Disturbing Behavior

photo still from Grey's Anatomy

Having been figuratively removed from the world for the past few days, I almost completely missed the explosion of the Vicente Sotto Medical Memorial Center Video Scandal into the Philippine media firmament. Now, because of some unthinking, insensitive, and generally stupid health care workers' behavior, the medical profession is once more being given the spotlight - and not in a good way.

My resident batchmates and I discussed this issue over dinner last Saturday. Having been trained in charity teaching hospitals, we are not unfamiliar with being surrounded with so many young student spectators, whether nurses or medical students, while in the heat of an urgent medical procedure - like an urgent intubation or even an on-going resuscitation.

Despite this understanding and experience, my batchmates and I were all hard put to justify the behavior of the nurses and doctors who are involved in the above case. While at the time, I had not yet seen the video, the mere narrative of what had transpired disturbed me. More so after I had.

As a medical resident, I have often taught my medical clerks and interns bedside with the patients themselves. Patients with textbook clinical findings are asked if it is okay for them to be made clinical learning material for medical students during consultant rounds. While their personal information is never divulged, some of these patients' clinical history and course are discussed lengthiliy over medical conferences in order for medical trainees to gain insight on managing similar cases in the future.

The nature of medical education hinges on the principle "see one, do one, and teach one." Unfortunately, there is much we cannot learn by mere lectures and working with dummies - and even more that we must learn with practice. When patients have themselves admitted in a charity hospital, they tacitly agree to becoming "learning material" for medical students and nurses in exchange for not paying fees charged by private hospitals which they cannot afford. If circumstances were different, I am sure the patients would never have chosen to be admitted to a charity institution in the first place, but circumstances simply force them to take the lesser evil of being taken cared of by medical trainees like myself than not being treated at all.

To be fair, I did not see anything technically wrong with the way the procedure was done. I have read blog reactions to this video, and some have commented about the way someone was shouting instructions while the patient was being operated on. This is standard practice in surgery, where the primary surgeon tells his first and second assists to maneuver instruments in such a way that he can perform the procedure with optimal light and exposure. He also needs to do this to inform the scrub nurse which instruments he will need next. In every operation, there is also a "circulating nurse," who does not "scrub in" so that he can retrieve things that are needed outside the operating field so that the team that is already "sterile" remains so.

Also, it is not uncommon for interesting surgical cases to be documented by video or still photos for future teaching purposes, although a patient's consent is always secured before this is done. It is also not uncommon for such cases to be observed by young trainees. Those of you who watch Grey's Anatomy are familiar with the viewing deck for the interns that overlooks the operating theatre where surgeries take place. Unfortunately, in the Philippines, we do not have the luxury of a similar viewing deck. So while the number of people in the OR is often regulated, students are allowed to observe some surgeries at ground level.

The above could explain why there were so many people in the OR that day and why perhaps an "official" video was being made. However, this does not justify the way that even the student observers were taking out their phone cameras and taking pictures of the patient, who was in no state to prevent them from doing so. That a copy of such a video was uploaded on a public server and could be accessed by anyone from anywhere in the world smacks of insensitivity and disrepect beyond the bounds of professional ethics. It completely disrespects the social mores by which we live.

The primary surgeon also shares some fault here, because as "captain of the ship" it was within his power to control the number of people in the OR that day. Instead, for whatever reason, he allowed it to be a spectacle for whoever "usiosero" wanted to come in and watch and tape. The mood of anticipation and underlying amusement was palpable and translated through the camera quite clearly.

The video is no longer on YouTube, but the damage has been done and is not easily repaired.

Again to be fair, laughter is - fortunately or unfortunately, depending on one's perspective - a common form of stress release for those of us in the medical profession. Humor is one valve which we must use from time to time to cope with the enormity of the responsibility we carry from day to day. The "baby out!" expression and the cheering could have been an expression of relief that the operation - by no means as simple or as easy as it looks - was a success, without any untoward events. But these expressions take on a new and less innocent meaning when one of the medical personel takes the canister, faces it to one of the cameras, and sprays it for no good reason. To me, it crosses the line between benign amusement into mockery.

This patient, regardless of the absurdity of his dilemma, certainly deserves much better than he was dealt. He may have been divested of his medical ailment, but the mockery and the humiliation that this incident has caused him has magnified his suffering several times over.

I am a doctor, and I am ashamed.

The public is, understandably, enraged that something like this can happen. Aside from feeling sorry for the violated patient (the fact that the video does not show his face at any point notwithstanding), it triggers that visceral fear in every mind with regards to becoming patients and the power doctors have over them. "What if I go into surgery and this happens to me? What if I get sick, and I have to expose myself - will they be laughing at me, too? Are they making me into a guinea pig?"

This incident has eroded into the already-precarious relationship between the doctor and the patient. Even if in their minds people do know that they cannot make a sweeping generalization that all nurses and doctors are like the ones who were seen in this clip, the gut fear will always be there now that there is solid proof that something like this could happen. It has tarnished once more the image of doctors in the country, at a time when we are being demonized as it is.

I just hope that the public will keep in mind that this incident is an exception rather than the rule. The good majority of medical professionals do not take their oath as lightly and continue to practice medicine to the best of their abilities to ensure their patients' well-being.