From the earliest days on the clinical wards, everyone probably worked with a senior physician who knew how to game the system. It might be doing a rigid sigmoidoscopy on admission for every patient who had a rectum — something not the standard of care forty years ago. Or maybe it was accepting a pharmaceutical company subsidized tax-deductible junket under the guise of CME at a place with sparkling white sand in February — something that might have been the standard of care 40 years ago. While people would question the propriety of these things, there did not seem to be any material challenge to the legality. And the patient would benefit in some way as well even amid the apparent avarice of the doctor — knowing that they did not have a distal colon cancer or their doctor could at least prescribe a medicine they didn’t need safety.
Nobody made the news for this. There were public scandals to be sure: medical directors of nursing homes begrudging their residents nutrition, doctors under-reporting their income to the IRS and — occasionally — the one who fired his pistol at someone. I read about them in the newspaper, like everyone else, but I️ never met a criminal physician. Later on, physicians started making the news when their malpractice suits came to trial, and those colleagues I knew quite well and thought highly of the majority, more often than not were exonerated by the jury.
As we progress to this era of continuous news and scrutiny that forbids a pharmaceutical salesperson from dropping off a logo pen, the tales of misconduct have been more visible, if not more numerous. Some people seek out the professionally lurid not matter what the size. The examples are as benign as posting a #MeToo story and as bad as running opiate mills or getting drunk at work or ripping off insurance companies.
I’ll admit I’ve clicked on a salacious headline or two when it piques my interest.
Stories about a physician in the president’s cabinet helping themselves to the type of free travel that was once their perceived due courtesy of the pharmaceutical industry does not cause much of an emotional reaction to me. That’s what senior doctors used to do early in my career and theirs.
Cheating Medicare — now that was never allowed. Cheating HMO’s might make some of them folk heroes except for the part about getting caught. Excessive opiate dispensing unrelated to responsible medical care never had much support anywhere in the legitimate medical community. But all of these things now appear in the digital realm a few times a day.
Even as these reports accumulate without end, my own professional shield remained intact. I’ve known a few of these newsmakers personally through school, training, a medical organization or the department holiday party. But I never shared patients with any of them nor had any treated my family — until recently.
Three such scandals of people I knew, shared patients with and had treated my family were on the front page of the newspaper and blasted on the local airwaves. The bombshells dropped in rapid succession.
There was a referral source who had treated many of my current patients. Another was a physician who I had on my A-list when somebody needed a primary physician. And one was nothing less a savior to my own family with whom I became friendly enough to chat about the trade on occasion. I respected the skill of all three. Never did I have a moment’s doubt of honesty nor hear a word of complaint from shared patients.
Accusations ran the gamut from excessive examination, overprescribing high-end analgesics and submitting bills for patients who had not been seen in the office but for whom insurance data was available.
They were all experienced and competent physicians.
For years, I have seen these news items pop up on my TV and Twitter. But knowing the people involved, respecting their abilities and trusting patients with them changed the perspective. It shifted from the rubbernecking entertainment of a physician getting caught to more of a betrayal of my profession. That’s because anyone involved in a medical misdeed has patients who trust them, colleagues who seek their expertise and families of their own. But if you don’t know them, you don’t care.
It’s quite a different story when the doctors in question are heroes to your family, like one of my family members who is successful thanks in part to one of these “criminal” doctors.
I am saddened by the course of all of these reported events. Members of the general public might feel outraged, but I’m not.
To me, all three of the aforementioned doctors served their roles as capable physicians, and we have a legal process to address their impropriety. But I am surprised that I never suspected them of any misconduct; they were my colleagues, after all.
Richard Plotzker is an endocrinologist.
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