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.