THE DIAGNOSIS DILEMMA

T homas is a genome scientist and geneticist at a leading pharmaceutical company. He works on identifying gene targets for drug development. He started his career in academia, but has since transitioned to working in the pharmaceutical industry in large part because he wanted to be involved in drug development and not just in gene research. He loves his job, and loves having the chance to see a project from the research phase through to the development phase: "I love discovery. I love creating and making the primary contribution that I know will break the problem and I enjoy following the process through."

Thomas says he does not really have a core set of beliefs or values that guide his work:

I am just so excited about discovery. If I had made a discovery or made a new breakthrough in the scientific challenge that we are working on, I just get elated. So I'm just excited about that. So you say, 'Gee, do you have some sort of feeling about God or mankind or things like that?' and I say, 'No, I'm just afraid I'm selfish.' I just get a big kick out of it when it happens.

However, there have been times in his life when he has been called on to consider his values and beliefs more closely, when he has been faced with situations that conflicted with his sense of right and wrong. Onesituation in particular stands out in his memory, and he says he will always worry about it. The incident occurred when Thomas was in medical school, during the last couple of months of his residency. He says he was "primed for anything" and that he "thought [he] knew it all." A doctor, someone that Thomas viewed as a mentor, informed him that he would be helping with his private patients beginning the very next day. Almost immediately, Thomas was challenged:

On about the third night, in came one of my professors comatose. It was an attempted suicide and we made the accurate toxics diagnosis. He was in a deep coma and in very bad shape. We worked through the night to save him.

Thomas and his mentor succeeded in saving the professor's life, and Thomas was very much relieved. However, the mentor looked over Thomas's notes on the patient the next morning, and told Thomas that he had "missed the diagnosis."

At first, Thomas was confused. They had both worked throughout the night to correct the toxicity in the patient's system, and they both knew the details of the chemistry data that they had gathered as they worked. It was quite clear that it had been an attempted suicide. Thomas's mentor continued: "this was an acute asthmatic attack; please write it up as such." Thomas quickly saw that he was being asked to help cover up the fact that it had been a suicide attempt.

Thomas did as he was told: he changed the diagnosis in the file, and then he and his mentor ran the patient "through the biggest blast-of-nonsense pulmonary tests you have ever seen in your life. He didn't have asthma or anything else but a suicide attempt."

Although Thomas had followed his mentor's directions, he did not feel comfortable about what had happened. He wasn't at all sure that they had done the right thing.

Clearly, he had depression. We just kind of got him through the embarrassment of having attempted to take his life and failed, but I really honestly don't know whether we really did the right thing for him. Maybe it would have been better to say, 'You almost took your life; you are going to a psychiatric ward [to get] psychiatrists that are going to work with you.'

A year later, as Thomas was leaving school to begin his career, he learned that the professor they had treated that night had again attempted to take his own life. Sadly, this second time, he succeeded.

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