
Surgeon admits to branding initials on patients' livers - gridscomputing
https://www.cnn.com/2017/12/14/health/liver-initials-surgeon-simon-bramhall-intl-trnd/index.html
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dvt
The fact that people are defending this guy, or treating it as "no big deal"
blows my mind. Just off the top of my head, a few ethical issues:

    
    
        - Breach of patient-doctor trust -- a very asymmetric relationship
        - Breach of the Hippocratic Oath (you don't *burn* healthy tissue without good reason)
        - Permanent bodily modification without consent
        - *Multiple* offenses
    

Should he have been terminated? Does the punishment fit the crime? Considering
he was a leading surgeon in his field, I honestly don't know. One would have
to consider potential future lives saved compared to these ethical breaches.

It's a tough call, for sure, but to exonerate him or, worse, downplay these
egregious violations as "victimless crimes" is, to me, unfathomable.

~~~
simplyfantast
I've been a physician for about 16 years. I won't defend the guy, it's just
that I routinely see things that I would consider worse: doctors drunk at
work, doctors who sleep with medical students in exchange for good
evaluations, rampant cheating in medical school, rampant stimulant abuse, and
the list goes on and on...

It's unethical for sure, but I guess my gut reaction is that it's not
necessarily an offense that demands termination.

~~~
c3534l
This seems way worse than those things. Relationship problems, nepotism, and
drug and alcohol abuse are problems. But permanently vandalizing a living
human body while the person is unconscious goes far beyond the pale. The
person should do jail time in addition to being permanently barred from
medicine. Defiling a patient's body for "fun" should be taken extremely
seriously.

~~~
chesimov
To me, a doctor drunk at work is far, far worse. I would much rather have a
doctor initial my liver but still do a good job of fixing my problem, than
have a drunk doctor operate on me (or treat me in any sense actually). I
suspect a lot of the outrage is to do with the insult to human dignity that
initialing someone's organs brings. But look at the outcomes.

~~~
jacquesm
What if your liver developed a problem due to getting initialed? What if every
doctor operating on you felt that carving their name in you was their right?
How about the entire team? After all, the outcomes are what matters right...
Really, this is _improper_ , it's nothing to do with human dignity, it's got
everything to do with trust and consent. And consent is - in case you didn't
know it - a rather large plank in our doctor-patient relationships. Doctors
are supposed to do what's necessary, frivolous actions are not supposed to be
part of the package.

~~~
chesimov
Yes, it is definitely improper to say the least. It also brings the profession
into disrepute. I agree that it breaks trust as well as insulting dignity; and
I should also clarify that my aim was not to defend the actions of the
surgeon. I'm not a doctor but I don't find the complications argument
convincing in this case though (unless it took a long time and resulted in
prolonged anaesthesia; then I believe there are added risks). I still maintain
that something like being drunk at work, especially as a doctor, is
significantly more dangerous and reprehensible - lives are put at risk. By
contrast, I think having initials on my liver, especially if I don't know
about it, is less of a hardship.

~~~
chesimov
Edit: I haven't been able to clearly determine if the actual initial burning
was harmful (in a significant way) or not.

~~~
DanBC
No, it wasn't. Surgeons have to mark livers to show areas they're going to
work on. These are normally temporary markings and heal over time. When this
surgeon made marks he also added his initials. He did this to one patient, and
the marks did not heal, and another surgeon found the marks.

I'm not trying to defend him, but it wasn't intended to be a permanent
marking.

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whiddershins
Argh I don't know enough abut medical ethics to know where the line is but for
all the people rejoicing in the guy resigning, losing his license, being
convicted of a crime, or any other horrible outcome ...

Please, please, really consider what it means to ruin someone's life when
advocating for a certain punishment. There's a whole range of reactions
between "eh, no big deal" and "destroy his career!"

Whatever the man did, what he didn't do was kill anyone or permanently curtail
someone's professional life or put someone in a cell for days/months/years.

All of the punishments discussed also remove a functioning surgeon from being
a contributing member of society.

I'm just saying, it's worth thinking about.

I feel like we all get so self-righteous and don't think about how much impact
these punishments have. It's like, a friend of mine always argued we should
really bring back public spanking. Sounds like a joke, but her point was there
should be a type of punishment that is the equivalent of society yelling a
whole bunch at you very very sternly and making you feel very very embarrassed
and then you moving on with your life and continuing to contribute to society.

~~~
jacquesm
I know enough about medical ethics that this guy is lucky to get away with
_just_ losing his license, being convicted of a crime would be a nice touch.

Keep in mind that you're on an operating table, passed out and 100% dependent
on those working on you. To treat you like a graffiti wall is not only
disrespectful, it wastes time under narcosis which carries some minimal risk,
and potentially could lead to complications (though not related, complications
were the reason this was discovered in the first place).

Let's say that treating this guy like a trendsetter would definitely not have
my vote. I've been operated on a couple of times in my life and I'm pretty
sure that the surgeons that did that would be _far_ more angry about this than
a patient ever would be because this guy damaged all of the medical profession
for his personal gratification.

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ggreer
This isn't the first time I've heard of such a thing. From _When the Air Hits
Your Brain: Tales from Neurosurgery_ by Frank Vertosick Jr:

> “He’s a big fan of yours, too, pal, ever since the bone flap thing.” The
> bone flap incident had occurred early in Gary’s chief year. Fred and Gary
> were performing a cranial operation to remove a benign brain tumor. Fred had
> performed the entire operation himself—a grave insult to a chief resident,
> known as “stealing the case.” After Fred left the OR, further irritating the
> chief by dumping upon him the tedium of closing the wound, an angry Gary had
> engraved the phrase “Fred sucks” with the electrocautery knife on the inside
> of the bone flap, the plate of skull bone that is temporarily sawed away to
> gain access to the brain. He had then wired the flap back into place,
> thinking that the inside of the patient’s skull would never again see the
> light of day. Unfortunately, the bone flap developed a staph infection and
> had to be removed a week later. Once contaminated with bacteria, the free
> piece of skull must be removed to cure the infection. The soft spot is
> filled in with plastic several months later. Gary coerced me into assisting
> Fred with the surgical removal of the infected flap. I’ll never forget the
> almost unintelligible stream of invectives that spewed forth when Fred saw
> Gary’s skull graffitti. Fred was too embarrassed to send the discarded flap
> to the pathology department as it was, and we spent an hour drilling the
> message off the bone before allowing it to leave the OR.

Considering the type of personality that surgery attracts, I see why this
happens. That said, I don't think this is a common occurrence. (And it should
go without saying, but such actions are unethical, unprofessional, and worthy
of criminal charges.)

~~~
dvt
Great passage, thanks for sharing. It's a bit unnerving that this kind of
thing may not be as rare as it might seem (engraving bones during a _brain_
surgery of all things).

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bikitan
Evokes a certain PBF comic: [http://pbfcomics.com/comics/transfer-
patient/](http://pbfcomics.com/comics/transfer-patient/)

------
dEnigma
The branding itself is bad enough --to put another burden on the system of
patients who are already in a bad enough state to need a transplant is just
cruel-- but this also means that he prolonged the operation just to satisfy
his vanity, possibly risking further complications, and wasting time that
could benefit other patients.

------
mpnagle
[http://pbfcomics.com/comics/transfer-
patient/](http://pbfcomics.com/comics/transfer-patient/)

------
ggg9990
Can't believe anyone is defending this creep. What if your nanny wrote
"FUCKSTICK" in washable marker on your baby's face but made sure to wash it
off before you came home?

~~~
kaffeemitsahne
Well, then what?

~~~
ggg9990
Would you fire her?

------
twiss
Related sketch, "surgeon pranks":
[https://youtu.be/MR76R4gaC48](https://youtu.be/MR76R4gaC48). Doesn't seem as
absurd now.

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KiDD
If I ever get surgery again I will be sure to give the surgeon permission to
leave his mark! Just don't kill me bro...

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orliesaurus
Luckily no one was harmed.

~~~
dotancohen
There was no danger of harm. In fact, though this was a stupid decision by the
surgeon, I'm of the opinion that he should not be removed from his post.

He was proud of his handiwork and signed off on it. Have we enough skilled
surgeons to remove them for a harmless boast? Reprimanded, sure, but removing
him from his post is both an over reaction and unfair to society which is
already lacking in skilled healthcare professionals.

~~~
pgsandstrom
His "stupid decision" shows a complete lack of judgement. I would never trust
anyone with my life if they are capable of doing something as absurd as this.

~~~
askvictor
People who are specialists in one thing might make terrible judgements in
other things. Your excellent judgement in designing software doesn't make you
an excellent driver.

~~~
khedoros1
When my bad judgment as a driver impacts my decisions as a programmer too, I
don't expect that to slide.

If his ego/vanity changes the actions that he takes when performing surgery,
that sounds like a problem to me.

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JSONwebtoken
Honestly if he had asked for my consent, I might have thought about letting
him brand my organ, it's not like anyone will see it or care. It might mean he
takes more pride in his work and thus do a better job.

I understand a professional wanting to "sign off" on their work; programmers,
scientists, artists, engineers and so forth really like putting their name on
things so why not doctors?

If he were forthcoming maybe only 10% of patients might agree to it, but that
should probably be enough to scratch some egotistic itch.

~~~
TrinTragula
I cannot phantom a reason to put your health at a risk just to accomplish the
ego of someone who should just do his work. I personally find it humilating.
Care to explain better? Sometimes I'm really curious about how someone can
have such a radically different view from me on such simple arguments, and I
always love finding the reasoning behind that.

~~~
Ultimatt
I can see this argument its not exactly burried. The article states there was
no associated health risk. The more general point is a surgeon that openly
requires signing your organ, is better than one less well trained surgeon in
the world. From a utilitarian pov. Not everyone would necessarily care, like
you do. Which is definitely true if you look at the range of responses on
here. That this guy did it without consent is what's properly bad, tangibly
more than the physical result of his breach of ethics.

~~~
benchaney
> The article states there was no associated health risk

The article says the following

> Bramhall's handiwork didn't appear to damage either liver

These are not even close to the same thing.

