Child pornography, sex with patients, drug abuse – why do doctors fall?
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Version 0 of 1. In February this year, the Medical Board of Australia reprimanded a Canberra GP for conducting a sexual relationship with a patient over the course of eight months. Before the matter came to light, the offending GP left the clinic and the patient divulged the details to a second GP, who in a gobsmacking breach of ethics, was found by the ACT Civil and Administrative Tribunal to have engaged in physical contact with the same patient over five consultations and compared her youthful looks to that of his former girlfriend. For the second doctor’s role in the salacious affair, the ACT Civil and Administrative Tribunal handed down one of its first findings of professional misconduct by a doctor for failing to make a mandatory notification. The news was greeted with equal outrage and mirth amongst many doctors who couldn’t believe that two of their colleagues could be so stupid and bring the profession into such disrepute. The subject of doctors behaving badly intrigues gossip columnists, patients and doctors and the cacophony of opinions that followed was natural but I was interested to find one doctor who simply shook his head disappointedly, saying only, “Who would have thought?” His reaction reminded me of my dismay at discovering the truth about one of my former colleagues. Related: A taste of Belle Gibson or Dr Oz's star power isn't worth a doctor's integrity | Ranjana Srivastava As medical students my friends and I were always on the lookout for junior doctors because in a busy hospital they were often our best source of teaching. They were mostly humble and prefaced their conversations by saying how little they knew but to us they were like gods because they knew far more than we did and still retained some memory of the difficult transition from the cocoon of a university lecture theatre to the bedside of a real patient. I was assigned to a very good intern. He was knowledgeable and amicable, popular for his looks and undeniable aptitude. As an eager student I welcomed the fact that he would let me tag along, getting me to read an ECG here, insert an IV there. I remember wondering if I’d ever become like him. Our paths crossed again after I graduated and we worked in the same hospital. While I figured out how to be a half-decent intern he was on the path to becoming a specialist. When we spoke, I was surprised to detect a note of impatience, even superiority, where previously there had been only camaraderie, but I excused it because I thought he was skilled. The next time I heard his name it was in relation to charges of downloading over a thousand images of child pornography and various other disturbing pictures on hospital computers. He was fired from the hospital, kicked out of training and hauled before the court where the judge rejected the excuse of a heavy workload and sentenced him to a suspended jail sentence. His fight to retain his medical registration succeeded but with such serious and prolonged restrictions that his career was decimated. The medical board castigated him for seriously discrediting the profession but his true punishment is having fallen in the eyes of all those who had trusted him. No matter what restrictions are lifted in future he must hurt to know that he will never enjoy the privilege of being the role model that he once was. If the cost of these transgressions is obvious, why do doctors download pornography, have affairs with patients and abuse trust in other ways? Dr. Kym Jenkins is a psychiatrist who heads the Victorian Doctors Health Program, a confidential service for doctors and medical students who have concerns including substance use, stress and anxiety. She points out that the vast majority of doctors do good work and genuinely care about their patients. “Of the very small number of doctors who misbehave, the question is whether they have turned into bad apples or were outright psychopaths to start with.” She thinks there are more of the former: doctors who have become damaged along the way. Substance and alcohol abuse can play a significant role in the lives of some doctors, who have easy access to highly addictive opioids and benzodiazepines. “Propofol is becoming the hypnotic of choice amongst anaesthetists,” Jenkins says calmly. The anaesthetic agent gained notoriety when Michael Jackson’s physician administered a fatal dose of it to the performer. Doctors can self-prescribe or pilfer but they can also afford to buy illicit drugs. Experiencing stress at work and not knowing how else to cope can lead to use that turns to abuse Anxiety and depression are intimately associated with substance abuse, Jenkins says. Experiencing stress at work and not knowing how else to cope can lead to use that turns to abuse, which ends up impacting judgement and insight and causing more entrenched symptoms. The cycle is as insidious as it is destructive but doctors excel at masking their illness. Their colleagues are either oblivious to the problem or hesitate to break ranks. Jenkins notes a sharp rise in medical students and junior doctors turning to her service, partly as a result of broader acceptance of mental stress but also because professional rivalry and its associated tensions are rising. Doctors at every level are subjected to low-level harassment, derogatory behaviour and disrespect at the hands of their colleagues. For some, bad behaviour towards patients becomes the outlet for their accumulated frustration. How is it that doctors can master a complex journal article but struggle to negotiate interpersonal relationships, especially when it comes to establishing boundaries with vulnerable patients? In a long career of counselling troubled doctors, Jenkins has noted two personality traits as red flags. Doctors are obsessed with the notion of being perfect at everything. “The child that gets into medicine may have been the golden child of the family, which creates a powerful aura of entitlement. This entitlement could extend to power over colleagues and worse, patients. And a belief they can get away with things they know to be wrong.” Many doctors also lack the capacity to self correct. “Sadly, some doctors display a striking mismatch between IQ and EQ,” reflects Jenkins. “They have spent so much time in training that they can lag in psychosocial and psychosexual maturation. And when you can’t read social cues, dysfunctional and frustrated relationships and odd ways of thinking can spill over into the patient encounter.” For example: “An adolescent girl tells a GP that he is the only doctor who understands her problems. The GP is flattered at being uniquely helpful. So the 15-minute consultation is extended to a half-hour that rolls into an hour. The GP starts staying back at night to listen to her, offers to drive her home, puts his arm around her and you could see how the boundaries shift.” Jenkins says that psychiatrists are explicitly taught about the danger of liaisons with patients and of the importance of maintaining strict boundaries, perhaps because the power imbalance between a mentally ill patient and her doctor often stares them in the eye. However for other doctors such training is typically absent and they must rely on their own ethical compass to navigate the all too human frailties of workplace attraction, sexual appetites and abuse of privilege. It should come as no surprise that doctors can be flawed like everyone else. Flagrant violation of trust is thankfully rare but the repercussions are significant. Academics groan that the medical curriculum is already crammed without having to teach doctors about the dangers of downloading pornography and having sex with patients. But if we agree that good professional practice involves more than writing a legible prescription, we must also acknowledge that the medical profession needs to do a much better job of recognising and rehabilitating its most damaged doctors before they act in a way that leaves us all feeling dismayed and even a little tarnished. |