Monday, December 12, 2011

Hospital politics, patient care and a doctor's suicide


What causes a doctor to commit suicide? A tweet from Helen Haskell (@hask) linking to a story about a radiation oncologist from Springfield, IL brought this strange case to my attention. Dr. Thomas G. Shanahan committed suicide by cutting his throat in November of 2011. He was respected in his field, having published many research papers and traveled the world helping to set up brachytherapy clinics in several countries. He also had been an acting alderman in his home city. He left his wife and three daughters.

Why did he do it? He had a history of depression. But an event occurred the year before his death that apparently significantly affected his personal and professional life.

Perhaps this story will puzzle you as much as it did me.

A patient with a diagnosis of advanced lung cancer was transferred to Memorial Medical Center where Shanahan worked. She had fallen and broken her leg and developed massive distension of the colon. She was having difficulty breathing. All of her doctors assumed she was terminally ill and advised the family to place her on a comfort care only status. Dr. Shanahan had received a request to see her and did so the next day. After evaluating her and her biopsy results from the first hospital, he felt that she was not necessarily terminally ill and should have a colonoscopy to decompress her colon. The other physicians declined to do so although inexplicably, a colorectal surgeon agreed to colonoscope her and ruled out obstruction but felt decompressing the colon would have been futile.

Shanahan then instructed a nurse to insert a rectal tube which evacuated all the gas and promptly resolved the breathing difficulty. The patient survived for seven more months with some diminished mental capacity thought to be related to the relative lack of oxygen when she was getting only comfort measures. She and her family were pleased with Dr. Shanahan’s efforts on her behalf.

The patient had Ogilvie’s syndrome, also known as pseudo-obstruction of the colon. It occurs in bedridden patients and those with recent orthopedic problems who receive large doses of narcotic pain medication. The treatment Shanahan ordered was correct.

But Dr. Shanahan admitted he had "ruffled the feathers" of some colleagues. He was called a “disruptive physician.” Memorial Medical Center conducted “an inquiry” to investigate his conduct. It was eventually dropped without any formal action being taken.

The chief medical officer at Memorial said, “Shanahan portrayed himself as ‘somewhat heroic’ to Reindl's family and was unnecessarily abrasive toward Springfield Clinic doctors and Memorial employees.”

Another account reported the following. Shanahan moved his office earlier this year from Memorial to St. John’s Hospital, telling friends and colleagues in an email June 28: “The last six months have been hard on me, deciding to defend a patient or turn my head and follow the herd. … I have received over 500 letters and emails supporting my decision.”

We will never know how deeply this situation affected Dr. Shanahan. He left no note.

Having learned all I can about this tragedy, I have some questions. Why was a radiation oncologist able to correctly diagnose and treat this patient while several more clinically oriented specialists could not? How is it that the doctor who made the right call over the objections of several colleagues is the one who is subjected to an inquiry and feels the need to move to another hospital? Is it OK to be “abrasive” when you are the only one who got the diagnosis right? Wasn’t he in fact a “hero” for refusing to back down and saving the patient’s life?

[This post used material from three newspaper reports (here, here, and here) and other sources.]

26 comments:

medschoolodyssey said...

The same sort of self-serving, egotistical behavior happens in every other field on Earth. Medicine isn't immune to the effects of the arrogance of its practitioners. The effects are just more significant and well-hidden.

Anonymous said...

Wow. MMC deserves to be brought to it's knees for this. I can only hope that they lose every last patient and nurse...

-SCRN

Anonymous said...

Well, who knows the reason why.....suicides tend to be incomprehensible (a couple of friends of mine are already gone this way). Leaving wife and three daughters with a throat-cut corpse does not seem so supportive either. It suffices to leave the herd, I guess.

Libby Cone said...

I'm thin-skinned like that. That's why I do locums.

Anonymous said...

I AM A DOCTOR. SOME TIMES MY DIAGNOSIS IS RIGHT EVEN LOTS OF SENIORS MAY HAVE MISSED.I ALWAYS LOOK FOR THE GOOD OF THE PATIENT.

Donna RDH in TEXAS said...

When doctors are to caught up in pleasing the admin, there egos, or there money hungry lives things go wrong. There are truly caring doctors I've seen them. I sometimes wonder if doctors got there education free and made way less money more people would do it because it's there calling and not just a means to support there insecurities by driving the fanciest car.As a dental hygienist and now a social worker I live my passion .. Yes I make less money but my effect on society is unmeasurable

Skeptical Scalpel said...

Thanks for all the comments. The case remains puzzling.

Anonymous said...

I think the doctor was murdered by one of his previous colleagues

Skeptical Scalpel said...

Thanks for commenting. As far as I know, there is no evidence to support the idea that he was murdered.

Skeptical Scalpel said...

I rejected an anonymous comment that was a personal insult to another commenter.

Anonymous said...

Hospital politics can be very strange and inexplicable at times. Administrators often play favorites, usually to those that make the most "rain". Perhaps the other physicians involved in this case applied pressure on the hospital administration to investigate and punish this Rad Onc even though he was right. They were embarrased, He was expendable!

Skeptical Scalpel said...

I agree. This story still bothers me even though I wrote about it several months ago.

JohnnyJay said...

I am sorry for this doctor, and for his family. I shall pray for them, and for other doctors who feel, reasonably or not, that a sword hangs over their heads. I'm an intern myself, and intend to do all I can for my patients without being overtly "abrasive" to my colleagues. Surprisingly, I didn't realize that as an intern, I still don't see much of the patients as I'm so busy running up and down wards doing clerical work. Please bring us more stories about the trials of doctors, SScalpel, so we can be forewarned.

Skeptical Scalpel said...

Johnny, Thanks for commenting. I hope the real story about Dr. Shanahan comes out some day.

Anonymous said...

Very sad. So sorry that this happened and sorry that it is still in your thoughts so much that you wrote about it again.

Just happened on to your blog. Very interesting. Thank you!

Skeptical Scalpel said...

Thank you. I am not usually known as a very sensitive guy, but this story really got to me.

Anonymous said...

In your view, how could Dr Shanahan make his peers’ bullying against him costly for them?

Skeptical Scalpel said...

Good question. I don't know if he could have made it costly for them. I suppose he could have sued them, but I doubt he would have prevailed.

Todd J. Scarbrough, M.D. said...

heyyyyy.... I'm a radiation oncologist and consider no one else more or less "clinically oriented" than me!!! This "soft bigotry of low expectations" must cease!!!

In all seriousness, we (radiation oncologists) hear things like this all the time. Also, I think we should try not to stereotype people, races, genders, or medical specialties. Finally, I think radiation oncologists can be some of the most annoyingly self-righteous, difficult-to-get-along-with, cranky, and weirdly perseverating people I've ever known!!!

Skeptical Scalpel said...

I agree with everything you said.

Anonymous said...

Perhaps we physicians would be wise to explore our biases and fears as they relate to the treatment of patients with advanced disease.

When compassion takes a back seat to egos, are we serving our patients?

This experience highlights the need for more training and focus on compassionate approaches to patients and to each other. When the focus is on which physician is "right" when the patient and family clearly benefitted, it is time to re-evaluate.

Skeptical Scalpel said...

I agree. It should not matter which doctor was right. It is a sad tale indeed.

Anonymous said...

Gastroenterologists have become like most members of my specialty (cardiology),i.e. "procedurologists". The answer to any GI consult that I request is invariably focused on which orifice they wish to advance the probe through first (its always both upper and lower GI endoscopy; the order of procedure may occasionally vary).If the patient is in any way not a "candidate" for routine scoping,then pill endoscopy (also billable by the GI expert) may be contemplated. I have yet to see my GI colleagues refer for virtual (CT) colonoscopy. The reason is obvious.......radiologists bill for those examinations. If the patient has other GI pathologies (e.g. liver function abnormality) the consultant loses interest (unless she/he can somehow justify endoscopy with ERCP (once again not MRCP, because then the radiologist may gain!).
In this patient who was clearly not a candidate for routine endoscopy; the GI consultant made the simple calculation. Insertion of rectal tube....how much $$$ does that pay? Not much. Next case......Move on to next patient. Ultimately it was done by an RN. Highly unlikely to be a "billable" procedure.
The economic incentive has for years been the engine that has simultaneously both developed and destroyed our medical system.
Although our medical system has declared that drug addicts have the right to be "weaned" off their habit (if you call getting a daily methadone fix as weaning); physicians were not given the opportunity to be weaned off their financial-incentive addiction. The drastic cuts in medical reimbursement have made many physicians go into an acute withdrawal syndrome,that blurs their already poor judgement.
So as not to spare my colleagues the rod; just try referring a patient to a cardiologist. Once again the answer is not how to manage his blood pressure or hyperlipidemia (the less sexy segment of cardiovascular practice).Rather it is the sequence of predictable battery of "diagnostic" cardiac/vascular etc. tests. Finally culminating in the diagnostic cardiac catheterization,and then down the predictable slippery slope of multi-vessel coronary interventions.After the cardiac function has succumbed to all the insults hurled at the patient (stent thrombosis/MI, by avoiding referral for cardiac surgery when appropriate); the turn of the cardiac electrophysiologist arrives. With their armamentarium of pacemakers/defibrillators/ablations (and what have you) the patient becomes a lifelong annuity.

Skeptical Scalpel said...

Great comments. At a place I know of, the GI people don't even see the patients. They have APRNs and PAs do it. The GI then meets the patient in the Endo suite.

Cardiology-Everyone gets an echocardiogram whether they need it or not.

I hate to say it, but fee for service is indeed the problem.

Anonymous said...

I don't think you mentioned I believe all the (incompetent) doctors were from Springfield Clinic. Second, he was found dead in his front yard from a knife wound. No suicide note. Springfield had a new coroner after the last one being dismissed for botched jobs. The new coroner's only qualification was that she was married to an alderman.

Skeptical Scalpel said...

I didn't mention the doctors and the clinic because I wasn't quite clear on who was who.

I also didn't know the details of the poor guy's "suicide."

Do you think the truth will ever come out?

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