Every relationship involves some level of trust. We trust our spouses not to cheat, we trust our children to do their homework and wash their hands, we trust our friends to pick us up at the airport at the correct time, we trust the bank teller to deposit our check into the right account. But nowhere is there more trust than in the doctor-patient relationship. Patients literally put their lives in our hands, and they trust that we will act professionally and take care of them to the best of our abilities.
Now, in the universe of health care, anesthesiologists hold a rather unique position—their associations with their patients are typically very brief, but vitally important. They are responsible for keeping people alive and breathing while they are sedated and paralyzed, reliant on machines to keep them from dying.
Unfortunately an anesthesiologist in Virginia failed to take her responsibilities seriously enough, and now she is paying for it dearly. She didn’t ignore her patient, she didn’t give the wrong dose of medicine, and she didn’t forget to turn the machines on.
Rather, she made fun of her patient while he was asleep.
According to a Washington Post article, a Virginia man identified as “D.B.” went to an outpatient clinic for a colonoscopy in April 2013 and started his cellphone recording, intending to record only the post-procedure instructions since he figured he would not be able to remember them properly. However, he accidentally left the phone recording during the entire procedure, and when he listened to the recording afterwards, he was shocked to hear the anesthesiologist denigrating him repeatedly.
“After five minutes of talking to you in pre-op, I wanted to punch you in the face and man you up a little bit,” Dr. Tiffany Ingham is heard saying. Regarding the patient’s penile rash, Dr. Ingham tells a nurse not to touch it and to gown up, or else she might get “some syphilis on your arm or something… It’s probably tuberculosis in the penis, so you’ll be all right.” In addition to numerous other insults (including calling D.B. a wimp and a retard), she also inexplicably wrote in his medical record that he had hemorrhoids despite the fact that the gastroenterologist performing the procedure found no evidence of them.
D.B. sued the anesthesiologist and the gastroenterologist for $1.75 million, stating that he suffered from anxiety, embarrassment, and loss of sleep. On the first day of the trial the gastroenterologist was dropped from the suit, and the defense argued that the man suffered no physical injury. After a three-day trial, a jury determined that even though he missed no work and wasn’t physically injured, that he was “verbally brutalized” meant he deserved compensation to the tune of $500,000—$100,000 for defamation, $200,000 in malpractice, and $200,000 in punitive damages.
Setting aside the lawsuit and monetary award for a moment, the bigger issue here is a total lack of professionalism. Everyone in an operating room—doctors, anesthesiologists, nurses, and techs—talk while their patients are asleep, but the vast majority of the conversation revolves around the procedure being done.
However, I will be the first to admit that I have made disparaging remarks about patients under anesthesia. A few months ago I wrote in The Daily Beast about what really goes on in the operating room after patients go to sleep, including that doctors sometimes make small jokes at the patient’s expense. I have remarked that a severely obese patient is a “big girl,” or I may tease about a misspelled tattoo or dirty socks. It may sound a bit insensitive, but I never say anything to anesthetized patients that I wouldn’t say to them awake.
But what Dr. Ingham said is beyond any conceivable ethical limits. She did not restrict her attack to superficial details, she got personal. She wondered aloud if the patient was gay because he had attended a formerly all-women’s college. She called him childish names better suited for a playground tiff. She suggested that he had a sexually transmitted disease. She said she wanted to punch him in the face. These are all things that would likely get someone assaulted were they said in a bar after a drink or two, but she had the audacity and impudence to say them to him while he was asleep, at her mercy, and at his most vulnerable.
And then there is the real complicating factor—intentionally writing a false diagnosis in the medical record. While it may not seem terribly consequential on the surface, Dr. Ingham purposefully chose a diagnosis of hemorrhoids, one that many people find humiliating and difficult to discuss. Falsifying a medical record in any way is reprehensible, but deliberately shaming and demeaning the patient is simply puerile and petty and fully deserving of reproach.
What Dr. Ingham said and did was offensive and thoroughly unprofessional. In entrusting patients with their lives, doctors are expected to act professionally, and patients should demand nothing less. That doesn’t mean that doctors must act like saints, only that they should act like reasonable people. Dr. Ingham abused that trust absolutely and completely. Her words and actions are so absolutely outside the norm that I would have found it difficult to believe had I not heard it with my own ears.
Since this incident, Dr. Ingham apparently left Virginia and moved to Tavares, Florida, where she still practices anesthesiology. According to the Virginia Board of Medicine, no action has been taken against her for this event, and there is no discipline on file with the Florida Board of Medicine. I would be surprised (and frankly outraged) if this remains the case now that this story has been publicized.
It is possible that this was a one-time event, and that Dr. Ingham was just having a rough day, which caused her outburst. However, that is not an excuse for her actions, nor is there any. I only hope that this ruling against her taught her a very important, and very expensive, lesson.