Professionalism and I: A Controversial Publication

In Editorial, Opinion by Brent Thoma9 Comments

I was on my way home from work last night when I checked twitter. 13 mentions in an hour – that’s kind of crazy (for me anyways). What could have sparked that?

It took me a second to piece together the conversation. When I did, I found that Eve Purdy, a medical student, twitter-friend and colleague of mine, had posted a link to an article that I had written more than 4 years ago that was published in Canada’s second largest medical journal, Canadian Family Physician. She wasn’t aware, but this was not just another article for me. It was the article that nearly ruined my life.

It was my first month of clerkship and I was a very green medical student. After a few weeks I had been exposed to a bit of everything, including the common sensitive exams, and felt I was doing well. Towards the end of my rotation I saw a patient that presented for a pap smear. After the history and non-invasive components of the physical exam I was concerned that her body habitus would make the procedure technically challenging.

So what did I do? I took a history and gathered the materials before calling a female nurse to chaperone and my preceptor to help with the pap smear. What I should have done was insist that my preceptor stay and assist with the procedure. However, I was not explicit in my request for assistance and ended up attempting the procedure alone. Imagine yourself standing there, speculum in hand, wondering if you should run out into the hall and call your preceptor back because you weren’t sure that you’d be able to complete the procedure independently. Would you have tried? Would you have allowed yourself to be reassured by your previous success?

Prior to this experience I would have told you without hesitation that, had I been put in this situation, I would have stuffed my pride in a bag and ran after my preceptor.

But in real life I didn’t. That was a mistake.

Instead, I tried and I failed – I could not find the cervix. I was embarrassed and the patient seemed embarrassed. It was a terrible experience for everyone and I remember wanting to sink into the floor of that room. I can think of only one time in my life when I felt like a more horrible human being than I did at that moment – and it’s coming up.

Unfortunately for the patient, when I went and got my preceptor they failed too. I felt terrible for the patient.

This experience is what I was thinking about when I put fingers to keyboard and wrote the article that Eve tweeted about. It’s available here and is still the top search result for anyone that googles me. I don’t promote it because I wish I had never written it. At the time it was a way to for me deal with my feelings of inadequacy and I certainly did not intend to offend anyone. While the piece is quite self-derogatory, it also made some crude jokes and comments about patients that I wish I could take back.

However, when the editor of Canadian Family Physician advised me that my manuscript had been accepted I was thrilled. What medical student wouldn’t be excited about hearing such great feedback about their writing? Or about having their work in one of their country’s most prominent journals?

When the article was published later that year the backlash was immediate and substantial. I remember first seeing the first comments in the Canadian Family Physician’s “Response to the Article” section at the beginning of December, just after completing my application for CaRMS (the Canadian residency match). I can still quote parts of the response that one of my preceptors (not the one that I had worked with that day) wrote. Earlier that year we had gotten along well and I received a good evaluation. But in that letter to the editor I was called a raunchy, pathetic, socially inept, juvenile, misogynistic, sexually abusive, failed learner with Neanderthal tendencies.

The day I read that response was the day that I almost kissed good-bye everything that I had worked so hard for. Up until that point I had been very successful – a medical student, the President of the med student society, the Chair of the student clinic’s Board, and (I think?) a fairly promising CaRMS candidate. That day I was a Neanderthal. My preceptor had said so.

It got worse. The National Post wrote a story about it and it went viral. Newspapers across Canada picked it up. The only thing worse than the articles themselves were the comments sections. It was the lowest point in my life. While some stood up for me (notably, the Dean of my medical school), others lampooned me and I wondered if I had ended my career with the click of a mouse.

The attention on this article settled down after 3-5 months and I would have liked it to stay that way forever. In fact, in the back of my mind I had this naive hope that someday this blog would knock that article right off the front page of google results for my name. However, that was a pipe dream. It was bound to come up eventually and, for better or worse, that article is part of the past that made me who I am today. It came up again yesterday and I am sure it will again in the future and so I feel compelled to provide a more substantial response to the controversy than I did in my timely apology.

So what did I learn?

Lessons on Professionalism

First, that as physicians, we need to maintain our professionalism in 100% of our interactions. We are given a privileged position in society and, as a result, our words, both spoken and written, may be held to a higher standard. This is particularly relevant to those of us that share our thoughts on blogs and in public forums. Saying something inappropriate even once can result in substantial unanticipated consequences for our patients and our profession.

Second, for the same reason, sharing our thoughts so openly makes us vulnerable. Only now, more than four years later, am I starting to feel comfortable writing in a forum like this. For obvious reasons, this post has once again made me uncomfortable. I really do not want to relive that experience. However, I am thankful that I am still working in medicine and able to share this story. Hopefully it will prevent someone who reads it from being as foolish as I was. I now routinely take more time before publishing my thoughts and often ask trusted mentors to review my posts and I would advise everyone else to do the same.

Third, that when one of my students screws up I need to show compassion and see it as a teaching opportunity. Despite the criticism that I faced, there were people that continued to support me. Other preceptors met with me and helped me to learn from it so that some day I could get past it and be a better physician for it. These are the people that I learned from and the ones that I hope to emulate when I have my own students.

Fourth, I can never be less than 100% explicit in letting my preceptors and colleagues know that I need their help. This whole situation could have been avoided had I done that in the first place. When I become a preceptor for procedures and sensitive exams I will always ensure that my students are completely comfortable performing any tasks before I leave the room.

Fifth, that even when you screw up big time, if your heart is in the right place someone will find it in theirs to give you another chance. Despite this article exploding during the middle of CaRMS, my program director and the director of my emergency department still interviewed me, still listened to me, and still decided to give me a chance. I hope that I’ve made them proud.

I’d like to end this post with the first tweet that I saw when I logged onto twitter last night. It reflects my current thoughts perfectly. Thanks for @AfternoonNapper for sharing it at the perfect time as it was just the inspiration that I needed.

I try to be a pretty decent human. Sometimes there are people who find fault within me. I am not faultless, so let it be.

Thanks as well to my mentors and colleagues who took the time to review this post. Your support has been extremely important to me.

Author: Brent Thoma @boringem

Peer Reviewers: Dr. Paul Olszynski of edus2, Dr. Rob Woods & Dr. James Stempien

Dr. Brent Thoma is a medical educator, blogging geek, and trauma/emergency physician who works at the University of Saskatchewan College of Medicine. He founded BoringEM and is the CEO of CanadiEM.