Friday, April 6, 2012

University of Wisconsin Physicians Disciplined

The Milwaukee Journal Sentinel reported yesterday that the University of Wisconsin School of Medicine and Public Health disciplined 20 physicians, including 11 faculty members, for handing out sick notes at demonstrations against Governor Scott Walker's union-busting legislation last year.

Here's what I wrote about the situation last March:
I supported the protests, and if I'd been a physician in Wisconsin I would have joined protesters at the capital, but I would not have given out doctor's notes. During the Vietnam era psychiatrists were not infrequently asked by draft age men to provide medical testimony that they suffered from a psychiatric illness that would make them undraftable. Colloquially this was called "copping out on a nut."

I opposed the war and frequently participated in marches and rallies against it, but I didn't write cop-out-on-a-nut letters. Physicians are given a special status in society through licensure, laws that create a framework for practice, and social respect that abets healing potential. I regarded truthfulness in medical testimony as one of the underpinnings for the profession's ability to function. Truthfulness was part of our implicit contract with society. As a citizen it was my duty to advocate in accord with my political beliefs and values. As a physician it was my duty not to use the privileges society gives the profession deceitfully.
Dr. Norm Fost, a distinguished pediatrician and ethicist, headed the University committee that investigated the incident. The committee concluded that the physicians had acted dishonestly. Fost was troubled that "virtually none of those involved acknowledge that they did anything wrong." Paul DeLuca, the University Provost, who rejected an appeal by one of the physicians, said the physician had "embarrassed [the University] by not showing any kind of respect for the integrity of the doctor/patient relationship."

11 faculty members were fined up to $4,000. Some were required to give up their leadership roles for up to four months. 9 residents received letters of reprimand.
Apparently the physicians defended themselves with the explanation that the sick notes were for demonstrators who were suffering from stress. This isn't clinically plausible. If I'm too "stressed out" to go to work I don't belong at a political demonstration. I was reminded of what I was told as a child - if I was too sick to go to school, I wasn't well enough to go to the movies!

When I wrote about the sick notes last year I was concerned that "in the overheated political atmosphere in Wisconsin the note-writing physicians could be at risk for severe penalties." I think the actual penalties were fair, but the risk of being fired or losing medical licensure was real -- State Senator Glenn Grothman, whose conservative credentials are impressive, was disappointed in the penalties - he'd been "hoping for something much stiffer."

We physicians, and the society we're expected to serve, should be vigilant about insulating medical practice from politics. That applies to the causes we believe in as well as to those we oppose. "Pro life" legislation that directs physicians to force patients who are seeking legal abortions to undergo unnecessary ultrasounds is wrong, quite apart from whether one is "pro life" or "pro choice." Likewise, writing work-excuse notes for demonstrators is wrong whether or not one agrees with the demonstrators. 


Sunita said...

Hi Jim, I'm interested to know what is the role of the hospital management in India while dealing with medical mistakes or negligence. I'm aware that legally the onus is on the affected person to prove negligence. But in the quest of provision of quality of care what are the steps that the hospital management can take when confronting problems in management of a patient- either by doctors or other medical or paramedical staff including the lab. I find that literature largely deals with doctors only. Regards, sunita

Jim Sabin said...

Hi Sunita

I apologize for my delay in responding to your question, which you first sent in a while back. I was planning to do some research to answer you, but never got to doing it. As a result, my answer is based on what I've observed in the US, and there may be things pertinent to India that I simply don't know about.

Hospital management has a crucial role to play by encouraging a climate of quality and safety for the hospital. Quality improvement and a commitment to patient safety require data about performance, and creating information systems is something physicians count on management for. A patient's right to sue for negligence if they've been injured is important, but PREVENTION of injury is much better than responding after the fact. My impression from the hospital visits I've made in India is that culturally there's a lot of hesitation to bring errors and near misses forward and to see them as opportunities for learning and improvement.

Organizations like the Institute for Healthcare Improvement can be useful for hospital managers, Its Open School is a source of on line courses that hospital managers could find very useful.

Please write to me off line at if you would like to discuss the topic more.