“We all need the strength” to challenge unacceptable behaviour


The editor-in-chief of Annals of Internal Medicine, Christine Laine, and her fellow editors have called for doctors to confront colleagues who act in a disrespectful manner towards patients after an anonymous essay in the journal highlighted incidences in which unprofessional behaviour was condoned. Laine et al claim that doctors owe it to themselves, their profession, and their patients to address inappropriate actions.

In Annals of Internal Medicine, for a “On being a doctor” essay, an anonymous author recounts the story of a medical student who laughed along when his senior colleague made a crude remark while prepping a woman for vaginal hysterectomy—the colleague apparently suggested the women (who was under general anaesthetic at the time) was “enjoying” him cleansing and scrubbing her labia and inner thighs. The author writes that the student told them: “Yeah, I laughed but what was I supposed to do? Have you ever been in a situation like that?”, which prompts the author to admit that they also joined in when a colleague acted in a manner that, according to Laine et al, had “heavy overtones of sexual abuse and racism”.

They then describe a case in which a physician named as “Dr Canby” saved the life of a patient (“Mrs Lopez”) by performing an internal bimanual uterine massage (with the patient under general anaesthetic) to stop excessive bleeding after a vaginal delivery. However, the author reports that Dr Canby subsequently—keeping his left hand in the woman’s vagina—started to sing dance so that it looked like he was “dancing with her”. They add: “He keeps dancing. And then he looks at me. I begin to sway to his beat. My feet shuffle. I hum and laugh along with him. Moments later, the anaesthetist yells ‘Knock it off assholes!’ And we stop.”

Laine et al write in an accompanying editorial that they published the essay because they hope it will “gnaw on the consciences of readers who may recall an instance of their own repugnant behaviour”. They add that they believe those who read the essay, upon realising how such behaviour appears to others, will “hopefully think twice before acting in a manner that demeans patients and make trainees and colleagues squirm”. Furthermore, the editors state that they want the essay to not only dissuade doctors from acting in such a manner but also “call out our colleagues who do”. “We all need the strength to act like the anaesthesiologist in this story and call our colleagues ‘assholes’ when that label is appropriate. We owe it to ourselves, to our profession, and especially to our patients,” Laine et al write.  

According to the editors, this is only the second time that the author of an article published in the Annals of Internal Medicine has been allowed to be anonymous. They explain: “Then, as now, we did so to protect the identity of any person who might be identified, most importantly the patients.”