It Matters Who Is in Charge: Of All People, That Man Should Not Have Decided My Fate
To save time, doctors often use only the bare minimum of information to describe a patient. For example, ‘Ms. H is a 33-year-old single woman brought to hospital following a suicide attempt after losing her job’. However, any clinician will know that there is always much more to the story, and this is especially true in psychiatry. The details and all the other factors that led this person to our care are essential not just to understand the underlying causes of the patient’s problems, but also to decide on appropriate management. While it’s easier to make snap judgments based on a small amount of information, there’s a lot more to consider if your decisions are to be beneficial and fair. Some people are particularly wise and thoughtful in navigating the nuances of complex situations. Others are not. Both as a clinician and in my experience with the medical regulator that controls clinical practice in my province, I know firsthand how essential wisdom is to just decision-making, and exactly how much damage one person can do if he is not a wise judge of the person or situation in front of him.
During my time as a psychiatrist in southwestern Ontario, I was heavily involved in the training of medical residents (junior physicians working to become specialists). I was a core member of our department’s RPC — Residency Program Committee — and my specific portfolio was to handle evaluations; not only of the residents in our program, but also evaluation of the training they received and of the faculty supervisors who were training them. In addition to that major role, I often stepped in as chair of the RPC when the program director was not available.
Shortly after I joined the RPC, our program expanded to include a site in another city. A senior psychiatrist at the new site was designated as their local training lead and, as such, he became a member of our RPC. To get him up to speed, a small team of us went out to the new site to do faculty training for him and a few of his colleagues. My first impressions of him were that he was welcoming and enthusiastic, but dismissive of the many challenges associated with running a residency program.
That senior psychiatrist and I sat together on the RPC over the next several years. We interacted regularly at meetings (some of which I chaired), during interviews where we selected the next year’s cohort of trainees, and whenever specific issues arose with the evaluation of residents or supervisors at his training site. In addition, he and I travelled to several national meetings as the only two faculty reps of our university’s training program. It was at those meetings that I learned how much he loves music, as he would chat to me on the topic given the chance and sometimes skipped our afternoon meetings to go to some music venue instead.
Because of my role on the RPC, I also got to know this man particularly well as an evaluator. As was the case for most colleagues on the RPC, he was regularly expected to provide evaluations for individual residents, and sometimes this meant dealing with complicated circumstances; especially if the given resident was struggling. What stood out to me the most about my colleague was his tendency to see people in black and white; in his eyes a trainee was either fantastic or terrible. His evaluations were usually short on detail and lacking in nuance. More than once, I was surprised to find that he provided a glowing but brief review for a resident that had been flagged as having major problems by multiple other faculty. At other times, he was remarkably quick to write off a trainee in trouble, without trying to understand the circumstances or underlying issues.
Even though he and I never had any outright conflict, we didn’t always agree or see eye-to-eye on issues of residency training. I never quite trusted his judgment, and I know that I wasn’t the only one. Years later I also heard from more than one male trainee, since graduated, that he was apt to make misogynistic comments in the company of other men. While he never said anything like that in my company, and I hadn’t heard anything about it at the time, it validates my and some of my colleagues’ suspicions of his judgment.
As much as many of us would like to believe that overt misogyny and abuse of women are not tolerated in medicine, there are too many women doctors who know differently. If you’re familiar with my story, you’ll know that I experienced gender-based abuse as a physician. However, my abuser was not a colleague but a patient. I’ve described in other posts that my tormentor used several weapons to keep me under his control — including my fear of my professional regulator — and ultimately set out to destroy me through The College of Physicians and Surgeons of Ontario after I finally stood up to him to protect myself and another woman. All this came to a head in September 2017 when The College suspended my medical license.
In the weeks leading up to The College’s decision, I’d tried to explain the complexities of my situation in a lengthy letter detailing the prolonged coercion, extortion, physical violence, and rape that I had experienced at the hands of this serial predator. This was extremely difficult for me, as it would be for any woman who has experienced these things. Many of our patients in psychiatry struggle to tell their story and detail what happened to them as they try to navigate the justice system — and there is a growing recognition that trauma-informed approaches are very important when women are disclosing their experiences of sexual violence. But this was not available to me. I could only communicate with my accusers through my lawyer’s written submissions, and so I wrote the most painful letter of my life confessing the details of my tormentor’s abuse to the physicians at The College.
Yet instead of responding with any sort of concern for my safety or any understanding of the trauma that I’d experienced, their response was harsh and simplistic. They zeroed in on my initial denial of what had happened and wrote repeatedly about how ‘deceptive’ I was. They called my actions ‘egregious’ and said that to ‘protect the public’, the three-person committee who had judged my case could see no alternative to suspending my licence. This was devastating to read. Even worse was that I recognized the name signed at the bottom of the letter. It was my colleague’s; the man that I worked with on the RPC and whom I did not trust to appropriately evaluate our trainees. He was the chair of their committee and therefore, my primary judge.
As I repeatedly re-read The College’s decision, my thoughts returned to the very familiar person who authored it. How could he not be more humane, given the traumatic nature of what I’d disclosed? As a psychiatrist himself, how could he be so dismissive of my safety and mental health? Had any of the residents in our program responded in this way to a woman’s disclosure of abuse and violence, it would have led to significant consequences for that trainee.
I was also deeply alarmed by my colleague’s disregard for the basic processes and norms meant to protect me as the accused. Recusing oneself from evaluating or judging colleagues is a fundamental requirement of serving on almost any professional panel. It is essential to ensure impartiality, avoid conflicts of interest — perceived or otherwise — and arrive at just decisions. It’s also plain common sense.
I researched The College’s own policy on this issue and read that, indeed, their committee members ‘should not take part in a decision if a reasonable and informed person would conclude that the member is not able to decide fairly and impartially’. It stated that committee members are responsible to flag any situation that ‘may give rise to the perception that the member would not make an impartial and fair decision’. Together with my lawyer, I sent a letter back to my regulator outlining my colleague’s breach of this policy. I told them that several physicians in our department felt that our colleague’s involvement in my case had been highly inappropriate and was a clear conflict of interest. I requested that my case be heard by an impartial panel, and one that includes women physicians and someone with expertise in trauma.
I heard absolutely nothing in response. After nearly a year, when on my urging my lawyer raised the issue again, The College’s investigator responded dismissively. He stated that they had asked my colleague about conflict of interest, and he had said that there wasn’t any.
It was much later, and only after a lot of digging through a mountain of files, that I found any evidence that The College had taken even a cursory look into my complaint. I discovered the record of a secret teleconference where The College’s lawyer and a few staff members presented my concerns about his breach of their policy. My colleague responded by claiming that he barely knew me. He said that he did ‘not remember a single instance of having a conversation’ with me. Though he acknowledged that we were on a committee together, he claimed to have no memory of me ever coming to his site or representing our program together at national meetings. He said that he did not know anything about me, not even my role on the RPC. He was, he said, ‘very surprised that [I] would characterize [our] professional relationship as significant’.
I was floored. His statements were so definitive and dismissive that I temporarily began to doubt myself. Had we truly interacted so little? Was it possible that he had no clue about what I did on the RPC? Had our professional relationship been that insignificant? Then I realized that I recognized this feeling; he was using the same weapon that my abuser used to make me question myself by claiming that I had remembered things incorrectly. I was being gaslit by my own colleague with the backing of the most powerful organization in medicine.
I tried to fight back; I gathered up all the evidence I could to demonstrate that my colleague and I had worked together for years, that he knew very well who I was and what I did on the RPC, and that we had indeed had numerous conversations. Together with my lawyer, I forwarded years’ worth of meeting agendas, minutes, and emails as proof. Of course, there could be no record of our offhand chats about music at national meetings, but I sent in what I had.
I have heard nothing in response. I suspect I never will.
My career is over, but according to official websites my colleague remains a faculty member at my former institution and now holds an even more powerful Vice Chair position within The College. I find this especially concerning, considering the known role of regulatory bodies in physician mental illness and suicide. My old lawyer told me that he is known as a particularly draconian judge, and that I am not the only colleague he has used his power over. Based on what I know of him as a colleague and evaluator of trainees, he’s nearly the last person I would have chosen to be a judge. But these are the people who seek out and are appointed to such positions of power.
Though I didn’t know it at the time, the suspension of my medical license in September 2017 marked the end of my career. That one decision by my colleague sent my case down a terminal path that I was powerless to change. I was never able to defend myself in front of an impartial panel and my tormentor ultimately succeeded in destroying my career. That same ruling against me was also instrumental to the prosecutor’s decision to drop the criminal case against my abuser, leading him to be released after serving a short amount of time for similar crimes against a young teenage girl.
Since then, I’ve often wondered: If, instead of choosing to be my judge, my colleague had appropriately recused himself and an impartial panel had thoroughly considered all the facts and complexities of my case, would they have come to the same decisions? It’s possible that other judges at The College might have responded exactly as my colleague did, but it’s also possible that they might have chosen an alternative approach; one leading to different outcomes that were more just for me and for the many women abused by the same man. Because of my colleague’s poor judgment, I’ll never know.