Health-care providers are in the unique position of frequently being privilege to extremely personal information about their patients. This information can be disturbing or entertaining, but it should always be kept confidential. Yet, who doesn’t come home at night and tell their spouse about what they encountered during the day? Who doesn’t mention an interesting case or an unusual patient to a colleague? But where should the line be drawn?
Dr. D was the chief resident finishing up his final year of a surgical residency in a prestigious hospital. The young physician had been a bright and talented student in medical school, excelled during his residency, and certainly had a bright future ahead of him. Dr. D was sharp and engaging with a wicked sense of humor and was liked by nearly everyone he worked with.
The clinician’s career, however, was derailed by a single incident. Mr. M had been admitted for routine hernia surgery, which Dr. D was scheduled to perform. Mr. M was in terrific health and had never been in the hospital before, so he was extremely nervous. Dr. D spent plenty of time explaining the procedure and reassuring his patient. Mr. M was a bit rough around the edges, but the two men got on well, and soon Mr. M was comfortable with the thought of undergoing surgery.
The patient was placed under anesthesia, and as Dr. D was inserting a catheter, he noticed that Mr. M had the word “joystick” tattooed on his penis. Dr. D couldn’t resist, and quickly snapped a photo of the patient’s tattooed genitalia with his cell phone. Several members of the surgical support team witnessed this, but no one said anything to Dr. D or the hospital administrators.
The surgery was successful, and Mr. M was soon discharged. Dr. D started showing the “joystick” photo to other surgeons and colleagues and even e-mailed it to his girlfriend.
Unbeknownst to Dr. D, one of the surgical staff that had seen him take the picture in the operating room became extremely disturbed by the surgeon’s cavalier behavior. She did not find Dr. D’s actions amusing in any way and was quite angry at how inappropriately Dr. D was conducting himself. She saw it as just another example of how surgeons think they can do anything. The surgical staffer decided to take action and anonymously called a reporter with the local newspaper about what had happened. The reporter then contacted the hospital.
When confronted, Dr. D was forced to admit that he had taken the photo and was immediately suspended from the hospital. He was also ordered to call the patient and explain what had happened.
Mr. M received a phone call from a hospital supervisor who told him that Dr. D had something to say to him. Mr. M was understandably alarmed.
“I have some distressing news to tell you,” began Dr. D.
“Oh, my gosh!” cried the patient. “Is something wrong with me? Did something go wrong during the operation? Did you find some other problem?”
“No,” said the physician, “There is nothing wrong with you. The operation went well. There were no complications or unexpected problems.”
“Then why are you calling? What’s going on?” asked Mr. M, his concern turning to confusion.
“I’m sorry to have to tell you this, but I made a very appalling error in judgment.” Dr. D took a deep breath and continued. “When I was prepping you for surgery, I noticed your unusual tattoo and, in a moment of stupidity, I snapped a picture of it with my cell phone.”
There was stunned silence on the other end of the phone as the patient processed this information.
“I’m afraid it’s a bit worse than that,” said Dr. D. “Unfortunately, I showed some colleagues the picture and somehow this information got out to a local paper. I wanted to call you myself to apologize and let you know in case this story should get out.”
The patient was understandably horrified when he realized what Dr. D had done. The physician’s profuse apologies did little to assuage the growing fury of Mr. M, who felt betrayed and humiliated by someone he had trusted with his life.
The hospital attorneys and administrators met to decide on the proper actions to take regarding the patient—who had hired an attorney and was threatening a lawsuit—and the temporarily suspended Dr. D. Hospital lawyers ultimately decided to negotiate a settlement with the patient and ended up paying him $250,000. Dr. D’s residency was terminated, and his future job offer with the hospital was rescinded.
No lawsuit was filed in this case, despite the fact that Mr. M had hired an attorney to represent him. Hospital attorneys and administration felt that compensating the patient for the gross disregard of his privacy was necessary, and the hospital wanted to avoid the bad press that would have come with a trial. Most cases never go to trial — either because they are dismissed early on, settled prior to trial, or settled before a lawsuit has even been filed. When medical errors or mistakes take place in hospitals and the hospital administration determines that its employees are at fault, efforts are often taken to pay the injured patient and make the matter go away without the cost and publicity of a trial.
Clinicians are privy to their patients’ most personal information and must treat that information with courtesy and respect. Dr. D grossly violated his patient’s privacy by taking and circulating a picture of an extremely sensitive nature. He took the picture when the patient was unconscious and unaware of the violation. There was no medical need for the photo or for pointing out the tattoo to coworkers in the hospital. Dr. D betrayed his patient’s trust and damaged his medical career.
Clinicians must respect patient privacy and never betray their trust. Discretion is extremely important. “First do no harm” encompasses emotional harm as well as physical.