24 October 2011


The ongoing Conrad Murray trial has introduced the public to one of medicine's underworlds--those doctors who break laws and abuse the status and privileges conferred by their profession.

I occasionally read state medical licensing boards' write-ups of disciplinary actions, and some read like crime thrillers. One case report abhorred me. A New York general surgeon had an affair with a married patient just after performing her hysterectomy (removal of the uterus). What made the case particularly sinister was the abuse of the doctor-patient relationship. The surgeon repeatedly phoned the patient requesting that she return to clinic for post-operative follow-up (generally, office staff place these types of phone calls). He had her come in after-hours, when office staff weren't around. When the patient revealed her worry that her husband might no longer find her attractive, the surgeon replied that he personally found her beautiful and kissed her on the lips. An affair developed, the surgeon's insistent overtures leading to a nighttime liaison at a motel. Patients with hysterectomies are supposed to wait a certain number of weeks before engaging in conjugal relations, and the surgeon damaged the patient's stitching.

The medical board investigation found that the surgeon also had badly botched at least two patients' surgeries and had made inappropriate sexual advances on at least two other female patients. Its condemnation was harsh:
Respondent has shown himself to be morally bankrupt...[He] used his status as a physician as a tool to obtain personal gratification from women who were his patients. In perverting his standing as a physician, Respondent did not only have a negative effect on the individual patients, he disrupted entire families.
Furthermore, as the facts in this matter become known, first to colleagues and ultimately to the community as a whole, Respondent has hurt his entire profession. Each time a physician betrays the trust bestowed upon him by virtue of his status as a license holder, the public has a right to take notice and wonder at the trustworthiness of all practitioners.
The board revoked the surgeon's license, its most severe punishment. I doubt the surgeon's wife was pleased. I couldn't find a record of criminal charges being brought against him, and it's not clear to me what he could have been charged with.

Yet there was also a hero of sorts: the patient's primary-care doctor. During a routine office visit with the patient he intuited that something was wrong. He asked around and gathered from another patient that the surgeon was behaving inappropriately. He brought the matter to the attention of the state board.

Plenty of violations result in reprimands, probationary licenses, restricted licenses, suspension, and for the most egregious misdeeds, revocation. Doctors get rapped on the knuckles for failing to promptly inform the board of a DUI conviction, or for repeatedly botching surgeries in ways that should have been avoided, or for keeping poor notes. Although policies vary state to state, looking up a physician's record used to be expensive and slow. Now, most states provide these records on-line, free of charge. I think the trend is on the whole a good one. Patients ought to know who they are entrusting their care to.

There is plenty more to discuss here. The medical board system resembles the criminal system: it is punitive, reactionary, and slow. There isn't a good infrastructure to help physicians whose performance is slipping (for example, a surgeon who is losing dexterity). And there aren't many jobs doctors can do besides medicine, meaning doctors who ought to hang up their stethoscope, and want to, might not be able to.

We need to discipline doctors who violate the rules. Yet we also need to set up a system that makes it easier to identify at-risk physicians and get them help, before the state medical board has to take their license away.