Ob/gyn: A specialty rooted in professionalism

Yalda Afshar, MD, PhDIn August, the Annals of Internal Medicine published an anonymous essay titled “Our Family Secrets.”¹ The gut-wrenching piece was accompanied by a a call to arms from the journal’s editors (“On Being a Doctor: Shining a Light on the Dark Side”), which rationalized for medical educators and leaders the decision to publish the essay and begged for a discussion on professionalism in Obstetrics and Gynecology:

“Many . . . essays highlight positive aspects of our profession and are uplifting and inspirational. Why did we choose to publish something that exposes medicine's dark underbelly? If you haven't read the essay, we urge you to read it now before continuing here.”²

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The essay describes 2 appalling, disheartening, and hideous stories as told by medical students who were asked, during an ethics class, to recall an experience they felt needed forgiveness and chose their ob/gyn rotations. Reading the stories was incredibly uncomfortable and very far from any lack of professionalism that I have ever witnessed. I hope that remains true for the rest of my career.

Our faculty responded to the call made by the journal editors and dedicated protected time for our medical students, residents, fellows, and faculty to sit together in a safe space and discuss the piece. The night before the discussion, the faculty facilitator had collected anonymous unprofessional anecdotes from all of the participants by means of an online survey. The raw stories were shared anonymously without judgment, affording residents and administrators the chance to identify and correct potential gaps in professionalism at our institution, a true quality improvement measure.

I read the short essay several times before our discussion because I had a hard time rationalizing how outrageous this piece of nonfiction was. Were my eyes deceiving me? I kept hoping it was a fictional essay to spur discussion; it was not. One of the things that I felt uneasy with from the start was that I was reading 2 horrific stories about my profession outside of my profession’s journal. The piece was published in an Internal Medicine journal and when The New York Times caught wind of it, popularized in an article entitled: “Doctors Behaving Badly.³ Was the essay originally sent to an obstetrics and gynecology journal and rejected? I hope not. I hope that my profession stands by their dark side and uses this as a stepping stone for improvement.

Just a couple months ago, a Virginia man won a $500,000 lawsuit after an anesthesiologist mocked his masculinity while he was anesthetized during a colonoscopy, and the remarks were recorded. Publication of that story already has had an impact on operating rooms (ORs) around the country. We have talked about that story in a handful of ORs that I have been scrubbed in of late. There has been a level of consciousness about the matter since the story has been made public. The anesthesiologist was fired. Notably, the hero in the Annals of Internal Medicine essay was an anesthesiologist whose own lack of filtering set the tone in the OR.

NEXT: How did the discussion go?

During the group session, we  sat uncomfortably recalling repulsive behaviors we had previously witnessed and jointly decided that, as a department, we would have absolutely no tolerance for or insensitivity to lack of professionalism. The next time an attending or colleague mentioned “tightening the vagina” during a laceration repair or the position we sit at during cystoscopy was referred to as the “cockpit” we would feel empowered to say something and not let the comment go by. If somebody made us uncomfortable with their sexual jokes, we aligned to have a plan to report it and/or feel confident in discussing the act with them. All in all, most of us are lucky in that we do not ever or often witness events that disrespect our patients and colleagues, but we all left with a heightened sensitivity and consciousness toward allowing any unprofessional act, however small, to go unnoticed and without reprimand.

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So yes, I will argue that publicizing bad behavior may help patients and physicians, but I sincerely hope it does not create a sense of fear for women who are trying to get care.  Our professional goal is to always provide excellent patient care in a safe, non-judgmental, and evidence-based manner. I do not think there is harm in discussing these ugly situations to raising awareness, however awkward it may be. I know that our specialty is filled with amazingly beautiful stories of professionalism and compassion, and that is how we are seen through the eyes of our patients and colleagues. I am proud to be an ob/gyn who works toward making women’s lives better in a respectful and collaborative manner because I know that our entire profession is rooted in professionalism.

References

1. Our family secrets. Ann Intern Med. 2015;163(4):321.

2. Laine C, Taichman DB, Lacombe MA. On being a doctor: shining a light on the dark side. Ann Intern Med. 2015;163(4):320.

3. Rabin R. Doctors behaving badly. New York Times. August 21, 2015. http://well.blogs.nytimes.com/2015/08/21/doctors-behaving-badly/. Accessed November 5, 2015.