Did hospital politics lead to physician suicide?

What causes a doctor to commit suicide?

A story about a radiation oncologist from Springfield, IL brought this strange case to my attention. Dr. Thomas G. Shanahan committed suicide by cutting his throat in November of 2011. He was respected in his field, having published many research papers and traveled the world helping to set up brachytherapy clinics in several countries. He also had been an acting alderman in his home city. He left his wife and three daughters.

Why did he do it? He had a history of depression. But an event occurred the year before his death that apparently significantly affected his personal and professional life.

Perhaps this story will puzzle you as much as it did me.

A patient with a diagnosis of advanced lung cancer was transferred to Memorial Medical Center where Shanahan worked. She had fallen and broken her leg and developed massive distension of the colon. She was having difficulty breathing. All of her doctors assumed she was terminally ill and advised the family to place her on a comfort care only status. Dr. Shanahan had received a request to see her and did so the next day. After evaluating her and her biopsy results from the first hospital, he felt that she was not necessarily terminally ill and should have a colonoscopy to decompress her colon. The other physicians declined to do so although inexplicably, a colorectal surgeon agreed to colonoscope her and ruled out obstruction but felt decompressing the colon would have been futile.

Shanahan then instructed a nurse to insert a rectal tube which evacuated all the gas and promptly resolved the breathing difficulty. The patient survived for seven more months with some diminished mental capacity thought to be related to the relative lack of oxygen when she was getting only comfort measures. She and her family were pleased with Dr. Shanahan’s efforts on her behalf.

The patient had Ogilvie’s syndrome, also known as pseudo-obstruction of the colon. It occurs in bedridden patients and those with recent orthopedic problems who receive large doses of narcotic pain medication. The treatment Shanahan ordered was correct.

But Dr. Shanahan admitted he had “ruffled the feathers” of some colleagues. He was called a “disruptive physician.” Memorial Medical Center conducted “an inquiry” to investigate his conduct. It was eventually dropped without any formal action being taken.

The chief medical officer at Memorial said, “Shanahan portrayed himself as ‘somewhat heroic’ to Reindl’s family and was unnecessarily abrasive toward Springfield Clinic doctors and Memorial employees.”

Another account reported the following. Shanahan moved his office earlier this year from Memorial to St. John’s Hospital, telling friends and colleagues in an email June 28: “The last six months have been hard on me, deciding to defend a patient or turn my head and follow the herd … I have received over 500 letters and emails supporting my decision.”

We will never know how deeply this situation affected Dr. Shanahan. He left no note.

Having learned all I can about this tragedy, I have some questions. Why was a radiation oncologist able to correctly diagnose and treat this patient while several more clinically oriented specialists could not? How is it that the doctor who made the right call over the objections of several colleagues is the one who is subjected to an inquiry and feels the need to move to another hospital? Is it ok to be “abrasive” when you are the only one who got the diagnosis right? Wasn’t he in fact a “hero” for refusing to back down and saving the patient’s life?

“Skeptical Scalpel” is a surgeon blogs at his self-titled site, Skeptical Scalpel.

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  • http://twitter.com/SarahWW Sarah Wells

    I think the real problem might have been physicians jadedly deciding this woman’s fate based on her terminal lung cancer. (“Why bother” being the operative sentiment.)  Being “right” exposed the other doctors who had expected to be the unchallenged arbiters of what was best.   I see shades of that expectation – or at least a  wish to direct non-intervention when the patient is old and sick already (before the new catastrophe), here on these pages with regularity.    He also, being right, exposed those other doctors to complaints and even the possibility of litigation (more of a resented fear than a real liklihood.)   It reminds me of the old “Adam Williker”  detention letter.   No is to blame for this man cutting his throat;  but he likely did face censure and shunning and vendettas, even, from his wrong colleages who felt he acted in a way that was embarrassing to themselves.

  • http://twitter.com/SarahWW Sarah Wells

    Correction to the old “detention letter” mentioned below:  It’s the “adam hilliker” letter

  • http://www.facebook.com/profile.php?id=655523194 Jeanine Satriano-Pisciotta

    What a tragedy, although he chose to make the patient more comfortable, he was shunned by those who did not. He did the right thing and I hope these other doctors remember the impact their actions and words have on others. Not just patients, but their colleagues too. May they learn the real meaning to “do no harm”.

  • Anonymous

    One doctor cared , the others didn’t . One doctor was ostrasised .

  • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

    This sort of thing happens more often than non-physicians might think

  • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

    Here’s an oldie but goodie from 2003. As true now as it was back then.

    http://www.post-gazette.com/pg/03299/234499-84.stm

    Follow the links, it was a long series.

  • Michal Haran

    I think it is not only a matter of being a true partner for your patient, but also being a true partner to your colleagues. I do not know the details of this specific case, but I have seen many physicians who think that being their patient’s advocate gives them the right to insult and humiliate colleagues who may have made a judgement error. Mistakes are the soil of our learning. “What is wisdom, to err and err and err, but less and less and less”. During my residency training we had a monthly M&M conference. Each of us, in his/her turn,  had to go over all the patients charts and pick up those in which we thought some mistake has led to less favorable outcome. We then discussed those cases openly (without mentioning the residents involved or pointing fingers), as a way of learning what could have been done differently. This experience also taught us how common it is to make mistakes, and how common it is not to recognize those on time, but only after the fact. It also taught us to learn from those mistakes and yet be forgiving to ourselves and others for being human. Mistakes and errors were taken very seriously, at the same time in a realistic understanding that those are to some extent inevitable. We were taught not only how to recognize mistakes (of ourselves or others) but also how to deal with them. 
    From my experience at least, when you find such a management error of one of your colleagues-an honest and respectful discussion with the patient and the physicians involved, and doing everything you can to correct this mistake leads to a better outcome for all. The same applies when you (or one of your colleagues) realize you have made a mistake. I always thank my colleagues (or nurses or a family member) when they have noticed something I have missed before significant damage could have occurred, and bring it to my attention in an honest and respectful way. 
    When I myself became ill, I had much more respect for those physicians who were ready to honestly discuss management errors, than to those who did not. I also had much more respect to those physicians who didn’t explain to me how wrong/inexperienced other physicians were (many times, being so confident in themselves, repeating the exact same errors) , but rather concentrated on doing better and truly learning from those mistakes without disrespect to their colleagues. 

  • Michal Haran

    That being said, I also think that this is a tragedy which should have been prevented. No physician in the world, should be brought to such a state of despair. No doubt that he has done the right thing in helping his patient even if it did offend some of his colleagues. And he too should have been treated in a much more considerate way. 

  • Anonymous

    This is not an isolated case. As a survivor of a viscious attacak of physician targeting, going through a sham peer review, I am constantly being scrutinized, although I have had almost 30 years of outstanding patient care and am recognized as a best physician, etc.  Then to further punish me, then went after one of my partners, another excellent surgeon who is also recognized nationally as a “best” physician. 

    Certain institutions breed this kind of culture and usually one or two physicians, usually in administrative positions, are the leaders of the mob. 

    The word “disruptive” physician has come to mean anyone with whom you have a disagreement be it clinical, political, or someone with whom you are in direct financial competition. 
    It is ugly and it is pervasive and it is the new way hospitals are using their medical staff leadership to tame doctors.  And the so-called oversight agencies, such as the Joint Commission have responsibility here because they have jumped on the bandwagon to encourage such “peer review.” 

    The looming physician shortage will be no doubt impacted by these types of “hospital politics” more than anticipated. 

    • Kevin Windisch

      You have hit the nail on the head here.  I’ve been there and done that like you.

  • Anonymous

    Personally, I’d rather be dead than live another seven months with “some diminished mental capacity”, especially with underlying advanced lung cancer.

    I’m guessing there’s more to this story, as there always is, and I’m guessing the physician had other problems.  No one incident leads to suicide.

  • http://twitter.com/Skepticscalpel Skeptical Scalpel

    Thanks for all the comments. Indeed there may be more to the story, but none of the other physicians involved in the care of the patient agreed to be interviewed by the local newspaper. Maybe it wasn’t necessary but Dr. Shanahan felt the need to move his practice.

    I was struck by the tragedy of this event and felt it should be shared with others.

  • http://www.facebook.com/mrmarasco Maddy Reeses Marasco

    I met Dr. Shanahan 2 years ago.  He and I spoke for an hour or so during a social event.  He was an oncologist and I a surviving cancer patient.  What an incredibly sensitve human being.  He let me ask and he answered so many questions about what I had just gone through and what to expect in the future.  Cancer survival is a scary thing.  I think it is rude to bother someone about their expertise when they are in a social situation.  But he seemed perfectly happy to share his knowledge.  Much of it comforting.  Sometimes such a caring soul has difficulty living in a judgemental world.  People who live in their hearts live in a very big place.  Rest in Peace.

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