This is a bit of a strange post, not least because it involves citing sources – a blog post, and a whole blog -that have since been taken down from the net, for reasons that will become clear. \u00a0It’s also going to involve a pair of fairly hefty quotations, largely because it’s the absence of a source\u00a0that motivates this post – which means I can’t simply tell you to follow the links. \u00a0It has to do with an apparent case of a surgeon deliberately causing a serious injury to a patient in the name of teaching, and with deceptions, and with apologies for those deceptions.<\/p>\n
It’s also a very long post, even by my prolix standards.<\/p>\n
OK: so, as quoted by Orac<\/a><\/span>\u00a0on his Respectful Insolence<\/em>\u00a0blog,\u00a0here’s the case that gets the story going. \u00a0It was originally recounted by someone calling themselves “Hope Amantine”, and was cross-posted atKevinMD.com, which bills itself as “social media’s leading physician voice”, is written by someone called Kevin Pho, and is a part a site called MedPage Today. \u00a0This means that Orac’s version is at least third-hand; but I can’t do better than that, for reasons that will become clear. \u00a0That’s a pain, but I’m going to have to take things on good faith – which, given what comes later, is perhaps asking for trouble. \u00a0Either way, here’s the story:<\/p>\n So here I was, handling the plane (the layer, or space) around the IVC [inferior vena cava] with care to avoid ripping it. It seemed like the intelligent thing to do. My attending asked, \u201cWhy are you being so dainty with your dissection there?\u201d I answered that I wanted to avoid ripping the cava because they\u2019re so much harder to fix.<\/p>\n Big mistake.<\/p>\n I take it he interpreted my comment as fear, and decided upon a teaching moment. He took his scissors and incredibly, before my eyes, and with no warning or preparation of any kind, cut a one-inch hole in the cava.<\/p>\n I was stunned. As I tried to process what I just saw, incredulous that he would actually intentionally make a hole in the cava, and as dark blood poured out of the hole, the tide rising steadily in the abdomen, he remarked, \u201cWell, are you just going to stand there or are you going to fix that?\u201d<\/p>\n And so I did. Whatever thoughts I might have had about his behavior, his judgment, and his sanity (and believe you me, there were many), I put my fingers on the hole to stop the flow. \u00a0I suctioned out the blood that had already escaped, and irrigated the field, the Amazing One-Handed Surgeon did nothing to help me. \u00a0This exercise was clearly a test. I got two sponge sticks to occlude flow above and below the hole which I instructed him to hold in position (which he dutifully did), and then I got my suture and I fixed the hole. \u00a0No problem.<\/p>\n All he said was, \u201cGood job.\u201d And we proceeded to complete the case uneventfully.<\/p>\n […]<\/p>\n Though I may not have agreed with his actions on that day, I do understand them. How do you teach someone to take charge when there is a crisis? I am certain that if I was put on the spot and shriveled and sniveled, and couldn\u2019t control the bleeding, he would have taken over. And I would have failed.<\/p><\/blockquote>\n […]<\/p>\n So on that day, when the vascular attending cut that hole in the cava, he was preparing me, both for the oral exam, and for life as a surgeon. He wanted to see if I could handle it.<\/p>\n I guess I made the cut.<\/p><\/blockquote>\n The excisions are mine – they’re where Orac makes a comment. \u00a0However, there’s one more part that’s important – and this is now in Orac’s voice:<\/p>\n The reaction to Dr. Amantine\u2019s post was furious and uniformly negative, both in the comments and in the Twittersphere, and yesterday there was an addendum:<\/p>\n Author\u2019s note 7\/8\/2015:<\/strong> This is a fictional article. No one was harmed, then or ever, in my care or in my presence. I apologize for any remark that may have been misconstrued.<\/p>\n<\/blockquote>\n Orac\u00a0calls BS on this, and I’m tempted to do likewise; but I’ll put that to one side for now. \u00a0I’ll also note that\u00a0I can’t check the flow of the original post, because it no longer exists. \u00a0Indeed, Hope Amantine’s whole blog would seem to have been taken down. \u00a0In the meantime, other blogs and pages also picked up the story from KevinMD: PZ Myers noted it<\/a><\/span> on Pharyngula<\/em>, Janet Stemwedel commented<\/a><\/span>\u00a0in a piece on\u00a0Forbes<\/em>‘ site, and I’m sure there were more. \u00a0This is noteworthy, because, as I said, the OP has now gone. \u00a0If you want to read it, you’ll have to go to where it was cross-posted or quoted (which makes this whole thing rather like a game of Chinese Whispers).<\/p>\n Indeed, not only has the OP gone: the KevinMD post has also gone. \u00a0Where it was<\/a><\/span>, there’s this message:<\/p>\n On July 7th, 2015, I cross-posted an\u00a0article from \u201cHope Amantine,\u201d a pseudoanonymous surgeon who previously blogged at Simple Country Surgeon: \u201cA lesson in the OR that prepared this doctor to be a surgeon.\u201d<\/p>\n On\u00a0July 8th, 2015, 11 a.m. Eastern, I was notified by an editor at MedPage Today about the controversy questioning the truthfulness of the story.<\/p>\n I then reached out to \u201cHope,\u201d asking whether her story was fictional or not. I received her reply at 12:38 p.m. Eastern, and added her addendum to the\u00a0story.<\/p>\n The story was initially presented as non-fiction,\u00a0then amended to\u00a0fiction after criticism. \u00a0 I don\u2019t have any further explanation for the change, other than the author\u2019s\u00a0addendum, nor do I know whether\u00a0the story is really true or not.<\/p>\n Of note, \u201cHope\u201d has since deleted her blog and Twitter account.<\/p><\/blockquote>\n OK. \u00a0With me so far? \u00a0Here’s a simplified account that tries to be as charitable as possible to everyone. \u00a0Hope Amantine published a blog post telling a story about what appeared to be a serious physical assault on a patient carried out in the name of teaching. \u00a0This story may or may not have been true. \u00a0Either way, it was subsequently deleted, but not before it had been picked up by at least one medical blog – in this case, run by Kevin Pho. \u00a0Pho’s post was also\u00a0deleted when Pho realised that the OP was unreliable, but not before it had attracted the attention of a number of high-profile bloggers.<\/p>\n Right. \u00a0I think we’re about half-way through now. \u00a0Time for another quotation, this time from Ivan Oransky on the MedPage Today site<\/a><\/span>.<\/p>\n On January 8, 1988, in an episode that captured widespread media attention, and even launched a lawsuit, JAMA<\/em> published a first-person column called “It’s Over, Debbie,” allegedly describing how an obstetrics-gynecology resident performed euthanasia on a woman dying painfully of ovarian cancer.<\/p>\n I write “allegedly” because there came to be serious doubts about whether the incident actually took place. As then-JAMA editor in chief George Lundberg, MD, wrote at the time, “As we do with authors of all articles and essays we receive, we trusted the author of ‘It’s Over, Debbie’ to be telling the truth, and we made no independent investigation of the facts.”<\/p>\n What made determining the truthfulness of the account even more difficult than usual for readers, however, was the fact that the author of “It’s Over, Debbie” had insisted on anonymity, a request JAMA<\/em> honored even following a lawsuit. Honoring a reasonable request for confidentiality is a standard practice at news organizations, and elsewhere I’ve noted why anonymity is necessary for vulnerable informants such as whistleblowers. But it can complicate matters.<\/p>\n […]<\/p>\n One lesson from [the Amatine] story –\u00a0and I have some expertise in scientific retractions, which are somewhat different beasts –\u00a0is that trust is a very tricky subject. Whenever I use an anonymous source, whether in a story in a guest post, I make sure to verify that person’s identity first. That doesn’t prevent someone from lying to me about something else, but it means some level of accountability, at least to me. And if I’ve earned my readers’ trust, that accountability passes through, hopefully.<\/p>\n I’m reminded again, as I write this, of Lundberg’s comment about “It’s Over, Debbie:” “As we do with authors of all articles and essays we receive, we trusted the author of ‘It’s Over, Debbie’ to be telling the truth, and we made no independent investigation of the facts.”<\/p><\/blockquote>\n I think Lundberg’s attitude is the right one here. \u00a0It seems to me to be a tenet of minimal decency that, if someone says something, the starting assumption should be that it’s honest. \u00a0It might still be\u00a0wrong<\/em>, of course, but a presumption of honesty seems to be a prerequisite of getting anything much done. \u00a0(Thinking about it, I wonder if that might be an element of the difference between a journal like the JAMA<\/em> and those “journals” who keep sending me spam emails: it’s obvious the latter are shysters, and one therefore has that much less of a reason to take anything in them seriously.) \u00a0There’s a moral peril here, of course, but so it goes. \u00a0Get duped too many times, and readers’ trust will take a hit; but that doesn’t really alter the desirability of the basic position.<\/p>\n