The Chief Complaint - Features - Atlanta Magazine
 
 
 

The Chief Complaint

In an excerpt from his forthcoming book, Emory professor and former Grady cancer director Dr. Otis Brawley pulls back the curtain on the medical machine

Photograph by Audra Melton
You’re a stickler for acting on the basis of scientific evidence. Where does that come from? I grew up in the inner city of Detroit with people who were not formally educated but who were wise. My father was also very inquisitive. I was influenced heavily by this and by the Jesuits in my high school, who taught me about the scientific process. They taught me there are three things: things that are known, things that are not known, and things that are believed. Very frequently doctors think of things they believe as things that are known. When you talk about cancer screening, many doctors of my generation and older never took a course that covered screening and don’t understand the basic principles.

You write some harsh things about doctors in private practice, including some here in Atlanta. Will you ever be able to eat lunch in this town again? [Laughs] There are a group of doctors, certainly not all doctors, who have lost the meaning of the word "profession." Everything is about business, and it’s not about putting the welfare of patients first. And some of these guys, due to laziness or a focus on money, have failed to evolve. So they practice the best medicine of thirty years ago, which was when they graduated from medical school. Some of the docs who read the book may very well say, “Is he talking about me?”

An excerpt from "How We Do Harm: A Doctor Breaks Ranks About Being Sick in America" by Otis Webb Brawley, M.D., with Paul Goldberg

She walks through the emergency-room doors sometime in the early morning. In a plastic bag, she carries an object wrapped in a moist towel.

She is not bleeding. She is not in shock. Her vital signs are okay. There is no reason to think that she will collapse on the spot. Since she is not truly an emergency patient, she is triaged to the back of the line, and other folks, those in immediate distress, get in for treatment ahead of her. She waits on a gurney in a cavernous green hallway.

The “chief complaint” on her chart at Grady Memorial Hospital, in Downtown Atlanta, might have set off a wave of nausea in a hospital at a white suburb or almost any place in the civilized world. It reads, “My breast has fallen off. Can you reattach it?”

She waits for at least four hours—likely, five or six. The triage nurse doesn’t seek to determine the whereabouts of the breast.

Obviously, the breast is in the bag.

I am making rounds on the tenth floor when I get a page from Tammie Quest in the Emergency Department.

At Grady, we take care of patients who can’t pay, patients no one wants. They come to us with their bleeding wounds, their run-amok diabetes, their end-stage tumors, their drama. You deal with this wreckage for a while and you develop a coping mechanism. You detach. That’s why many doctors, nurses, and social workers here can come off as if they have departed for a less turbulent planet.

Tammie is not like that. She emotes, and I like having her as the queen of ER—an experienced black woman who gives a shit. When Dr. Quest pages me, I know it isn’t because she needs a social interaction. It has to be something serious.

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  1. KatherineL_2082 posted on 02/29/2012 10:51 PM
    Please read my story about my own experience with breast cancer and you will see how duplicitous are many people associated with the disease. My story is posted at

    http://mammogramsanddcis.blogspot.com (mammograms and dcis). You'll be shocked about

    what we aren't told.
    1. Nathan, MD posted on 04/28/2012 01:33 PM
      @KatherineL_2082 Great article. Unfortunately, the above poster's site doesn't address MANY of the relevant issues regarding the larger picture of nationwide breast cancer screening (I understand it's a huge issue, but what is left out is pretty important), and her misleading representation of the story and her assumptions about the medical system are disingenuous. In the above article, Dr. Brawley briefly touches on prostate and cervical cancer screening issues, but what he says can certainly be more broadly applied. Our medical SYSTEM is deeply flawed, and doctors' medical decision making DEFINITELY isn't perfect, but there's no system-wide "secret" as she alleges that prevents good care.

      Bad doctors here and there, sure. Unethical doctors here and there, sure. A system that makes it difficult for large populations to get good care (like Dr. Brawley focuses on), sure. But read what Dr. Brawley says about cervical cancer screening (Pap smears) at the beginning of the interview section above. A recommendation of less frequent testing for CERTAIN low risk populations of women who have had multiple recent normal Paps caused outrage. "You’ve got all the folks who are upset" Dr. Brawley says, "because we say they should be tested every three years." Yes, IN THOSE POPULATIONS, the evidence says that yearly testing isn't necessary, and all it does is waste money and lead to more false positive tests.

      The same thing applies to breast cancer screening. If your doctor is up-to-date on the latest recommendations, the doctor won't be a burden on the system by ordering too much testing and he or she won't cause unnecessary worry for patients by ordering testing that has a high risk for false positives.

      And, yes, every now and then someone will get cancer, and that sucks. But doing testing the way that Katherine proposes would further bankrupt and cripple our system, and we wouldn't even be doing our patients any favors.
    2. Karen Thomas posted on 04/29/2014 06:12 PM
      @KatherineL_2082 A very vompelling poignant yet uplifting and enlightening communication Katherine. I was immediately captivated and could not stop reading until the end. Thank you for your courage and sharing.
  2. Jeff Kinz posted on 05/01/2012 10:34 PM
    Gee, wow - a person dies because their employer won't allow them to take off a half day instead of a whole day, and they work for the phone company? The Phone Company? which is Verizon, who has a quarter of a million employees, that is to say - 250 hundred thousand people on staff, couldn't find a way to let this lady go see her doctors for a few hours every month?
    2 things need to happen here:

    #1 - Verizon needs to be strongly fined for having policies that contributed to this lady's death
    #2 - legislation needs to be passed to make it illegal for companies to have policies that prevent people from seeing their doctors.


    Third and MOST IMPORTANT: Health care is a service industry for the public. WHY THE HELL ISN'T IT OPEN EVENINGS AND WEEKENDS?????
  3. Accipiter posted on 05/02/2012 11:17 PM
    When I was a student in Atlanta, a girl in my dorm had what I could only call a mental breakdown. She went completely ballistic, was running around half-naked, collapsing, screaming. I called 911 and the first question the operator asked me was, "what is wrong with the woman?" The second question she asked was, "is she black?"

    When the ambulance finally arrived, they kind of dicked around, not really willing to bring the gurney all of 50 feet to the front door (they couldn't drive up to the front door because the dorm was in an arts center and there were pillars in the way. They didn't seem concerned at all, even as they looked at the hysterical girl.

    I found out these guys were sent from (and taking her to) Grady. The way they treated this girl was absolutely insulting and disrespectful. They treated her like she was on drugs (she wasn't. All her friends and roommate said she was strictly anti-drug. Later blood tests showed she was completely clean). They took their time and seemed to not give a single care about this black girl writhing on the floor.

    Eventually they gave her injections of something to calm her down, and then took her off to Grady. I still wonder to this day if I should have lied to the 911 operator and said she was white. I bet you anything they would have sent an ambulance to take her to a different hospital, and maybe the ambulance that came would have treated her more respectfully.
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