A Patient Who Was Violated By Her Doctor (3:17)
Every physician is bound by oath to treat the ill to the best of his or her abilities. But what happens when the medical system we dutifully serve fails to weed out a doctor who harms his or her patients? That’s what makes the horrifying patient abuse stories at the hands of Dr. Daniel Tesfaye and Dr. Nikita Levy on the "Dr. Evil" episode so shocking — and so necessary for me to comment on.
Everyone would agree the actions of Drs. Tesfaye and Levy — profiled in the January 3, 2019 broadcast — were appalling, and that their former patients Lisa and Stazi were brave to share what happened to them while under their doctor's care. But their stories are also part of a series of system failures, procedural, legal, and ethical, that made it possible for these physicians to continue treating patients. It serves as a call-to-action for all doctors to police one another. As a doctor myself, I deeply believe that all doctors have a responsibility not only to treat patients, but also to ensure that these issues are proactively and properly addressed. In fact, professionals in all fields have an obligation to do the right thing, to follow rules of conduct, and to model ethical paths and behaviors for the rest of society. It’s the same basic promise if you’re a doctor, lawyer, architect, or any other professional: "I will take care of you as though you're the most important thing in my life, and nothing that I personally feel is going to get in the way of that relationship."
In medicine, we have names for some of these rules, such as the Hippocratic Oath, which is one of the oldest binding documents in history and is still held sacred by physicians: Treat the ill to the best of one's ability and teach the secrets of medicine to the next generation. Doctors pledge to this oath when we graduate from medical school and are first and foremost held responsible for treating patients and their illnesses as best we can.
The second responsibility we have is to advance the field. You stand on the shoulders of people who worked before you, and you make the field even better than it was. You’re not there just to tread water, you're supposed to be a little bit better tomorrow than you were today — and today should be better than yesterday. Physicians actually measure our success, not just in academic circles but throughout medicine, by our ability to do just that.
We're pretty good advancing the field and we're actually pretty good at taking care of our patients. But then we start running into trouble, because the third thing that a physician (or any professional) must do is be accountable for the other members of his or her professional community. Why? Because the ethics of managing a doctor's behavior is best identified by another doctor.
Some things the average person might not think are not the norm when practicing medicine actually are: There are some things we have to do just to take care of patients. We, as doctors, know this. But we also know that some things are not the norm. As a patient, these can be tricky to decipher. Patients typically see doctors when they are not feeling well, which is a very vulnerable time. Patients rely on a doctor’s certainty and confidence in his or her actions — confidence that is undoubtably required in the field of medicine.
But there's fine line between confidence and arrogance, and Drs. Tesfaye and Levy from the "Dr. Evil" episode crossed that line again and again. It is every physician’s responsibility to draw the line, to be transparent about what is and isn’t acceptable conduct, and to monitor and address these problems amongst our peers. It’s difficult but critical that we, the professionals, take action when there are problems with some people in our profession.
It’s not easy to speak out. We are healers. We ask ourselves, "Am I going to destroy someone’s life because they did something inappropriate and unprofessional?" And we think, “I don't want to throw away years of training and society's investment in this doctor. Maybe there is something I can do to fix it.” This reflects the culture of medicine itself, which is to repair, to retrain, and to educate. If we do, maybe these doctors won't ever do it again.
Unfortunately, retraining doesn't always work and doing nothing surely never works. Therefore it is imperative that we remain alert and awake, despite our culture of healing, to say this about our colleagues: Sometimes you don't heal, you have to just amputate and remove.
And sometimes that’s not even enough.
In the case of Dr. Tesfaye, the Medical Board of North Carolina took action but didn't tell anybody. There wasn't a system to communicate what had happened to the people who needed to know. So that meant this doctor could just move to another state and do the same thing again. Which is exactly what he did. We heard that the folks who were in charge of his sentencing in the second incident that we covered on the show say that if they'd known about the first incident, there would have been a much different outcome.
If bad doctors are being allowed to practice because there's a bad law, the rest of the medical community has an obligation to speak up. We need to change what the rules are so they're not protecting the doctor, but they're protecting the patients. Doctors have the ability to discuss tough cases at our ubiquitous Grand Rounds, where all physicians present their complications. In the safety of this conference, all doctors can weigh in and offer suggestions as well as share best practices. If this fails, doctors can confront each other privately or address concerns to the division chiefs and department chairmen. If this fails, the hospital leadership can intervene. Finally, the specialty board (for example: plastic surgeons hearing about plastic surgeon issues) or a state medical board will hear complaints, which results in censorship. If all of these ethical and professional systems have failed, law enforcement should be called.
When the ethics aren't adhered to and the law isn’t followed, it is up to physicians like me to fulfill our fourth civic responsibility: If you see something, say something. Tell society what we think needs to happen.