Failure to self-police

May 23, 2006 at 5:25 pm | Posted in professional ethics | 5 Comments

So today I heard reports that a classmate of mine was posing as a 2nd year surgery resident at one of those temporary post-Katrina medical treatment centers last fall. Apparently he didn’t actually do anything that 3rd year med students can’t do without supervision, but still. That’s a serious violation of professional conduct, if not outright illegal, and it probably should have been reported to the dean’s office. But I wasn’t a witness to it, so I can’t exactly report it myself. Apparently one of the faculty members was, and yet still nothing happened. So my classmate who did observe it, even though he feels strongly that his fellow student should be punished in some way, believes that he has no right to report it if the physician faculty member didn’t do so. Still, I wish someone would, because that kind of thing is an early warning of the kind of professional behavior that leads to licensure sanctions and reflects poorly on all of us.

I like the guy, despite the fact that he would constantly talk during lectures 2nd year, which was very disruptive for all the people around him. He’s extremely smart, and always has some snarky comment to make about whatever’s going on, so he’s pretty entertaining to be around. Although I’ve never actually seen him do it, I’m pretty certain he could talk his way out of just about anything. He’s one of those bellwether students, in that the opinion of others’ about him says more about that other person than it does about him. Whether a particular faculty member likes him, loves him, or is skeptical about him generally correlates well with my prior opinion of the perceptiveness of that faculty member.

But he’s fun to have around in more informal settings, and I’m not close enough to him for any potentially less-than-ethical behavior to put me in a difficult position. I’m not afraid to do my professional duty when necessary, but the fact is, I haven’t personally been witness to anything reportable. So there you have it.

5 Comments »

RSS feed for comments on this post. TrackBack URI

This is really, really, really appalling, Jill.

I don’t care how brilliant or charismatic this guy is — those who were there and witnessed his charade should have put an immediate stop to it and reported him, and that includes the faculty member who was there.

This type of behavior is unacceptable and I can’t begin to tell you how disturbing a situation this paints, not only of the callous disregard of the faculty member at unethical behavior, but at what kind of precedent this might be setting for your classmate. Indeed, what was he thinking when he decided to pose as a 2nd year surg resident? Now that he’s gotten away with it, what’s to stop him from trying again?

I have seen some disturbing things among medical students on rotations, but never one actually posing as a resident.

Comment by Tea and Books, etc— May 27, 2006 #

Reply
The tricky thing here is that he was functioning as a volunteer during a period of time when the med school was out of commission due to the hurricane. So the jurisdiction of the med school over his behavior may be questionable. And under normal circumstances, it would be impossible to pose as a resident. There would have to be verification of someone’s credentials just to let them in the door. But at a field clinic that close to New Orleans, that soon after the hurricane, there was too much chaos to do anything more than accept people at their word. If they’d insisted on checking, they would have had to turn any medical personnel from Orleans Parish away, because no one’s credentials could be checked at that time.

But I completely agree, it’s disturbing that anyone in med school would be so opportunistic as to take advantage of the chaos and pose as someone with more training and autonomy than they actually have. It’s not just his own license and future he’s risking, it’s those of everyone else he works with also, and the reputation of the school itself. The only thing saving all those people from a lawsuit if he hadn’t been stopped, is that I doubt he’d actually make a mistake in patient care.

As for why it wasn’t dealt with immediately, that I can defend. The administration of the school was busy putting the school back together, and this, while important, was not an issue of quite such urgency.

However, I can’t defend the continued lack of attention to the matter, now that things are more settled. Since that time, I’ve been called on the carpet for things that are VERY minor compared to that, and I’m quite certain that if I had done what this guy did, I’d have been unceremoniously kicked out of med school. And that bothers me just as much as anything else about the situation.

Comment by Jill— May 27, 2006 #

Reply
I agree and disagree with what you’ve written. I’ll have to organize my thoughts some more before I respond in full.

Comment by Tea and Books, etc— May 27, 2006 #

Reply
I should clarify: it’s not the fact that I’d be kicked out for posing as a resident that bothers me, because that’s more than enough justification. It’s the disparity between what I think would happen to me in that situation, based on how I’m dealt with over minor things, and what’s happened to this guy, which is less than a slap on the hand.

Some of that is my own fault: I wrote a letter defending some students who’d chosen not to participate in a particular activity, because I’m good at explaining behavior in a logical and non-whiny way. But because of that, the administration thought I was the ringleader, even though they really should know me better than that. And they should certainly know that I don’t have enough social influence with my classmates to pull off something like that, even if I were the type to try.

I’ve always been the one to ask permission BEFORE doing something questionable. And I usually get told no. But people who don’t ask permission generally get away with whatever they do, so it seems like the more effective tack is not to ask permission.

That’s my one peeve about my school. It’s a big one, though.

Comment by Jill— May 27, 2006 #

Reply
I apologize, first, for my delay in responding and, second, for the length of my reply. It’s taken me some time to formulate what I want to say in a relatively calm way.

Also, since I’m not a lawyer and neither you nor I were there when this apparent imposture took place, we don’t know what actually happened. Therefore, I’m going to preface this reply by saying, first and foremost, that the imposture allegedly took place and my responses would be the same for any situation that was similar to the alleged event. Since we’re not revealing anyone’s identity or the location of the incident, I don’t think we are being libelous. In any event, it’s not libel if the statements are true.

The tricky thing here is that he was functioning as a volunteer during a period of time when the med school was out of commission…So the jurisdiction of the med school over his behavior may be questionable.

While I agree that in normal circumstances, a volunteer tends to be outside the jurisdiction of his/her company, etc, this was an emergency/crisis situation and specifically involved a medical student — whether his school sent him out as a volunteer or he volunteered himself — and he is going to be viewed as under the school’s jurisdiction, regardless of whether the school was functioning or not. And, in fact, part of the Good Samaritan laws is that the good Samaritan (in this case the volunteer) act within his/her capabilities and do no harm.

… under normal circumstances, it would be impossible to pose as a resident. There would have to be verification of someone’s credentials just to let them in the door. But at a field clinic that close to New Orleans, that soon after the hurricane, there was too much chaos to do anything more than accept people at their word. If they’d insisted on checking, they would have had to turn any medical personnel from Orleans Parish away, because no one’s credentials could be checked at that time.

While I concede that there would have been a lot of utter chaos during this period, as with any crisis situation, and that it would have been extremely difficult to check people’s credentials, it wouldn’t have been impossible for at least some credentials to be checked. How? All practicing physicians and residents and other healthcare professionals (nurses, EMTs, etc) have work ID, not to mention driver’s licenses and other forms of identification. Granted, even some of these could be forged but it would be highly unusual, I think, to do so in this type of situation as opposed to, say, some sort of financial scheme.

As for turning medical personnel away because credentials couldn’t be checked — either because there was no one to check with or because IDs had been lost, etc… maybe, but very unlikely. One doesn’t need a medical license to check vitals, do quick H&Ps, affix bandages, and provide basic first care, or even assist elsewhere, such as setting up shelter, more field hospitals, gathering what supplies might be available, etc. Aside from H&Ps and the vitals, any lay person can do, and often has done, the rest.

…it’s disturbing that anyone in med school would be so opportunistic as to take advantage of the chaos and pose as someone with more training and autonomy than they actually have. It’s not just his own license and future he’s risking, it’s those of everyone else he works with also, and the reputation of the school itself.

This is 1 of the 2 things that disturbs me most about this situation, and it is a twofold: that he apparently would and did seize this opportunity and that it was in this type of situation. All of the things you mentioned above are absolutely at risk — his license and others’ and the school’s reputation — but also the patients’ health and well-being. In essence, I feel he was treating all those people coming into the field hospital as guinea pigs.

Harsh? Unjust? Maybe, but I don’t think so. Why else would he pose as someone more advanced and autonomous if not to have more chances to do more than he’d normally be allowed? And if it was simply because of ego….

The only thing saving all those people from a lawsuit if he hadn’t been stopped, is that I doubt he’d actually make a mistake in patient care.

Here, I again disagree. A 3rd year medical student and a 2nd year surgical resident are quite different in their skills, knowledge, experience. If he was providing care beyond what he should be doing, it doesn’t matter how intelligent he or anyone else thinks him — he could be Doogie Howser, MD — mistakes can and do happen at all levels.

If a lay person had walked into that field hospital and claimed to be a physician and later was found to have no medical credentials at all, what would likely have been the result, regardless of whether anyone was harmed or not (let’s assume no one was harmed)? At the very least, an investigation would ensue. Prosecution and jail time might follow, even if the incarceration is for a short period (let’s say 1-2 months).

The fact that nothing has been done about him is a very bad thing.

…why it wasn’t dealt with immediately, that I can defend. The administration of the school was busy putting the school back together, and this, while important, was not an issue of quite such urgency.

I disagree again. The health and well-being of patients is the number 1 priority, always. Yes, obviously the school and other infrastructure needed to get up and running again, but I refuse to believe that this matter of dealing with a student who was essentially posing as a physician was less urgent. Let’s face it, New Orleans and the other devastated areas are not going to be near 100% for a long time to come, and other disasters — hopefully on a much, much lesser scale — are not going to disappear…

Unless he is shown that there are consequence, and severe ones, what is to stop this student from lying again? Having seized the opportunity once, he can do so again. By your own admission, the guy is intelligent and charismatic; he’ll know how to pick and choose carefully.

However, I can’t defend the continued lack of attention to the matter, now that things are more settled.

And this is the other thing that bothers me the most. While it could be argued that other priorities took place over a student infraction (which I’ve already mentioned that I disagree), there is absolutely no excuse for not dealing with the matter now. And, again, I ask, what kind of message is this sending to not only this particular student but others? If one got away with this type of thing, why shouldn’t another student try?

…if I had done what this guy did, I’d have been unceremoniously kicked out of med school. And that bothers me just as much as anything else about the situation.

You’re quite right; many schools would at least impose severe punishment if not outright expulsion for his behavior. Legally, I’m sure the expulsion could have been fought, and likely won by the student, but to do nothing, that’s worse. It’s a tacit agreement to the imposture and ethical wrongdoing… is this the kind of message that should be sent?

I’ve no doubt that others in your class are equally disturbed by the situation, and if nothing continues to be done, people are going to become more jaded and cynical, possibly indifferent, and who would want our physicians and other healthcare providers to have these attitudes? It’s terrible enough that bad physicians do exist; it’s worse when good physicians, or those who will enter the field, end up going through the motions than really caring about what they do.

…it’s not the fact that I’d be kicked out for posing as a resident that bothers me, because that’s more than enough justification. It’s the disparity between what I think would happen to me in that situation, based on how I’m dealt with over minor things, and what’s happened to this guy, which is less than a slap on the hand.

I agree completely. He should be kicked out, but barring that, he emphatically should be punished.

That’s my one peeve about my school. It’s a big one, though.

It is a big peeve but it’s also justified. As I wrote above, I think it highly unlikely that you’re the only one who perceives the situation this way.

Comment by Tea and Books, etc— June 3, 2006 #

Reply

Hurricane Jill