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Comment by simplyfantast | Hacker News Reader

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.

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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.

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.

Yeah, if someone's initialing my liver, that's probably a good indication the operation went well :P

That's the defence he used. Something like "this is a work of art, and I'm proud of the skill and care I took"

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.

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.

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

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.

> What if your liver developed a problem due to getting initialed?

He only initialed livers as part of a wider set of markings that surgeons normally make. If the initials are going to be a problem those other normal marks would also be a problem.

> What if your liver developed a problem due to getting initialed?

I mean.. at least you know who to sue.

The Joe-job potential is limitless.

It's not a permanent modification in most cases.

He pled guilty to a criminal offence, but that offence is at the lower range. (Assault covers a range, from assault at the low end (doesn't require physical contact), then assault by battery (requires physical contact) to ABH then GBH.

I think he's going to get a suspended sentence.

He's got a warning from an interim hearing from MPTS, and you can see the warning on the GMC lists.

Does this work?

http://webcache.gmc-uk.org/gmclrmp_enu/start.swe?SWECmd=Goto...

Here's the text of the warning:

> In August 2013 and on more than one other occasion Mr Bramhall initialled patients’ livers using an argon beam coagulator. This conduct does not meet with the standards required of a doctor. It risks bringing the profession into disrepute and it must not be repeated. The required standards are set out in Good Medical Practice and associated guidance. In this case, paragraph 47 and 65 of Good Medical Practice are particularly relevant. 47. You must treat patients as individuals and respect their dignity and privacy. 65. You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession. Whilst this failing in itself is not so serious as to require any restriction on Mr Bramhall's registration, it is necessary in response to issue this formal warning.

>it's not necessarily an offense that demands termination.

Someone murdered someone near my workplace. This surgeon branding his initials on someone's liver isn't so bad in comparison. Therefore, it isn't so bad in the absolute.

You set up the slope yourself and then proceeded to slip on it.

Doctors are people too, so whatever ails the general population should not be a surprise to be found among doctors. Drug abuse was pretty common (after all, easy access to drugs) as was sexual abuse of doctors with patients. Even so, to treat your patients as a tree to carve your name in when they're powerless to do anything about it has a deliberate component that is inexcusable way beyond doctors simply being human.

Also, it would help if you did not include the word 'fantast' in a novelty account while making claims of being a physician for 16 years and then making light of this. Either you really are a fantast or you are not exactly a credit to your profession if you really believe that this does not warrant termination. As a patient I'm pretty cool with it, if I go under to trust a doctor with my life I'd rather not they use me as a calligraphy scratchpad and if it takes one doctor out of all those out there to be made an example of then it's a loss but not a large enough loss to offset the breach of trust between doctors and patients the world over by this guy.

You don't think he should lose his license?

That opinion stems from a place of privilege and over-entitlement. UPS drivers would get fired for ALL of that behavior, to not hold yourself to that standard at a minimum is shameful.

If it is a question of 'not having enough doctors' so we need to keep bad physicians around, then that's another reason that we need to drastically increase our enrollments for medical school. We certainly have enough willing and able Americans that would be ecstatic for the opportunity.

I assume physicians have something like law-enforcement's 'blue line', but it's pretty imperative that professionals like you hold each other accountable.

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