post

Thoughts on the Newman Crimes

Dear Readers,

First a quick warning: this post is not a clinical post, however I have decided to write this in order to openly discuss some recent events that have caused a lot of unrest amongst the FOAMed community.  If you do not wish to read the rest of this please come back in a few days for the next routine post..

Last week David Newman, former New York Emergency Physician and FOAMed contributor, confessed to the sexual assault of four women whom he was treating.

I will not go into the details, you can read a summary of events here.  These events took place about a year ago, the judicial system has indicted Newman and his guilty plea will lead to sentencing.

The victims of these crimes have endured both the initial violation and the subsequent scrutiny that the media and the court system place them under.  It should be clearly stated that these acts are an abhorrent assault.  One which we as a community or broader society should never condone, conceal or minimise.  It is these victims we should consider when discussing the events. These are brave women who chose to speak out when they knew the upheaval that doing so could bring upon them.

What disturbs me the most about Newman’s actions is the breach of the fundamental social contract that exists between clinicians and their patients.  We are granted a powerful privilege when we take the Oath.  We conduct intimate examinations, discuss deeply personal thoughts and place our patients in utterly vulnerable positions as a “matter of routine”.  Although these moments are routine to us – they are anything but to our patients.

Imagine yourself undergoing anaesthesia, having a colonoscopy or discussing your marital disharmony with your doctor.  The trust you place in that other human is absolute.  This is why I find the assaults committed by Newman so disheartening, that trust was maliciously broken.

Sadly, David Newman is not an isolated case.  Physician sexual assault is alarming common. The numbers are hard to define but there are hundreds of disciplinary actions taken in the USA every year against doctors for sexual misconduct. (Reference ). Reading the reports, it appears that sexual misconduct is often hushed up, attributed to mental health issues or dealt with “behind closed doors” rather than in the criminal justice system.  This is not the point of my post, however, it does seem that we as a culture of clinicians need to change the way we talk about and deal with assaults such as these.

The crimes and confessions of David Newman have caused many in the FOAMed community to become angry, confused and pessimistic.  What should we make of this man – we have known him as a charismatic and compassionate physician, powerful orator, deep thinker, teacher and researcher.  He was a leader in the advancement of rational, evidence-based medicine and patient-centred care. And yet… he did the unthinkable.  How can we understand this paradox?

As Emergency clinicians we see everyday seemingly nice, normal people do strange and irrational things.  We are witness to human nature at its rawest moments. For us it is commonplace to see a wife bashed over a jealous quarrel, a child neglected or an older person mistreated.  Humans are messy and unpredictable at times.

I do not know or would guess as to the internal compulsion that occupied Newman’s mind when he committed these actions.  However, I do recognise that’s it is all too human to be duplicitous and that we are extraordinarily good at compartmentalising our lives – our ego often relies on this defence.  Good people do bad things, this I know is true.  I am in no way apologising for his actions. I am merely observing that it is possible and commonplace for a human mind to contain both good and bad intentions simultaneously.

So now we arrive at the big question.  As a community we are suffering cognitive dissonance.  How can we reconcile these facts?

1) Newman shared and taught some excellent ideas, knowledge that is beneficial to our patients and our peers.

2) Newman has broken the trust between doctor and patient- and as such should be condemned.  He is irreconcilably flawed.

This is a tough ethical question.  I can only speak for myself.

This I should how I shall proceed.

I do not feel it is helpful or productive to expunge the past material that Newman produced. He was primarily a populariser of ideas that others invented. These ideas remain sound, they are not tainted by the messenger’s transgressions.  I would posit that the only good that could come of all this is if the ideas that Newman shared remain intact and a new messenger carry them to educate us all.  In Aussie Rules football there is a saying: “play the ball, not the man.”  We need to separate the man from the ideas. Let us not burn his books, they contain ideas worth knowing. Instead let’s do something positive.

When you read an article Newman wrote, or see a reference to SMARTEM – do not cringe and throw it down.  Instead let these works remind us of our special obligations and duty when we interact with people on their worst days.

I am galvanized do by this tragic story to do better.  I will aim to teach professionalism and empathy to all my students.  I would try to create a culture in my ED where patients have a voice and any lapses in our sacred contract may be recognised and appropriately resolved.

Most importantly we need to listen to our patients when they have experienced unprofessional conduct. We have  a duty to our patients to protect them if we suspect a colleague has done wrong.  No more hiding in Hippocrates Shadows.

That is all I wanted to say.

I would be more than happy to hear your thoughts either here or by private correspondence if you prefer.

Casey

Comments

  1. Kirsty Challen says:

    Thanks Casey, this has expressed the uncomfortable dichotomy in my head very well. His actions were vile and indefensible. His victims should be given all possible support. I have to admit to being one of the FOAMed community who couldn’t believe it at the time the accusations were first made; I have learnt since, to my horror, how common medical sexual abuse is and how much more credence I needed to give to the accusations.

    However, some of the ideas he promulgated were of value both to us and to patients. I adopted his technique of framing the non-prescription of antibiotics after I heard him at SMACC Chicago and it works for me. I’m not going to stop using it just because it came from him, any more than I will unlearn some things I know about syphilis and hypothermia because the information came from Tuskegee and the Nazis.

    It behoves us to apply our own brains to what is said whether it comes from the perceived heroes (Scott or Cliff) or someone entirely different.

  2. Max Kamien says:

    Dear Casey,
    Your eloquently put argument is similar to the one I favoured with regard to the results of Nazi medical experiments and argument over whether the infamous “Pernkopf Anatomy Atlas should continue to be held in Australian university libraries. My view was that the atlas should be available and that there should be a screed within the inside cover that explained where the atlas and the dissected bodies displayed within it came from. I wrote a screed to be placed within the inside cover of this atlas which was held by all Australian universities that then had a medical school.
    The University of Vienna was eventually dragged kicking and screaming to investigate this atlas. The medical faculty found that nothing untoward had occurred. The Rector Magnificus was a historian and he smelt a rat. He got the faculty of modern history to re-examine the medical faculty’s investigation. Eventually the University of Vienna produced its own retraction on the work of Pernpopf. I send this to all be Australian universities in a letter countersigned by the head librarian at UWA.

    Last year I visited a number of these libraries and asked for the Pernkopf Atlas. Not one had either my screed or that of the University of Vienna on the inside cover.

    I showed a page of SS lightning signs and swastikas to a young library assistant who was also an art student at that University. She did not know what a swastika was.

  3. Very eloquently put. A charismatic teacher does not always equal a ‘good’ person. Love the AFL analogy. FOAMed breeds celebrities IMHO. And we are never surprised by celebrity scandals.

  4. Well said and frames the internal strife very well. I agree that the best we can do is take the good and remember the bad so both are not forgotten.

  5. Kristin Boyle says:

    Thank you for helping to bring this out into the open. “Don’t mention the war” does not do justice to the situation. This case was personally very challenging for me. I know the facts on sexual assaults; it is many times more likely to go unreported than for false accusations to be made. Yet despite this, my initial internal reaction was one of denial, (must have been a different David Newman,) more denial, (It’s not true, she must be making it up or else was confused and hallucinating.) The media reporting felt grotesque and gleeful. The fact that it could be true caused such cognitive unease that I leapt upon alternative explanations. I was simply unable to comprehend that someone who I greatly admired and appeared to live a model life as a physician and family man could be capable of such a horrific assault and violation of trust. In my mind I framed him and his family as the victims in an awful situation. The true victims, I’m ashamed to say, were faceless to me.

    Based on online conversation (or lack thereof) it appears many felt the same, and I feel as a community we have done a disservice to his victims. Can you imagine how hurtful it would be, having had the guts to come forward after being abused in this way to read comments from his colleagues expressing disbelief that it ever happened, that it was even possible for it to happen in a busy ED, or a petition where hundreds of doctors express their support for your assailant? While allowing the law to follow due process was appropriate, and he was entitled to this, I suspect we went too far in allowing him, “the benefit of doubt.”

    There is a lot for all of us to learn from this case. Thank you again for bringing it in to the light and highlighting the key issues, while keeping the true victims at the centre of the story, where they belong.

  6. David broke my heart and that of so many others. When the story broke, I happened to be in NYC and contacted him immediately, essentially saying “Of course I don’t believe it. I’ve got your back.” His cryptic response (at the time): “Yours is the most logical response I have heard, but it’s only going to get more bizarre.” At the time, of course, I had no idea.

    David and I taught at many of the same meetings, and I never failed to learn from him. He was always “the smartest kid in the room.” This heinous activity has destroyed his life and career, his marriage and family, and, of course, the lives of many patients who put their trust in him.

    I like to think of myself as a forgiving man. This I can never forgive. He besmirched the specialty which raised him to a place of awesome respect. He betrayed friends who knew of his prodigious talents. But he also grievously abused patients at a time of their greatest vulnerability; this can never be forgiven.

    I hope you can find some inner peace, David, but you are no longer welcome in our community.

  7. I agree that we should not unlearn something simply because the messenger was bad. It’s a disservice to us by ignoring the transgressions, and a disservice to any patients that aren’t benefitted by the ideas that we forget.
    However, this also demonstrates that medicine (and not just FOAMed) should be based on the ideas, and not the people who create them. Just like we shouldn’t accept something just because it comes from JAMA, The Lancet, or NEJM, we also shouldn’t accept something just because it comes from the mouth of someone we trust.

  8. Kristin Boyle says:

    Thank you for helping to bring this out into the open. “Don’t mention the war” does not do justice to the situation. This case was personally very challenging for me. I know the facts on sexual assaults; it is many times more likely to go unreported than for false accusations to be made. Yet despite this, my initial internal reaction was one of denial, (must have been a different David Newman,) more denial, (It’s not true, she must be making it up or else was confused and hallucinating.) The media reporting felt grotesque and gleeful. The fact that it could be true caused such cognitive unease that I leapt upon alternative explanations. I was simply unable to comprehend that someone who I greatly admired and appeared to live a model life as a physician and family man could be capable of such a horrific assault and violation of trust. In my mind I framed him and his family as the victims in an awful situation. The true victims, I’m ashamed to say, were faceless to me.

    Based on online conversation (or lack thereof) it appears many felt the same, and I feel as a community we have done a disservice to his victims. Can you imagine how hurtful it would be, having had the guts to come forward after being abused in this way to read comments from his colleagues expressing disbelief that it ever happened, that it was even possible for it to happen in a busy ED, or a petition where hundreds of doctors express their support for your assailant? While allowing the law to follow due process was appropriate, and he was entitled to this, I suspect we went too far in allowing him, “the benefit of doubt.”

    There is a lot for all of us to learn from this case. Thank you again for bringing it in to the light and highlighting the key issues, while keeping the true victims at the centre of the story, where they belong.

  9. David Berger says:

    Talk about compartmentalisation!

    The guy who is (was) a world expert in risk-based decision making didn’t make very well-judged decisions, did he? It’s a mystery none of us will ever be able to unravel. As he surveys the wreckage of his once glittering career and, presumably, marriage and as he hopefully reflects on his grotesque, unforgivable betrayal of his vulnerable patients, I wonder if he knows why he did it?

    Perhaps if we could understand why he did it we might find out a lot about human nature, though I don’t think we’d like much of what we discovered.

    • Kristin Boyle says:

      To be honest, I don’t think we need to psychoanalyse this too much. Sex abuse by those in a position of power, mostly men but sometimes women, is common. The only thing that makes him different from your garden variety grubby sex offender is how smart, likable and charismatic he was. In my own small state a neurologist recently suicided when revelations came out he had abused many disabled young men over a long career, and an oncologist was recently jailed for drugging and sexually assaulting one of his residents. Look outside our own community at religious institutions. I still believe that that vast majority of doctors, and indeed people, would recognize the inherent wrong in behaving in such a way. I would like to add while bad people maybe be capable of good deeds, no one who has violated another person in this way could ever be considered good. The deed simply cannot be separated from the character of the perpetrator.

      • David Berger says:

        I’m not psychoanalysing in any depth, merely remarking on how un-understandable this all is to people who don’t commit crimes like this. And, as you say, this relates to anyone who does this kind of thing, which is INCREDIBLY, unbelievably common. You cite some notable examples and here is another one:

        http://www.bbc.com/news/uk-england-cambridgeshire-29206727

        It happens all the time. In this case, the perpetrator was part of the hip, foam-ed, smacc community, part of the ‘new wave’ of docs, patient-focused (he’d written a book on the doctor-patient relationship, right?), cool, smart, ‘evidence-based’ and implicitly I think everyone thought ‘that kind of thing can’t happen in THIS community’. Well, it can and it has. Foam-ed comes of age and that can be a painful process.

        I just find it interesting to speculate how the thought process works in this situation and I think the answer is what Casey said: it’s compartmentalisation. Humans are very good at that.

        Anyway, it’s always a good idea to reflect on these kinds of events, no?

        • Kristin Boyle says:

          Didn’t mean to imply that you were overanalysing, simple that his acts, while truly awful, weren’t extraordinary. I like your description of him at his peak, in my eyes he really did appear to be the perfect modern emergency physician, even part of a star couple. How the FOAMed world deals with this challenge will shape it moving forward. I think we certainly have to be more careful about creating celebrities. (from someone a little prone to hanging on to every word from those I admire.) And yes, reflection is essential, which is why I’m glad Casey opened the conversation. As to the thought processes behind the acts, my understanding from forensics is often these cases are about power, the sexual element is secondary. People start small, even accidentally, then experience a rush when they get away with it. From there they can slowly escalate or rapidly spiral out of control. Some are true sociopaths, incapable of any empathy, others dehumanise their victims and likely compartmentalise, as you and Casey have stated. The classic “madonna/whore” approach to women.

  10. Cian McDermott says:

    Thanks Casey -- references to this news story have favoured the approach of not speaking about the unmentionable -- I understand the merits in that too. I think we are collectively abhorred at these revelations and the #FOAMed community will find it difficult to forgive such acts whatever the reasons behind his actions.
    Thanks for sharing your thoughts -- insightful as ever mate 🙂
    Nollaig Shona duit

  11. I agree with your article and I’m thankful that it’s been discussed at last. It was frustrating that this news was just being whispered about given how many people were interested in the podcast and his teachings.

    I would just like to add my deepest sympathy to Dr Shreves whom I always enjoyed listening to on the Podcast and who must be suffering terribly.

    Thanks for a great article.

  12. “Dear Casey
    Thanks for writing the post on David Newmans conviction . The comments from Joe Lex and Kristin Boyle really echo my sentiments on the matter .

    I am disappointed by the general lack of commentary nor discussion on his criminal conviction , by the FOAMEd community given his celebrity status and prominence as a thought leader and educator

    You say a good person is capable of bad things . Of course that’s true but multiple repeated acts of evil for no other purpose than personal sexual gratification at expense of others rights is not a sign of a good person

    To try to minimise the evilness of the acts by saying his teachings are great is in itself another harm visited upon his victims

    Does any one seriously think his 4 victims who spoke up are his only ones ? In my opinion it is highly likely there are others and if there is any one whom we should honour and respect as role models to our medical profession it should be his brave victims who stood up to be counted and actually stopped his evil doing .

    Many colleagues are feeling hurt and confused cause he fooled us all . He taught one way of behaving as a physician yet behaved in totally the opposite way . He used his physician skills to commit multiple sexual crimes and the extent of this is likely greater than isolated to this conviction alone .

    I have been disappointed by some within the FOAMEd community who contacted me to ask that I minimise /suppress my online commentary on the Newman trial and subsequent conviction . Apart from your blog site , none of the other popular FOAMEd sites has published any statement or discussion at all . Some have told me there is no point in making things worse by talking about it . I think this is a tragic attitude and insensitive to the victims and their families . Why did the victims speak up ? So that this doesn’t happen to someone else ! So that abuse by physicians is not just swept under the carpet yet again!

    I have already said a lot on twitter about it and aim to publish a statement soon on the PHARM come the new year .

    Regards
    Minh Le Cong “

    • David Berger says:

      Good for you, Minh. I can’t believe you were asked to keep quiet.

    • Thanks Minh

      I think we all feel much the same.
      My only disagreement is with your 4th paragraph- I do not think anyone is trying to minimise the seriousness of the crimes by stating he was a good teacher.
      His ideas were and are useful. The NNT is not suddenly an evil statistical concept as a result of these terrible actions… it remains a good way to communicate stats to patients & trainees. Just because he had a website named by it, does not taint the idea.

      I also suspect that the lack of discussion from the community is symptomatic of the dissonance and disillusionment we all feel rather than an active desire to “keep it quiet”. I personally took a long time to ponder how I was going to reconcile this dilemma in my own mind. I imagine others felt, and continue t feel the same

      C

  13. Hi Casey and all who posted comments above.

    Thanks for posting. The post above and subsequent comments, particularly Joe’s, Kirsty’s, Kristin’s and Justin’s pretty much paint the picture. I have similarly struggled initially with incredulity and then by conflicted decision-making in trying to understand the FOAMed community’s silence on this and my own silence. I suspect your reply on the 27th reflects much of the reasoning.

    However, now that there has been a conviction, it may be that we can resolve how to respond individually and as a community. In the immediate time frame there should be nothing but unequivocal support for the four women and for David’s family, whose devastation we can only guess at. Thereafter, you said it perfectly in your post:

    “I am galvanized do by this tragic story to do better. I will aim to teach professionalism and empathy to all my students. I would try to create a culture in my ED where patients have a voice and any lapses in our sacred contract may be recognised and appropriately resolved.”

  14. David Strauss says:

    In no way do I condone Dr. Newman’s behavior. In no way do I excuse his behavior. He should suffer the legal and professional consequences of his crimes. I think his crimes stir such outrage not because they are so completely alien, but because they touch seeds we recognize buried deep in our own psyches. Primitive drives we suppress consciously, or subconsciously. I do not believe he is beyond redemption or forgiveness. While life continues I believe the hope of redemption and forgiveness exist.

  15. How dreadfully sad. How awful for everyone. I kept wondering what had happened to David. Maybe people like him are not actually evil or bad -- maybe they have faulty circuits in their brains. This is not to deny the horrendous impact his actions will have had on his victims, and still no doubt has, but it is to say that this man, so wonderful in so many ways, is maybe a victim too -- a victim of something we do not as yet understand. Is a psychopath responsible for their lack of compassion and hurtful actions? Did this intelligent man plan these attacks fully aware of the potential consequences. It just doesn’t make sense to me. I can not make sense of it other than to think of it like a seizure. I personally will miss his amazing presentations.

Speak Your Mind

*