Health care practitioners are in the unique position of frequently being privileged to extremely personal information about patients. In the course of their work, doctors, nurses, and physician assistants see things that most people do not normally see.

Sometimes these things can be disturbing and sometimes entertaining, but in all cases they should be kept confidential. Yet, who doesn’t come home at night and tell their spouse about what they may have encountered during the day? Who doesn’t mention to their colleague about an interesting case or an unusual patient? The question is: where should the line be drawn? In this month’s case, a young physician makes a very poor decision about how to handle seeing something unexpected, and this decision ultimately compromises his entire future.

Dr. D, 29, was the chief resident finishing up his final year of a surgical residency in a prestigious hospital. Life was golden for the young doctor. He had been a bright and talented student in medical school, and stood out during his residency. Dr. D was sharp and engaging and had a wicked sense of humor. He was popular with his colleagues and his superiors, and had a bright future ahead of him. The young physician had been promised a prime job at the hospital, and with very few exceptions, was well liked by everyone who knew him.

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His career, however, was derailed by a single incident with one patient. Mr. M, 39, had been admitted to the hospital for routine hernia surgery, which Dr. D was scheduled to perform. Mr. M was in terrific health and had never been in the hospital before, so he was extremely nervous.  Dr. D spent plenty of time explaining the procedure and reassuring his patient. Mr. M was a bit rough around the edges, but the two men got on well, and soon Mr. M was comfortable with the thought of undergoing surgery.

The patient was placed under anesthesia, and as Dr. D was inserting a catheter, he noticed that Mr. M had a tattoo on his penis. It read “joystick.” Dr. D couldn’t resist, and quickly whipped out his cell phone and snapped a photo of the patient’s tattooed genitalia. Several members of the surgical support team witnessed his actions, but no one said anything to him or to hospital administration.

The surgery was successful and Mr. M was soon discharged. Dr. D, however, began showing the “joystick” photo to other surgeons and colleagues and even sent it via e-mail to his girlfriend. Unbeknownst to Dr. D, one of the surgical staff who had witnessed him with his camera phone in the operating room became extremely disturbed when she saw Dr. D cavalierly showing the image to colleagues.

She did not find Dr. D’s behavior amusing in any way, and in fact was quite angry at how inappropriately Dr. D was behaving. “It’s just another example of how surgeons think they can do anything,” she thought to herself. The surgical staffer decided to take action, and anonymously called the local paper, telling a reporter what had happened. The reporter then contacted the hospital.

When confronted, Dr. D was forced to admit that he had taken the photo and, despite his sudden remorse, he was immediately suspended from the hospital. In addition, he was ordered to call the patient and explain what had happened so that Mr. M would not find out by reading it in the newspaper.

Mr. M received a phone call from a hospital supervisor who told him that Dr. D had something to say to him. Mr. M was understandably alarmed, and assumed something had gone wrong with the operation.

“I’m afraid I have something distressing to tell you,” began Dr. D, hesitantly.

“Oh my God!” blurted the patient. “Is something wrong with me? Did something go wrong during the operation? Did you find some other problem?”

“No, no,” said the physician, “There is nothing wrong with you. The operation went well; there were no complications or unexpected problems.”

“Then why are you calling? What’s going on?” asked Mr. M whose concern was turning to confusion.

“I’m so sorry to have to tell you this, but I made a very appalling error in judgment.” Dr. D took a deep breath and continued. “When I was prepping you for surgery, I noticed your unusual tattoo and, in a moment of stupidity, I snapped a picture of it with my cell phone.”

There was stunned silence on the other end of the phone as the patient processed this information.

“I’m afraid it’s a bit worse than just that,” said Dr. D. “Unfortunately, I showed some colleagues the picture and somehow this information got out to a local paper. I wanted to call you myself to apologize and let you know just in case this story should get out.”

The patient’s initial alarm at hearing from the surgeon that he had “something distressing to tell him” turned to horror of a different sort when he understood what Dr. D had done. The physician’s profuse apologies did little to assuage the growing fury of Mr. M, who felt betrayed and humiliated by someone he had trusted.

The hospital attorneys and administrators met repeatedly to try to decide on the proper actions to take regarding the patient, who had hired an attorney and was threatening a lawsuit, and Dr. D, who was currently suspended and not working. Finally, hospital lawyers decided to negotiate a settlement with the patient, and ended up paying him a sum of $250,000. Dr. D’s residency was terminated and his future job offer was rescinded.