Wednesday, February 07, 2018

Are You With Us, Dr Gu? - Vanderbilt Suspended Surgical Resident Allegedly Due to Patient's Mother's Compaints About His "Taking a Knee" on Social Media

In the US, our political situation seems to be leading to new threats to free speech in academic medicine. 

Background: Dr Gu's Activism 

 his story was first reported by The Chronicle at Duke University, and here it is in chronological order

Congressional Subpoena about Fetal Tissue Research

Dr Eugene Gu is a pediatric surgical resident at Vanderbilt University Medical Center (VUMC).  He has a history of political activism starting at least since he was a medical student.

As a third-year student at Duke Medical School in 2012, Gu earned a Howard Hughes Medical Institute fellowship, allowing him to perform fully-funded research at Stanford Medical School. There, he worked with stem cells.

In particular,

he performed the first successful fetal kidney and fetal heart transplants in immunocompromised rats—a project funded by family, friends and small angel investors, he said. The ultimate goal was to help babies with congenital heart and kidney diseases.

In order to do this research,

Gu obtained the tissue from third-party StemExpress, not directly from patients.

He was rewarded with a congressional subpoena:

in March of 2016, Gu was subpoenaed by Congress for his work.

Rep. Marsha Blackburn (R-TN) put the subpoena into motion after manipulated videos tried to 'make it as though Planned Parenthood employees were selling fetal tissue in violation of federal law.'

Several subsequent investigations found 'no evidence of wrongdoing' by Planned Parenthood.

Congress said it subpoenaed him and other researchers at this time to 'get the facts about medical practices of abortion service providers and the business practices of the procurement organizations who sell baby body parts.'

Gu called it a 'witch-hunt' along with StemExpress CEO Cate Dyer in a joint op-ed in Nature.

The Association of American Medical Colleges issued a statement supporting the sort of research Gu was doing, signed by dozens of top medical schools, including Duke and Stanford.

Lawsuit After President Trump Blocked Dr Gu on Twitter

Dr Gu was not shy about replying to President Trump on Twitter.

Gu said the tweet that got him blocked by the 45th President of the United States poked fun at his infamous 'covfefe' typo:
'Trump often announces changes in national policy exclusively from his personal Twitter account,' Gu said. 'It has become a de facto town hall in the modern era of social media. Not being able to participate in the conversations underneath his tweets is like being silenced from the public sphere.'

This lead Dr Gu to become party to a lawsuit against Trump for blocking him and other Twitter users from this public forum.

The Knight First Amendment Institute filed a complaint on behalf of him and six other Twitter users blocked by President Trump in the Southern District of New York July 11. The group alleged that preventing citizens from accessing his account, a 'public forum,' was in violation of the First Amendment.

Dr Gu Suspended

After having demonstrated that he was not in agreement with President Trump and some of his supporters on a number of issues,

The now-Vanderbilt University Medical Center (VUMC) resident was placed on paid administrative leave for nearly two weeks on Nov. 9. He says it might have to do with a patient’s mother complaining that he took a knee on Twitter to protest white supremacy.

She wrote two public Facebook posts identifying herself as the patient’s mother that kicked Gu out of the room and prevented him from caring for her son because of Gu’s actions. She did not respond to multiple requests for comment from The Chronicle.

The Chronicle journalists did a little digging,

According to emails obtained by The Chronicle with the name of the patient and their mother redacted to protect patient privacy, VUMC administration officials discussed investigating all the mother’s complaints regarding his social media posts on Nov. 8. That day, Seth Karp, chairman of the department of surgery, requested that someone document the mother's complaints about Gu and get them to him by the end of the next day, Nov. 9.

One day later, Gu was placed on administrative leave.

VUMC did not return more than a dozen requests from the Chronicle for confirmation that Karp is involved in personnel decisions over more than a week, over email and the phone.

A later article in The Chronicle noted

on Monday, VUMC denied that he was placed on leave due to his kneeling after a wave of social media criticism and reports from major news outlets covering The Chronicle’s story.

'The assertion that Dr. Gu was disciplined because of his expression of political or social views in social media is untrue,' the new statement read. 'All of VUMC’s actions relating to Dr. Gu’s progress as a surgery resident have been and will continue to be based on his performance and his adherence to VUMC policies.'

The VUMC statement further said:

He has been advised of the need to adhere to VUMC’s social media policy, which requires that persons who are identified as representatives of VUMC clearly state that their views are their own. He has also been advised that resident physicians should be professional and respectful in their interactions and communications with and about one another,...

How Dr Gu might have violated the medical center's social media policy, or how his tweeting might have amounted to unprofessional or disrespectful communications with colleagues was not made clear.

According to his Twitter account, Dr Gu is still a resident at Vanderbilt but is seeking to transfer elsewhere.

This case apparently was also covered in a single story in the Tennessean, and inspired a single op-ed by a medical student in the Toronto Star. Beyond that, it has been anechoic in the news media or scholarly medical literature.

The Toronto Star op-ed suggested:

This is a cautionary tale for any resident physician. Medical trainees are at the mercy of the hospitals that employ them because mandatory residency education is a prerequisite for board examination and certification. Without these, a physician cannot practice independently.

Due to this power imbalance, physicians-in-training are averse to any action that would put themselves at professional risk, including political advocacy that may be perceived as contrary to an institution’s value system. The stakes are simply too high.

The real question, however, is whether society wants its physicians to also be advocates.

Discussion and Conclusions

This case suggested that at least the leadership of one prestigious university medical center is very uncomfortable at best, with its residents publicly expressing certain political opinions, even clearly outside the confines of the hospital.  Whether the leaders felt licensed by the President of the United States, who had banned the person at the center of this case from following him on Twitter, is a reasonable question.

It may not be unreasonable to expect physicians and physician-trainees, as medical professionals, to avoid getting into political arguments with patients.  However, it is unreasonable to expect physicians to avoid making any public political comments that could ever be expected to offend any patient or relative.

And this case also raises the question of whether it was the patient's mother's offense, or the Department Chairman's offense, that mattered.

Attempts to censor political speech in academia are unfortunately not rare (see the website of FIRE, the Foundation for Individual Rights in Education, for many examples).  However, they have not seemed to be that frequent in medical education. (Our most recent example was from 2015.)

I wonder, though, if the ongoing attacks on free speech and the free press (e.g., look here and here) by the current President and his cronies are emboldening censorship in US society.  The President does set the tone and agenda for the country.  A president who personally threatens free speech and a free press will encourage other would-be censors to crawl out of the woodwork. 

We will only be able to restore the freedoms promised in our Constitution, and ostensibly inherent in the nature of academic organizations, if we can get a new president who upholds the worth of these freedoms, and actually will preserve, protect and defend the Constitution of the United States.

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