Not all residents are smart...

[DCJenn]

Re: Not all residents are smart...

Stella-

I'd prefer that my GP have ethics and morals, probably even more than I'd prefer that my surgeon have them.

anyway...

Here's another take on it. If I took a picture of any one of my clients without prior written permission (and a consent that has an expiration date) I'd be fired. Period. I've devoted 20 years to this field and I'd NEVER work in the field again. That's how important patient confidentiality and rights are.

There is nothing personal about this. I don't know either party from Adam. I don't really think that tattoo guy is the most stand-up moral dude in the world. It still doesn't matter who he is or what he does or doesn't do. If he were in jail, he'd still have a viable complaint.

As morally repugnant as this man may be, he's still the victim here. and if he profits from it, then that's our tabloid society at work.

Jenn

[Stella]

Re: Not all residents are smart...

Stella-

I'd prefer that my GP have ethics and morals, probably even more than I'd prefer that my surgeon have them.

anyway...

Okay, maybe I'm not making myself clear. I'M not the one who made it sound like SURGERY was the only way. It's certainly not.

All I'm saying is that if he gets fired, he has OPTIONS. He doesn't lose out on medicine entirely. And that's what OTHER PEOPLE were saying. I'm saying he can be a general practitioner if he is fired from his residency. I'm not saying whether or not he SHOULD be a GP, I'm just saying he COULD. Am I wrong?

Geesh.

[Sheherezade]

Re: Not all residents are smart...

I would think he'd still have to be accepted in to some program- correct? I bet that anyone could find a residency if they were open to anything at all, but I think this guy will have a black cloud over him in that process. Either way, I don't think he can just walk out and be a GP now. He'd have to complete the residency for that. And...he doesn't have a license yet to lose, right? So if he's dinged now on by the medical board, won't that affect his license applications everywhere?

It isn't a situation I would want to deal with - and I don't think any transition he makes will be easy. Not that it should be, but....it won't be an automatic switch to GP-hood.

Of course, I know nothing. Feel free to explain how it really works if anyone has bailed late and gone to GP hood.

[Stella]

Re: Not all residents are smart...

I would think he'd still have to be accepted in to some program- correct? I bet that anyone could find a residency if they were open to anything at all, but I think this guy will have a black cloud over him in that process. Either way, I don't think he can just walk out and be a GP now. He'd have to complete the residency for that. And...he doesn't have a license yet to lose, right? So if he's dinged now on by the medical board, won't that affect his license applications everywhere?

It isn't a situation I would want to deal with - and I don't think any transition he makes will be easy. Not that it should be, but....it won't be an automatic switch to GP-hood.

Of course, I know nothing. Feel free to explain how it really works if anyone has bailed late and gone to GP hood.

Someone earlier had said that if he gets fired that he could move across the country and open a private practice as a GP...or something along those lines. I was under the impression that you didn't need a residency, just an MD. If I'm wrong, I'm sorry. I'm not trying to undervalue ANYONE. I googled "general practice residency" and the only thing that comes up is dentistry. :huh: :huh:

Re: Not all residents are smart...

ITA with Heidi. No one died, no one was even physically harmed, raped, beaten or even touched inappropriately. Disciplinary measures are in order but ruining his career in surgery is totally uncalled for in my opinion.
And yes, if he gets fired now, without finishing his GS residency he would most likely have to start over to be a GP. Which could mean he would need to complete another residency in family medicine or internal medicine (if any program would take him) and his 5 years of general surgery residency would be flushed down the toilet. He may have options to finish his GS residency at a "less prestigious" community hospital but who knows. He can't take his GS boards unless he finishes this last year of residency either. He's trapped.
An MD can't practice medicine unless he or she has completed a residency and are board certified. So no, an MD can't be a GP without a residency.
The surgery culture is harsh and unforgiving. If he gets kicked out of this program, he will have few options of staying in medicine, IMO. And options that will cost him time and money and reputation.
I feel for the patient, I really do. I wonder if what he wants from this? Has he demanded the doc be fired? Is he simply looking for financial compensation?

[Vanquisher]

Re: Not all residents are smart...

That's exactly right Kozmo. The reason I said he could be a GP is because he could possibly maybe find a program to take him. Maybe. No surgery program will ever take him again. He would have to do a complete GP residency from beginning to end including intern year because it is a medicine internship versus surgical. Even if, in the unlikely event he found a surgery program to take him, he would likely have to do at least two years over again completely due to ACGME rules. Believe it or not, lots of people don't match in surgery. It's not easy to get a spot, and this guy is toast for ever getting a spot. That's why I threw out GP, only because there is a demand for them and the need isn't being met and there are unfulled spots everywhere.

So, no, I don't think he has options, and that's why I think his career would be over. He is six months from the finish line, and any aspirations for fellowships are over. Licensing will be difficult if he can finish anyway. He could not practice medicine, maybe ever.

It's not as if I am saying he should get off free here. I'm not. And, it's not as if I have no compassion for the patient. Certianly his rights were violated. Yes, I would be pissed if someone took a photo of my uglies during surgery, but I am unwilling to ruin someone's career over it. I would bet a huge sum of money that this dude would take Annie's punishment AND the HIPPA tattoo far before being terminated in the final stretch.

Wow, just wow.

[Flynn]

Re: Not all residents are smart...

DH and I talked a bit about this last night.

We both agree that he should be SEVERELY punished....but termination is too harsh. Honestly I'd subscribe to another INTERN year for this guy. The thought of that is so hideous to a guy 6 months from the finish line...it would be appropriate. The call alone would be awful.

We also both agreed that the reality is, the hospital will fire him. It's their only option now and this guy did something SO DUMB (and likely illegal) that he will be fired.

Finally, if he did decide to go the GP route, he likely would get at least a year credited to him for doing FOUR years of surgical training.

That would leave him two more years to complete a GP residency. It's three years right?

[SuzySunshine]

Re: Not all residents are smart...

Who's to say nobody *did* go through internal channels? Call me cynical, but it's possible higher-ups dismissed this until it hit the press, isn't it? I don't like the press creating this kind of pressure, but if it's the only way...

(and I have no idea either way, I may be way off base, it just seems like a possibility, to me).

I doubt the higher-ups dismissed it, with it only happening last Tuesday I'm sure there was already at least an internal investigation before it hit the papers. DH gets e-mails sent to all residents about once or twice/year that say "don't do X because of y" and you know they only send them b/c someone did something stupid. He hasn't seen one on this yet but I'm sure he will.

From the local reporter I got the story from originally:

I called the reporter in Arizona and asked how she found out the patient name.

Here's her response (really) "You are the smartest person in the world! That is the question no one has asked me."

OK...so?

"I can't reveal my source."

I respect her stance on that, but it does seem there is an story here that might be more interesting than just the Hot Rod pics.

[SuzySunshine]

Re: Not all residents are smart...

The thing is being Cheif is not an option or a privilege here in GS. They all do it, its a requirement. So taking the title away is probably not an option.

I agree the source should be in trouble as well because of HIPAA.

Re: Not all residents are smart...

Just back to the GP / practicing w/o completing boards, etc. As long as the person has a medical license (which can be obtained after 1 clinical year of PGY training) he/she can practice as an MD. There really aren't any practices anymore who hire w/o at least board eligibility, but they could hang out a shingle and practice. It would be a PITA to get licensed in a different state, and I can't imagine malpractice insurance, but it technically can be done. My guess is these are the folks who approve prescriptions online and such.

[Vanquisher]

Re: Not all residents are smart...

The thing is being Cheif is not an option or a privilege here in GS. They all do it, its a requirement. So taking the title away is probably not an option.

I agree the source should be in trouble as well because of HIPAA.

Right, but that doesn't mean they can't make it that way. I agree with everyone that this resident is going to be fired. I just think it isn't the right thing to do.

I agree that the punishment should be very severe, but I think it should stop short of termination, but it won't.

As far as the source goes...holy crap. That is huge to me. The source is the one that put this in the spotlight, the one who is brandishing the patient's name for the world, the one that put Mayo in the spotlight for this. I do think that's worse. I really do.

Re: Not all residents are smart...

I've been thinking about this since last night, and I discussed it with dh when he rolled in LATE. Most of what I believe has already been stated in earlier posts, I just what to throw my hat out there AGAINST firing him. I can agree to almost any punishment/torture that anyone can come up with, including the resident's own penis photo publicized and/or
tattooed...redo intern year...ridiculous insurance payout that would make his liability rates skyrocket forever...tar and feather...you name it. However, I don't believe that his career/job should end because of this one mistake.

Again, most of what I would say has already been said so I won't repeat it...just wanted to go on the record against firing him.

[planet]

Re: Not all residents are smart...

What a wildfire topic! Clearly this hits us all rather personally since we can imagine being on both sides of the issue.

Throwing my .02 into the pot.

Of course he’ll have to get axed to save the hospital.

My first thought, which reveals a perspective of more individualized rather than equal opportunity justice beliefs, is that this guy is a strip club owner who gets money for putting women’s body parts on display. Yeah, ok, so it is my personal prejudice, but from knowing a former stripper (turned lawyer) I have heard how the majority of these girls are a mess and not furthering a better life by being strippers. I do not sit as a public juror and compare this to a woman or even a man in another situation. This guy doesn’t have a problem putting his penis out for a bet or out on a table to get needles stuck into it. So I don’t really believe he suffers such emotional harm from his goods being seen. And at the same time, I'll admit that the setting has completely different expectations emotionally, even perhaps for this guy.

I see the greater problems as these; dissemination of media from a private source in a protected environment and the total misunderstanding of modern medical practices. The first second this resident pulled out his cell phone IN THE OR (um, I always got a nurse when dh was in the OR) everyone in that room should have been on his arse asking him what the hell he was doing!! Have any of you asked to record your own birth or operations? No friggin way. Official or professional recordings, which can be passed on (sometimes questionably) as teaching devices or given to the patient are one thing. Cell phone, camera, video…NO WAY. This guy’s actions cannot go unpunished because to not slam him would be to set a precedent that it is in any way acceptable to do personal recording. This is actually more for the protection of our docs than the patient, ya know. In this sense I could care less if it was his penis or his shoulder in the pic. I’ve heard about the bs and raunchy talk that goes on. Bringing everyone into the OR even is still different from snapping a photo. A few people have mentioned how the person doing the telling needs to be in deep doodoo too. In this case, whether the narc was the reporter’s lover or brother or made an anonymous phone call or went up through the proper channels, so far as I understand, this chief made a grave judgement error. He showed it to someone who could have been offended by the act or perhaps felt that this guy did have a habit of bad calls. The narc could have been an arsehole too. But the resident made the bad call to let it be seen by this person…am I really to believe this resident never thought it would piss someone off? This resident shows bad judgement on the greater scheme by not understanding that medicine today is defensive. Even my dh, only half way through residency, understands this. CYA. I think that this is what will kill this guy’s career moreso than even getting fired. Who would want to hire a guy that is a target for lawsuits?

As far as the vulnerability under gas (sorry, can’t spell the other word), I think this is a huge issue. But the reality here is that what goes on in the OR and even general hospital setting, is pretty bad. I was lucky enough to hear two nurses completely humiliatingly ridicule me, unaware I was just on the other side of the curtain, and this was at the Brigham. I was so offended and hurt for days over it, but, that’s largely how the talk often goes. This is a systemic issue, and sometimes valid means of coping, but more often, I suspect just thoughtlessness. Still, even with the changing notion of privacy in today’s world, I think an image is a different thing from words and first hand and second hand are also to be distinguished. Oh, and having dated a fireman, I think their talk is muuuuch worse. Or at least more crude. Back on topic though, this resident shows bad enough judgement IMO to be kept away from the OR.

On the other side…as far as his future…I see that he could turn this around. Who called it Hollywierd? I wonder if he has the personality to go on to work as a consultant for a medical tv show or movies given his solid surgery background? Also, I have heard of worse cases that were not career destroying.

Oh, and Cheri, you think Mayo has good media control? How many of you heard about the BU med student who murdered someone after finishing paying off a settlement on assault – and he wasn’t kicked out of med school – and he was working at the hospital when/where his stab (or maybe shooting - I can't recall anymore) victim came in?

And Annie,

I'm not sure I understand? The reporter got information from a source. But didn't the resident have to call Mr Hot Rod to tell him because he knew the story was already on it's way to press? So the question for punishment of the narc would have to be based on what information he gave initially, wouldn't it? If he just said that some resident took a photo, no issue for him, but if he gave the details, then isn't he also going to be looked at?

These are just my thoughts and opinions though. The law follows it's own course.

Re: Not all residents are smart...

Training is about weeding out people that shouldn't be allowed within 10 feet of a patient, and he has proven himself to be incapable of mustering even a minimal amount of respect for patients.

It can be but does that really happen? Or happen the way it should? I think that in more cases accomodations are made to just get residents through. Say, pair up a weak senior IM resident with a strong intern because the program knows the senior guy might kill someone on a bad ICU month. :huh: Not that I have ever heard of that happening...

I see your point but I can think of so many more instances where this isn't the case that I don't believe that is justification enough for firing him. If training is supposed to weed out the bad apples, how did he squeak by for 4 and half years?

re: the GP thing. I think (?) that is an antiquated term. Internal medicine doctors, at least ones that I know, tend to think of themselves as internists. I think that family practice is closer to what GP is. That is a three year residency. I suppose his surgery residency could count for the intern year of that and he would do two years after?

[DCJenn]

Re: Not all residents are smart...

The loose cannon who told rick to F himself in front of a patient was removed from his military residency (for lots and lots of other issues) and while he completes his military payback is working at the health clinic on the grounds of USUHS. (at last we heard)

What he does when he's done with the payback? Don't know, he's an MD who completed one year of a residency in neurology. Not exactly marketable. But not exactly the kind of guy I'd like to share a call schedule with, either.

Jenn