

That's the defence he used. Something like "this is a work of art, and I'm proud of the skill and care I took"

Re: Surgeon admits to branding initials on patients' livers

#75

Post by [deleted] » Mon, Dec 18, 2017, 11:41 AM UTC

jacquesm wrote: post #56

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…

Doctors are people too, so whatever ails the general population should not be a surprise to be found among doctors. Drug abuse was pretty common (after all, easy access to drugs) as was sexual abuse of doctors with patients. Even so, to treat your patients as a tree to carve your name in when they're powerless to do anything about it has a deliberate component that is inexcusable way beyond doctors simply being human…

[deleted]

Re: Surgeon admits to branding initials on patients' livers

#76

Post by DanBC » Mon, Dec 18, 2017, 11:50 AM UTC

King-Aaron wrote: post #10

Johnny555 wrote: post #4

Earlier quoted context omitted.

I think that depends on your definition of "harmed". If I used a laser to burn my initials into your underarm in a place that no one would ever see it.... would you say that I harmed you? Is it certain that a couple inches of laser beam scar tissue in a liver has not, and will not in the future cause any medical issues for the patients in question?

> Is it certain that a couple inches of laser beam scar tissue in a liver has not, and will not in the future cause any medical issues for the patients in question? It could well lead to Cirrhosis of the liver. Not to mention Adhesion that could become painful. I'm not too sure how likely either issue is, however I wouldn't like to assume that scarring your liver is going to be completely free of complications... Tho…

It's not intended to be a permanent scar. These marks are routinely used to mark out areas of the liver to be worked on, and they should normally heal.

In this case he did it to a patient and the marks didn't heal. (By definition he works on patients who's livers are less likely to heal), but it didn't cause any further harm.

Re: Surgeon admits to branding initials on patients' livers

#77

Post by DanBC » Mon, Dec 18, 2017, 11:52 AM UTC

ramblerman wrote: post #18

drops wrote: post #14

Earlier quoted context omitted.

You're comparing a victimless "crime" with injuring someone. That doesn't make any sense.

If it's important to the analogy then lets say we caught him driving super drunk but he hadn't hurt anyone yet. Should we let him off the hook?

That's a poor analogy, because people driving super drunk have the potential to cause very great harm.

If we're sticking to car analogies he wrote his name in the dirt on the back of a truck, but the dirt was abrasive and so he also scratched his initials into the paint.

Re: Surgeon admits to branding initials on patients' livers

#78

Post by jacquesm » Mon, Dec 18, 2017, 12:27 PM UTC

corobo wrote: post #73

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…

> What if your liver developed a problem due to getting initialed? I mean.. at least you know who to sue.

The Joe-job potential is limitless.

Re: Surgeon admits to branding initials on patients' livers

#79

Post by mcphage » Mon, Dec 18, 2017, 2:02 PM UTC

gadders wrote: post #34

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…

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'm not sure why this evokes such a strong reaction in me. I think it's because it's like a claim of "ownership".

That's because of the use of the word "branding", which is what cattle farmers do to their animals to indicate ownership. Had they used something more value-neutral like "initialed", our reactions wouldn't be nearly as strong.

(I'm not saying that "branding" is the wrong word to use, nor that "initialed" would have been better, just that the specific words we hear matter, even when their meaning is mostly the same)

Re: Surgeon admits to branding initials on patients' livers

#80

Post by theprotocol » Mon, Dec 18, 2017, 2:46 PM UTC

hycaria wrote: post #65

theprotocol wrote: post #62

Earlier quoted context omitted.

>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/…

>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 ?).

I have not seen a photo of it, but it's frankly irrelevant. You're shoehorning in your experience of having seen exposed organs as giving you some kind of expertise; but it does not, this is an issue of ethics about a breach of body autonomy and consent.

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

This is a very mechanistic interpretation which does not regard justice or principles as being a thing and only considers results.