“Our Family Secrets” Exposed — The Ethics of Whistleblowing

This week the Annals of Internal Medicine published an article so controversial they felt the need to publish an accompanying editorial, explaining their decision to publish the anonymous article.

The article, “Our Family Secrets” describes two experiences where a health care provider has acted inappropriately while patients were under anesthesia. The editorial describes the acts with poignant alarm: “The first incident reeked of misogyny and disrespect—the second reeked of all that plus heavy overtones of sexual assault and racism.”

Few things are as disturbing as the knowledge that things like this happen, perhaps more than we’re comfortable admitting, even if this is an extreme example. Treating patients with respect is a core value of health care, but “although we wish it were otherwise, most physicians at some point find themselves in the midst of situations where a colleague acts in a manner that is disrespectful to a patient.”

What is the right way to respond to this kind of behavior? What if the person acting inappropriately is your superior? Do you confront them immediately, as the anesthesiologist did? Do you report to their superiors? Do you try to ignore it? Do you join in, begrudgingly or otherwise? Do you write an essay for all the world to see?

While the actions of the individuals in the article are a topic for a lengthy discussion, the author’s decision to write the story, and the Annals of Internal Medicine‘s decision to publish it are an interesting conundrum altogether. The author ends his essay with, “I know this is my silence to break,” but is whistleblowing in this fashion the right way to handle these shameful secrets? It places serious negative connotations on the health care profession, including many innocent, respectful people. It might deter people from seeking the help they need, or make them wary of fully trusting or disclosing to their physicians or nurses. It could cause serious, palpable harm. The editorial discloses, “We all agreed that the piece was disgusting and scandalous and could damage the profession’s reputation. Some believed that this was reason not to publish the story. Others believed that it was precisely why we should publish it.”

In the end, they decided they would publish the story, but only anonymously. They decided that if this article gives just one person the courage to stand up to inappropriate behavior, then it is worth the backlash and potential harm. The editorial ends with this powerful statement, which I hope all will take to heart:

“We hope that medical educators and others will use this essay as a jumping-off point for discussions that explore the reasons why physicians sometimes behave badly and brainstorm strategies for handling these ugly situations in real time. By shining a light on this dark side of the profession, we emphasize to physicians young and old that this behavior is unacceptable—we should not only refrain from personally acting in such a manner but also call out our colleagues who do. We all need the strength to act like the anesthesiologist in this story and call our colleagues ‘assholes’ when that label is appropriate. We owe it to ourselves, to our profession, and especially to our patients.”

While we need to be careful about making sensitive information public, especially through mass media, the author of the article and the staff of the Annals of Internal Medicine do an eloquent job of handling a delicate situation with the grace, humility, and candor that necessitate discussion, change, and with any hope, healing and forgiveness.

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