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Lessons to be learned
An introduction by Tom Harbin, MD, the author of the book Waking Up Blind: Lawsuits Over Eye Surgery (Minneapolis, MN: Langdon Street Press 2009), followed by comments by four prominent American glaucoma experts: Robert Fechtner, Richard Lewis, Bruce Shields and George Spaeth.
Waking Up Blind -Lessons by Tom Harbin
Many colleagues
have sent emails thanking me for exposing these problems and telling me
of their plans to have residents read the book as part of their education
about ethics. Such discussions can only improve and strengthen medicine.
If we do not internally address our problems within our profession, one
day an outside entity will. And then it will not be pretty.
One goal
of writing the book was to set the story straight about our colleague (and
glaucoma specialist) David Campbell. We are now much more aware of his travails.
There are other lessons in the book.
- For doctors in an organization:
If you see problems or misdeeds, speak up. There can be a high cost of silence, to patients and to the organization. - For leaders of an organization:
If you see or hear of problems, investigate and take appropriate action. You are responsible for the culture of your organization and for preventing harm to those entrusted to your care. Ignoring problems can lead to higher cost and greater damage. - Ethics count very much:
This book documents what happens when ethics are ignored. Patients are harmed, vision is lost, reputations are damaged and lawsuits occur. Ethics count very much. - Whistleblowing can be dangerous:
We have an ethical and moral imperative to report problem behavior. Yet, many, if not most, whistleblowers are not received well and indeed, can lose their jobs. Therefore, reporting such behavior should be done in such a way that problems are addressed without jeopardizing one's own career. Whistleblowing can be dangerous.
Comment by Robert Fechtner (Newark, NJ, USA)
Over twenty
years ago a powerful department chair operated on the wrong eye of a patient
who eventually went blind and eventually was sued.
Any of us in the
U.S. who were in the world of academic ophthalmology during the time of
the events recounted in this book were aware that there were problems and
discord at Emory. In Waking Up Blind, Dr. Harbin pieces together a chronology
of events based on interviews, correspondence, news reports, legal records
and other sources. He has a point of view that is sympathetic to some individuals,
but that does not make this story any less chilling.
Aside from the
voyeuristic thrill of reading the details of these events, why should ophthalmologists
within or outside the U.S. care twenty years later?
I find the title
of this book misleading. It is about so much more than medical errors and
resultant lawsuits. Underneath the somewhat sensational dust jacket is a
plain black book cover with no identifiable markings. This might serve as
a metaphor for how complex organizations deal with ethical challenges.
We have an obligation of responsibility to those who have placed their trust in us
Academic departments of ophthalmology remain hierarchical organizations
with a chair who controls resources and thus influences the opportunities
for success of the faculty. That chair must function within a universities
or medical center under continuing pressure to provide care and remain economically
viable.
"I wanted to document in full detail what happens when
leadership fails to respond to people bringing credible warnings about
existing problems [..] current headlines bear witness to the many
consequences of other leaders ignoring warnings of problems similar to
those in this book."
Some variation of an ethical challenge will intrude in each of our lives if we have leadership responsibility. How will we respond?
For those of us who have dedicated our lives to caring for other people, we have an obligation of responsibility to those who have placed their trust in us. External pressures provide challenges to everyone practicing medicine and we are faced with moral and ethical choices regularly. What is best for the person what has given me power and responsibility? Have I done harm! How would our political and business leaders rate if evaluated by these standards? I believe it is just as possible today as it was twenty years ago that the leaders of our institutions may find it expedient to ignore or compromise ethical issues when dealing with real and credible problems. George Spaeth was involved in these events representing the Ethics Committee of the American Academy of Ophthalmology. I believe we should all contemplate the contemporary importance of his words when we view our own professional and personal communities. "The 'villain' in Waking up Blind was not the person who was thought to be doing 'wrong things'. The real villain was people who created the culture in which he worked, a culture that so strongly encouraged people to bring in grants and make 'important contributions' that inappropriate behavior was considerable tolerable - sort of collateral damage that had to be allowed for the purpose of achieving a supposed greater good."
Some variation of an ethical challenge will intrude in each of our lives if we have leadership responsibility. How will we respond?
Comment by Richard Lewis (Sacramento, CA)
Physicians
are frequently faced with ethical decisions in the care of patients. We
try to do what's right while doing no harm. What if your colleagues don't
adhere to the same ethical standard? When do you speak out? What price are
you willing to pay to correct an ethical lapse? Tom Harbin, MD, an Atlanta,
GA glaucoma specialist and author of the book, Waking Up Blind: Lawsuits
over Eye Surgery, raises those questions in detailing the true story of
Dwight Cavanaugh, MD, chairman of ophthalmology at Emory University from
1978-1987. Despite what appeared to be a brilliant career as a corneal surgeon
and academician, he violated ethical standards during his tenure.
The privilege of being a physician carries the responsibility that we are held to a higher standard
The most serious charges include wrong eye surgery, overwriting medical records, and lying to colleagues. What is most interesting in this book is the response of his colleagues. Only two members of the department faculty had the courage to speak out and in the process sacrificed their academic careers. They paid a very high personal price while the other faculty members continued to flourish, heads in the sand. Waking Up Blind is a riveting story; the privilege of being a physician carries the responsibility that we are held to a higher standard. This story reinforces that tenet remarkably well.
Comment by Bruce Shields (New Haven, CT, USA)
Tom Harbin's
Waking Up
Blind has stirred emotions and evoked responses ranging from righteous indignation
to soul searching for the ethics of our profession. The circumstances have
been interpreted variously, depending on one's personal and professional
perspective. But for those of us who were in some way involved in the actual
events, it recalls a time of great sadness - a time when friends were pitted
against each other - a time when lives and careers were derailed, if not
destroyed. So what can we take from this tragic episode in our history?
Surely there are lessons to be learned and maybe even a silver lining to
be gleaned from the dark cloud. For me, the lesson and the silver lining
are a reminder of one of the greatest examples of the integrity within our
profession. David Campbell and I were fellows at the Massachusetts Eye and
Ear Infirmary in the mid 1970s.
Two things that impressed me about David were his remarkable ability to unravel clinical mysteries and his integrity, which reflected that of our mentors, Drs Chandler and Grant. In his fellowship and early practice, he identified ghost cell glaucoma and elucidated the mechanisms of the iridocorneal endothelial syndrome and pigmentary glaucoma, just to mention a few of his contributions. Ironically, however, it was his integrity that would abruptly alter this brilliant career and rob the world of what additional gifts he might have given us. It is not surprising that his colleagues at Emory turned to him for answers during a time of concern, nor is it surprising that he responded with typical integrity, even when it threatened his own career and life. In the years that followed, I watched my friend suffer greatly for his efforts to do the right thing. But through it all I never heard him say an unkind word about anyone (and maybe we shouldn't either). What we can do is take pride that within our profession there are still people with the integrity to do what they see to be right regardless of the cost.
We can take pride that within our profession there are still people with the integrity to do what they see to be right regardless of the cost
Two things that impressed me about David were his remarkable ability to unravel clinical mysteries and his integrity, which reflected that of our mentors, Drs Chandler and Grant. In his fellowship and early practice, he identified ghost cell glaucoma and elucidated the mechanisms of the iridocorneal endothelial syndrome and pigmentary glaucoma, just to mention a few of his contributions. Ironically, however, it was his integrity that would abruptly alter this brilliant career and rob the world of what additional gifts he might have given us. It is not surprising that his colleagues at Emory turned to him for answers during a time of concern, nor is it surprising that he responded with typical integrity, even when it threatened his own career and life. In the years that followed, I watched my friend suffer greatly for his efforts to do the right thing. But through it all I never heard him say an unkind word about anyone (and maybe we shouldn't either). What we can do is take pride that within our profession there are still people with the integrity to do what they see to be right regardless of the cost.
Comment by George Spaeth (Philadelphia, PA, USA)
Tom Harbin, an ophthalmologist
in Atlanta, Georgia, has done the world a real favor in narrating a tragic
episode at Emory University. His book, Waking Up Blind, is carefully researched,
appropriately restrained, well written and important. He describes what
happens when an ambitious individual is supported by an ambitious institution,
both individual and institution appearing to benefit from each other and
both taking procedural and ethical shortcuts to enhance the apparent benefits.
Even if the delineations of the principal players are not at the level of
Sophocles or Shakespeare, the heroic strengths and the pitiful flaws of
the principal players can be discerned as well as the terrifying role of
destiny.
Not acting guarantees that the silent person or group becomes a partner in the wrong doingThis is a well-told, true parable, powerfully illustrating the consequences of speaking up and of remaining silent. The speaker is always at risk, especially when his or her comments are directed at a powerful person or institution that perceives a threat. But safety does not lie in being quiet, either; not acting guarantees that the silent person or group becomes a partner in the wrong doing.
