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Our Responsibility Starts on Day One: A Response to Anesthesiologist Dr. Tiffany M. Ingham, MD


As physicians-in-training, it is tempting to accept that we have no place to stand up to our colleagues or superiors. That we should just hold our tongues, keep our mouths shut, dodging confrontation like the plague.  This is false. From the day you received that acceptance letter in the mail, you committed your life to protecting others. What was it uncle Ben said to Peter Parker? “With great power comes great responsibility.” At times, this might mean getting uncomfortable to do the right thing.

Recently in Maryland, anesthesiologist Dr. Tiffany M. Ingham, MD underwent litigation for defamation and malpractice. The patient discovered demeaning insults that were stated by his anesthesiologist during a colonoscopy. In preparing for the procedure, the patient used the record function on his phone so he would not miss any important instructions. The phone remained on record throughout the procedure. What he heard on the way home was disturbing. During the procedure, the physician and other staff members berated the unconscious patient. Because he was nervous about receiving an IV, the physician stated that, “I wanted to punch you in the face and man you up a little bit.” Throughout the recording the patent was called a “retard” and it was joked that he had syphilis and tuberculosis on his genitals. All of this occurred while the patient was under full sedation.

It is unfortunate that this one case has become publicized and will fuel distrust in physicians. But for students and residents, it is a timely reminder that how we behave matters 100 percent of the time.

When we join the care team, we become responsible for that patient. Whether it is protecting their airway or protecting their dignity, we must not allow our opinions to affect obligation. We must also not allow the fear of acquiring enemies prevent us from informing our colleagues that a behavior is inappropriate. Our duties extend beyond just managing medical care of patients and require us to preserve trust. We must give patients the assurance that our sole focus is on them and that we will protect them while they are under our care.

Remember what brought you to medicine in the first place? Sure, we all joke that medical school is full of type-A gunners who never got less than a 95 percent. But the truth is, you were welcomed in because someone saw more than your grades. They saw your integrity and compassion. They saw someone willing to devote their lives to people who were sick and scarred. They believed you had the potential to be a great leader and an example to those around you. Sadly, these are things the physician from Maryland had clearly forgotten.

The way we behave today is indicative of how we will behave tomorrow. Medicine can ill afford us waiting until we are “done with our training” to stand up for what is right. Before you know it, you will be a doctor. And in reality, most patients that you care for today already see you as one. You owe it to them to assure they never experience what that man in Maryland did, at least not while on your watch.

On day one we were given confidence and a stethoscope. Soon after, we donned a brilliant white coat. All of these are symbols of authority and power. So let us be bold for those we care for and embrace the responsibility that comes with it.

Eric Donahue Eric Donahue (9 Posts)

Medical Student Editor

University of Washington School of Medicine


Eric serves as a medical student editor at in-Training and he attends the University of Washington – Class of 2017. In the past he has worked in EMS and international community health. As for the future, a career caring for the community is in the works. He believes writing is an essential expression of human ideas, passion and intelligence. Eric is a husband and father of three.


  • Ricardo

    Good message. Conduct yourself with high standards, and never speak ill of others. One would think that we learn this as children but not so apparently.

  • Dave Richards

    I’ve followed all the discussions in all of the Forums regarding Dr. Ingham’s apparent misconduct, and I’d like to offer a somewhat tempered perspective. In short incremental bytes of information: 1) I note that she is a former military physician, who served our troops deployed in Afghanistan. She deserves full and appropriate credit and appreciation for her honorable military service, under very trying circumstances. 2) I listened to the recorded conversations in the OR, and it frankly reminds me of the banter in historic TV “M*A*S*H episodes! The voices of the participants in this case are rather jovial and jocular. Obviously their comments were politically incorrect, and they should never have been spoken in the presence of a patient. But I also remember, as a teenager, having a cyst removed from my upper buttocks, under spinal anesthesia, and the surgeon remarking in a jocular way to the anesthesiologist, “He’s really hairy, isn’t he!” Well, he was correct — and I didn’t take offense! 3) I absolutely agree that the patient was entitled to the damage settlement, given the clearly inappropriate behavior of the OR staff — and I would not have minded seeming him receive the whole $1.5 million. Clearly this should be a major wake-up call to Dr. Ingham: you are “on display and on notice” ANY TIME that you are serving in your official capacity as a physician, and you need to temper your professional behavior accordingly, no matter what your private opinions might be. Thanks to the managers of this forum for allowing me to “sound off” on a sensitive subject. — Dave Richards (Yale ’72MA)

    • Pompous Twerp

      How about the fabrications she put in his medical record? Clearly, professionalism is a problem here, but how she practices medicine is of more concern to me, frankly.

      • Moniker

        I think this claim is overblown. She stated that the patient had hemorrhoids and technically speaking it would be true as everyone has hemorrhoids –they are part of the normal anatomy.

        • Pompous Twerp

          Well the fact remains she is heard saying that she didn’t see them but would write it down anyway. So she’s basically a liar. I wouldn’t trust her with my care as a result, and isn’t trust at the very core of the Doctor-patient relationship?

          • Moniker

            See them or not, they are always there. Is it a lie to say something is there when it is infact there? Also I think this patient pretty much showed his contempt for the trust in the Doctor-patient relationship when he surreptitiously recorded the doctors’ conversation.

          • Pompous Twerp

            Sounds like a case of rationalization. She did the wrong thing, plain and simple. Those who don’t see that are untrustworthy themselves.

          • Moniker

            I never said that she didn’t do anything wrong. You said that she was putting fabrications in the chart. Saying that some one has hemorrhoids when everyone has hemorrhoids is by definition not a fabrication and is not a reflection on her ability to proved competent care. She said some things that were insensitive and unprofessional. She should have received a reprimand and mandatory counseling. She does not deserve to be crusified as she has been. And certainly the patient didn’t deserve to cash in from the doctor’s insurance company to the tune of half a million dollars as he skillfully has. In my opinion both parties are at fault here. It’s just that I don’t buy the plaintiff’s case hook line and sinker like everyone else seems to.

          • Pompous Twerp

            I respect the fact that you can have your own opinion. Simply put, she didn’t see hemorrhoids but she put it in the medical record. She lied. It’s wrong and she is paying for it with her career. You can’t be cavalier as a doctor. Frankly she was being stupid and people with that poor of judgment shouldn’t be trusted and shouldn’t be practicing medicine.

          • Moniker

            She’s the anesthesiologist! She never sees what she has to put in the record for the diagnoses determined by colonoscopy but she has to do it anyway.

          • tet4tet

            Anesthesiologists diagnose? They don’t diagnose anything in this instance. They put you under.

          • Moniker

            For billing purposes third party payers will require a coded diagnoses to go along with each bill from each provider. More than likely the anesthesiologist’s EMR default list of diagnoses did not include “normal screening colonoscopy”. So she used the non-diagnoses diagnoses of “hemorrhoids” instead. It is no more than an esoteric billing/coding issue, but the plaintiff successfully painted it as ethical malfeasance.

          • frosty7530

            Well Pompous, it looks like you’ve at least got some good insight into yourself. “She did the wrong thing, plain and simple. Those who don’t see that are untrustworthy themselves”. Are you stating, that those who disagree with you or have a different perspective on this controversial incident, are also untrustworthy, or bad/immoral themselves? I don’t know about you, or others, but I don’t feel like I am getting a complete picture of this. I read the Washington Post, but it revealed very little of her pre-op interview with him. There was no information on Dr. Ingham, in re to her training, how she is perceived by her co-workers, other pt. reports of their experience with her. On one site, it did mention she did a rotation at MD Anderson, one of the very top cancer research centers. Also interesting to note her high risk military service.

          • Pompous Twerp

            Did you listen to the recording?

          • frosty7530

            Happy New Year Pompous: I regret challenging U, because I know you meant well. I don’t argue that nobody should go through a horrid experience like that man did. Yes, I heard her tape. I am curious about this woman; and nobody seems to know much about her. For better or worse, there seems to be a black-out on “Tiffany Ingham”. I wonder why she became a Dr; did she switch to anesthesiology because it required less pt. contact? Should she have switched to research or pathology? Is Tiffany Ingham a cold sociopath or a burned out Dr?.; she is not the only doctor out there with bad bed-side manner. That is for certain.

          • Maud Kennedy

            That conversation in itself means no one can’t trust the surgical team that is supposed to care for them. If they can’t wait for you to be under to start insulting you,how can one trust them for anything in first place? They’re always the first to say to people afraid to be naked under the gown they’re professionals and they’ve seen everything,talk about a hypocrits bunch!

          • tet4tet

            You are stupid. You sound like a doctor protecting their own.

          • Moniker

            So you encountered someone who irritated you and you responded by being insulting. How are you any different from the doctor in this case?

          • tet4tet

            The doctor had no basis for such name calling.

          • Moniker

            Neither do you. But I would point out that from the recording it is clear that everyone in the room that interacted with the patient before the procedure had a bad experience. Is it not possible that the paient’s behavior before the procecure -you know the part he chose not to record- was offensive and disrespectful to the medical staff? Not that it would excuse the behavior, but it would make it closer to your own weakness.

          • Jack Straw

            As a doctor, I think I can answer that one: Dr. Ingham took an oath when she received her white coat.

          • Moniker

            As a doctor you would kmow that that is not true. There is no required oath. I do, however, agree that she assumed a higher responsibility than the average person to control her behavior even in response to extremely irritating interactions But this doctor used poor judgement and forget that she is not permitted to act like people like tet4tet.

          • Jack Straw

            Your first mistake: assuming that I was making a general statement about oaths. Wrong. Dr. Ingham attended Eastern Virginia Medical College where there is an oath required at graduation. So that is what separates her from someone randomly posting on a forum.

          • Jack Straw

            Yup. If you knew anything about medicine, you would understand that an official diagnosis requires clinical/laboratory/radiographic evidence.

          • Moniker

            To bill for services the anasthiologist has to submit an ICD-9 code along with the CPT code. The person who makes the official diagnosis with a colonoscopy is the gastroenterologis, not the anesthesiologist. So why does she even make a comment about the dx? -for this billing requirement. She is required to do this on every case, but she never really sees anything on any case as she is the anesthesiologist not the colonoscopist. It is something that only a billing coder is ever going to see and technically it is a correct diagnosis as the presence of a rectum is more than sufficient clinical evidence for the diagnosis of hemorrhoids.

          • Jack Straw

            Not sure where you went to medical school or how you practice medicine (although I have my suspicions) or what text books you read, but I’ve never heard the presence of a part of the anatomy being sufficient for diagnosis of anything. Hemorrhoids (both internal and external) can be diagnosed by digital rectal exam and internal hemorrhoids visualized by colonoscopy or sigmoidoscopy.

          • Moniker

            Hemorrhoids are part of the normal anatomy. They are not an ailment.

          • Jack Straw

            In an earlier post you referred to it as a “diagnosis” and now you say that they are “not an ailment” so are you saying that doctors diagnose people with having normal anatomy? Sounds ridiculous to me.

          • Rily Jane

            Showed his contempt? I don’t think he went in there to do battle with two doctors that day. He went in for a procedure. And let’s see..what did that recording reveal about the TRUST in the Doctor/Patient relationship? Hmmmm? It has now given THOUSANDS of patients who have put off getting a colonoscopy (which could save their lives) reason to distrust medical professionals. That’s what it’s done.

          • Maud Kennedy

            If it was an anomaly,I’d agree with you but it isn’t. Many doctors have admitted to do so so what can of trust can really exist in the doctor/patient relationship?

          • BatWoman

            “Surreptitiously” ? What kind of jackass are you that you think someone doesn’t have the right to know what is being said about them and done to them while under anesthesia? I’m pretty sure you wouldn’t have lined up to have these assholes do you next! Anyone that shows that much contempt for a pt. seems a little unstable and not trustworthy as to where they cross the line of what’s ok to do to them out of dislike.

        • Rily Jane

          No it most certainly is not true that “everyone has hemorrhoids.” And it is definitely not said….in a cavalier, mocking manner ..when the patient is under..or falsely ..to his face. Overblown my foot. That man deserved EVERY penny..and SHE should be drummed out of the medical profession..as well as the other doctor.

        • BatWoman

          Why to h is an anesthesiologist even documenting about hemorrhoids to begin with . That was the asshole gastroenterologist’s job

    • frosty7530

      I’m glad to see your response, as it’s one of the best I’ve read on this case. I would really like to know more about this doctor. Very one-sided reporting on this case.

    • Maud Kennedy

      Politically incorrect?? I’d have said disrespectful and insulting but it’s kinda the same thing,isn’t it??
      That’s coward as hell to spit on someone because they’re under anesthesia about things that could be said about absolutely everyone,including them.
      Who’s perfect with a perfect body?? Absolutely no one.

    • JustASoccerDad

      Point 2 is also of little merit. First, it was a TV show. Second, the banter and subsequent disrespectful commentary was between the medical staff, not towards the patients. While you want to give her the benefit of the doubt because she was deployed to AFG, I cannot agree. I am very lucky to have the opportunity to work alongside people who’ve been deployed multiple times to IRQ and AFG, have taken great risks, seen things that no one ever wishes to see. They don’t get a free pass to be disrespectful or dishonest in their daily lives. Nor should Dr Ingham. EVER.

    • BatWoman

      How do you know she deserves full credit for serving our troops or that he military service was “honorable”. Who’s to say she wasn’t doing this same exact thing to our troops. What do you think, that this behavior was an isolated incidence. No it wasn’t. No one speaks like that at length on a one-time or first-time basis.

  • My mother recently shared with me the story of her visit to a nursing home. She goes there once a month to teach a Sunday School class. As my mother was speaking, she noticed that one of the residents had wrapped her arm in the hem of her blouse and began to lift it over her head. One of the nursing staff quickly came to the woman, smoothed down the blouse and gave her a reassuring smile and a quick hug. That stuck with my mother. She was so encouraged by the genuine concern, respect and care that the staff provided. This should be the norm, not the exception, in any medical staff situation. Every patient should be confident that his or dignity will be protected by all medical staff…especially when one is incapacitated in any way.

  • artone

    This is a great response…however, the damage done to patient/physician relationships is severe….the next time I am in for any kind of procedure that requires loss of consciousness, I will bring along my trusty dash cam or go-pro …..”trust but verify” is a solid policy in the face of such events………….as a matter of fact, perhaps medical professionals should be required to record the procedure as is now required of police in many locations…I am going to start talking to state legislators about this…..the technology is affordable and now apparently necessary……

  • Connor Boushell

    “But the truth is, you were welcomed in because someone saw more than your grades. They saw your integrity and compassion.They saw someone willing to devote their lives to people who were sick and scarred. They believed you had the potential to be a great leader and an example to those around you.”

    Seriously? Are you kidding me?!?! I know plenty that went to school to become doctors. It had NOTHING to do with caring for others or being compassionate. It had EVERYTHING to do with prestige, and an expected large salary. I met many home-coming king/queen types who went on to work in the medical field because they thought it was a popular decision that would earn them money and popularity, and maybe a TV show if lucky!

    I’ve never known anyone who becomes a doctor because they want to help. All those people become therapists, mental health professionals, teachers, etc.

    This anesthesiologist perfectly represents those in the public health/hospital/doctor industry. She thinks she is amazing and thinks everyone else is a loser. Just like the captain of the cheerleading team at your high school.

    • BatWoman

      “I met many home-coming king/queen types who went on to work in the medical field because they thought it was a popular decision that would earn them money and popularity.” Exactly! And if you had the unfortunate experience of having to go through school with them you would have seen also that they expected that popularity, looks etc. to allow them an easy ride and even expecting the entitlement of cheating off others!

    • Kate Joyce

      I am so sorry that you have not met anyone who becomes a doctor because they want to help others. I assure you, they exist. I am also sorry that you have only known arrogant, narcissistic cheerleader/homecoming king/queen types. I have met jerks in those groups as you describe, but I’ve also met compassionate individuals in both groups. As someone who worked as an EMT and in public health for nine years before going to medical school…..I can say that I’ve met docs on both sides. Notably, the screening process for getting into medical school has changed. There are people who get in who have no scruples and care mostly about prestige or money….but many really want to help people achieve optimum health for the betterment of the community at large.

  • Richard

    Interesting article……EXCEPT it is a rosy picture painted by a doctor trying to “heal” the tarnished image his profession got. I worked for multiple years at a Medical School in Georgia, so I speak with some grains of truth. Yes, there are a few who went into the medical profession to indeed help their “fellow man/woman/person” and for those I salute and respect them highly. However…
    -Some went into medicine after quite frankly exhausting other possible majors ( Masters in Public Health, Vet School, research, one even MBA ) and for some reason…did not pursue their training…..in essence…professional students!
    -Some because of the “push” by family members who were doctors and thus wanted the “bloodline” to continue.
    -Some because of the misguided notion that they would be “drowning” in the amount of money they would see rolling in or the prestige they would be courted.
    – One because …and this is her quote I overheard talking to her friends….” It was either this or waitress til some rich dude with a wad could propose to me” Believe me, I burned her image and name into my mind and the moments she steps into ANY loved one’s room / office, I will physical throw her out! ( Note to others…be careful who you sit around or speak to in tutorial rooms….sometimes the mics are on for maintenance and you hear the most amazing things! )

    The arrogance and unprofessional talk/conduct by Faculty and Med Students shocked me beyond belief. From jokes about people with mental illnesses to snide comments about special needs children, sometimes I really had to stop and pray that these people would one day experience the same suffering or tragedy that they were laughing about.

    in the end, I have seen these “physicians” and have frankly lost TONS of respect and treat the newer ones with MUCH less honor and respect. I practice the art of “if you are out of residence less then 10 years”, I don’t want you period! As to the rest, rest assured if I am going under or sedated, I am wearing a “wire” and capturing every sarcastic and shitty comment for my attorney to listen and play for a court to hear!

    I am sure the anesthesiologist in question in the article was covered by the code of “silence and covering up anther’s mistakes” that other doctor’s silently subscribe to. In my opinion, she needs to loose her license and be banned from the practice of medicine. Guess she slept thru the “professionalism lectures” the med schools are now peddling to the students who treat these lectures as “free time” to text others or browse porn!