Doctors often don’t have the time to address social slander

Not long ago a woman in my community, who was a patient of an esteemed local oncologist, died.  Let us call her “Beverly” and let us say she died of “breast cancer.”  I am familiar with the details of the case because one of my partners saw her in consult, but HIPAA and common courtesy forbid me to be any more transparent.  Beverly was very popular in our town and many attended her funeral.  It was there I learned, to my astonishment, that Beverly’s death had occurred because of medical error.

As I listened at the viewing and service, it was common knowledge that Beverly had suffered massive liver failure because of an overdose of a chemotherapy agent.   Apparently, according to many with whom I spoke, she had a small amount of treatable cancer and should have survived many years, perhaps even been cured.  Massive inappropriate doses of a drug had melted her liver, and she died swollen, confused and yellow.

This was very distressing news.  Beverly had been under the care of a brilliant, contentious doctor, who had saved the lives of many men and women.  This shared knowledge will no doubt affect his future practice and most of the people who understand the terrible events, as well as their friends and relatives, will not recommend him.  However, what disturbed me the most, really cut to the core, is that these facts, this community finding of guilt, was not only the refuse of rumor, it was absolutely untrue.

What had killed Beverly was the cancer.  Breast cancer, as it very often does, had spread to her liver. This resulted in liver failure.  She had indeed received chemotherapy, but it was in an attempt to save her liver and extend her life. The therapy had not been successful, her liver was destroyed by cancer, and Beverly had died.

Thus, a gifted doctor, who gave compassionate and state-of-the-art care, is condemned by the very community for which he sacrificed and is sentenced by the privacy which every patient and doctor values.  He cannot respond or explain and neither can any other professional caregiver who was involved in the case.  Her family might be able to give him support, but they are fragmented, mourning and confused by the falsehood frenzy.  Grief and guilt are fertile ground upon which rumors flourish.

Whispered reputation deconstruction occurs all the time and is often propagated by the viral contagion of the Internet.  Committed, hard working caregivers are tried and found guilty in the court of errant popular opinion and have no practical or legal way to counter.  Because their reputation is soiled, communities lose access to doctors who are right down the street.

In the day-to-day practice of medicine, most doctors do not have the time or tools to address social slander, and instead move on to the next patient, attempting always to give the best possible care. While frustrating, and increasing the chance of burnout, rumors may motivate the physician to work even harder to counter the bad PR.  Perhaps the net effect may be to improve the quality of care, but since the doctor  d may never hear about the negative rumors, he or she is simply left with fewer patients and less opportunity to contribute.

As a physician and patient, I would suggest healthy skepticism when we hear scuttlebutt about complex cases about which we do not have intimate knowledge.  Accepting and passing on negative information, which you cannot confirm, may do great harm.  Not only can this hurt the memory of people we love and cripple the coping of their families, but may deprive us of valuable medical care when we need it most.

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

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  • Anthony D

    Great article doctor. Thank you for posting!

  • DoubtfulGuest

    A few thoughts, Dr. Salwitz…this is an important topic. I’m so sorry for this patient, her family, and also for the doctor. I hate to think he should have to work harder — I imagine what you said about burnout is more likely, as opposed to quality of care getting even better. As a patient and member of the public, I’ve heard lots of people say things along the lines of wanting to crack the whip on doctors, like everything would be fine in medicine if they’d just work harder. This isn’t right. When mistakes ARE made, there are so many system factors that come into play and in some ways actually set up our medical professionals for failure. I wonder how well any of us could function under those conditions.

    I wonder how these rumors started? If there’s uncertainty in the patient’s family, perhaps this could be corrected? How can we help the public learn more about bad outcomes that are no one’s fault? And that doctors aren’t God? On the other hand, I’m not sure that any talk about bad outcomes among laypeople should be dismissed as “scuttlebutt”. People need social support, and talking is part of that. If we were passing on factual information, it wouldn’t be harmful. There’s a real problem with lack of transparency in your profession. On top of that, the doctor-patient relationship has deteriorated. In my own experience, I haven’t been allowed to get the facts about what went wrong with my care. Perhaps none of these factors apply to the case you mention. I just wanted to point out the general trend I notice that 1) patients are criticized for lack of knowledge/understanding and 2) we’re not given information we’d need to understand. We might also examine how the legal system helps perpetuate this vicious cycle.

  • rbthe4th2

    There could be more to it. Maybe that’s what happened and maybe not. Having been on the end of doctors trying to protect each other and seeing just how far they’re willing to go to protect themselves and let me go down hill, its hard for me to believe it.
    I’m sorry but my experience has taught me a lot about the “frat”.