Fix what’s broken

Pulling doctor privilege is not OK, even if everything that happens afterward is much less OK.

Hartsfield-Jackson Atlanta International Airport

After the release of video documenting the forcible removal of Dr. David Dao from United Airlines flight 3411, viewers worldwide expressed horror at his injuries and outrage at decisions made by both the airline and law enforcement throughout the episode. The anger and deep sense of injustice articulated at deafening volumes online were followed by United CEO Oscar Munoz’ promises to “fix what’s broken” and several requests for review of the incident by members of congress and Chicago officials.

I, too, felt horror at the aftermath of Dao’s removal, not least at the eyewitness accounts of the bloody scene that unfolded when Dao ran back onto the plane after being dragged off. He looked and sounded deeply traumatized during the event; according to his family and his lawyer, it was worse than what he underwent leaving Vietnam during the fall of Saigon.

But I felt something else, too: shame. When I heard the episode was triggered by Dao’s refusal to deplane because, as he said, “[he is] a physician,” I was embarrassed to see a colleague falling back on an outmoded trope — a doctor who thinks he is above the rules.

As a physician, I have worked with and been supervised by several physicians who used their professional status to get things they wanted, or get out of things they didn’t want to do. When I hear “I’m a doctor” outside of a patient care situation, the hair on the back of my neck stands up.

Over the past 50 years, public trust in the medical profession has plummeted from 73 percent in 1966 to 34 percent in 2012, and the U.S. recently ranked 24th of 29 countries in public trust of doctors. At the same time, wrote Nadia N. Sawicki in the American Medical Association’s Journal of Ethics in 2011, many have argued — not entirely defensibly — that physicians’ behavior when “off the clock” predicts their attitudes toward patients.

But in the swift social media response to the incident, there seems to be little interest in discussing a doctor’s use of his professional status to justify exemption from rules others must follow. (While there is currently no consensus on whether the airline was acting legally or not when it asked passengers to deplane after boarding, three other passengers complied with the request prior to Dao’s refusal.)

I imagined the anger that would have been directed at Dao had the only video released been that of his refusal: as a public, we do not look kindly on the “Do you know who I am?” approach to rule-bending. But when I tried to raise the question in conversation, I was instead told angrily that it was an irrelevant distraction.

It is not. If we’re going to talk about how to make the airline industry more respectful of customers — and we are — we need to talk about individual claims to privilege often made in these scenarios. Do we accept that some customers are more right than others?

In an April 11, 2017 article in Medscape News, ethicists weighed in on the question of a blanket exemption for physicians from getting bumped from flights. Nancy Berlinger, a research scholar at The Hastings Center, a bioethics think-tank, was quoted as calling such exceptions unfair: “We all have good reasons, and we tend to think our reasons are really good ones,” she said.

“There has been a culture of pulling rank on a regular basis, just in the everyday routine of making patients wait, for example,” Linda Emanuel, MD, PhD, a medical ethicist at Northwestern University, told the publication. “None of that is really necessary and it is arrogant.”

In private conversation, a friend remarked to me that in certain cases, passengers should have the ultimate authority to defy an airline’s order to remove themselves from an airplane. However, this kind of subjectivity about rule enforcement seems to invite opportunities for bias, leading to a system where more empowered people receive deference, and less empowered people get rebooked on the next day’s flight. Furthermore, suspending some rules for certain passengers in the absence of true hardship sends a signal both to them and to others that they can get away with other infractions.

Most of us eagerly identify with a passenger who has been mistreated by an airline. However, we can feel collective dismay at this particular passenger’s treatment while disagreeing with his logic. If we don’t do both, we risk ending up right back where we started.