Branding livers


An eminent surgeon made headline news a couple of weeks ago when he was found to have tattooed his initials on his patient’s liver.

This doctor has been working as a transplant surgeon for over a decade. One of his old transplant patients went for another operation, and when the new surgeon opened the patient up, he noticed the initials ‘SB’ carved into the liver. Reports state that this had been seared using argon gas.

Most of us recoiled in horror at hearing this story. One could assume that this is not the only patient that ‘SB’ has tattooed. It would be rather coincidental if the only patient he’d ever branded is the one who went for further surgery for his handiwork to be discovered.

There is no suggestion that this surgeon’s graffiti has led to harm of the patient, and no accusations of clinical incompetence or poor performance from the surgeon who, by all accounts, has an impressive record. But it still seems intrinsically wrong.

Consent is certainly an issue. It seems as though the patient had no idea that this had happened. Should the surgeon have asked the patient’s permission, ‘I like to sign my livers after they’re in, do you mind if I put my initials in your body?’. That would sound ridiculous, perhaps because it is.

But in actual fact, we don’t consent patients to every miniscule step of surgery – they aren’t informed about every staple, every suture and every tool used. They are usually provided with an overview of the planned surgery and the main risks to them. So if this ‘signing’ is part of the surgeon’s routine practice, then he could regard it as just another minor detail of the operation that does not require specific consent.

However, what it does represent is an underlying arrogance. The patient is regarded as his masterpiece; the liver owned by the surgeon; and his work so fabulous that his name should forever be preserved inside the patient.

And the fact that nobody else has mentioned this earlier further compounds the image of surgeons as pompous and overbearing. It is surely not possible that the surgeon signed his initials in secret. There must always have been other theatre staff there to see – scrub nurses, anaesthetists, junior doctors. Why did nobody speak up sooner?

When we talk about the changing nature of the doctor-patient relationship, this is exactly the kind of problem that we are all trying to move away from – where doctors see themselves above accountability and on a higher level of importance than the patient. Whilst the new generation of doctors are changing public perception, it is clear there are plenty of old school doctors who still cling on to the old white lab coats and cigars on the golf course.

What is wrong with this case is not that the patient was harmed (which they were not). It’s that the surgeon used the patient for his own gratification.

For this surgeon, it wasn’t about how the patient would feel, or whether the patient would consent. It was about arrogance and self-importance.

Patients don’t like that. It erodes trust and breaks down the relationships we’ve been working so hard to rebuild.

(image via

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Tessa Davis is a paediatric emergency registrar from Glasgow and Sydney, but currently living in London. Tessa tries to spend time with her 3 kids in between shifts. @tessardavis | + Tessa Davis | Tessa's DFTB posts