Abstract

Last fall, I spent a month working in Indonesia under the auspices of a philanthropic organization that oversees volunteers to visit developing world locations in need of neurosurgical help. I was both operating and teaching the local neurosurgeons and their residents. It was very beneficial for my new Indonesian friends, but I'm sure I got even more than I gave. It was a truly wonderful experience for me, and I will be returning this coming fall. Despite the fabulous month I enjoyed, one rather unsettling event transpired in which I was invited to visit a country home by one of the neurosurgery residents and we inadvertently and completely by accident ended up in the company of two prostitutes on the way. I won't bore you with the details, but I will make it perfectly clear that no inappropriate contact took place and nothing untoward happened to me or anyone else. Neither being disloyal to my wife nor putting myself and my loved ones at physical or psychological risk have ever been options for me.

When I returned to Canada, I wished to publish various chunks of a long narrative I wrote about my experience. Biomedical journals, medical magazines and other publications were all to be the targets of different aspects of the story. Four thousand words of the piece and numerous photos were published in a doctors' travel magazine. Another piece reflecting on the ethical dilemmas encountered by a surgeon working in a philanthropic role in the developing world made it into a peer-reviewed surgical journal. For the tale about my near-miss with a prostitute, which I felt had a number of useful lessons and observations, I thought a "men's magazine" might be an appropriate venue, mainly to reach a large audience - the most likely one to benefit from such a piece. So I tried to look up the submission instructions for Penthouse magazine by using a routine search engine on my computer at work early one morning, but found that access had been blocked. I tried a few other similar websites and discovered the same thing. Perhaps I had been naive, but I was honestly surprised. It certainly made me question whether it is appropriate for my hospital to encroach on the autonomy of its staff by blocking access to certain Internet sites.

Clearly, strong paternalism toward healthcare workers is alive and well in the hospital, but is it justified? I assume that the administration's rationale behind this initiative is that they feel there may be decreased productivity by employees if they have the opportunity to engage in cyber-distractions while on the job. This is essentially what I was told when I made inquiries to our Information Technology Department, and they volunteered that the level of Internet blocking at our hospital was "moderate" compared to some organizations. In all fairness to my hospital, I suspect that versions of the same policy obtain at most hospitals in North America.

But if the administration is worried about hospital employees spending time on unwholesome and diversionary activities, how do they know I don't keep a stack of Playboy magazines in my office? If they monitor and block Internet access, will they soon be checking my briefcase in the early morning hours as I drag myself into the hospital at 5 a.m. for another 14-hour day?

In the last few years, I have been interested in organizational ethics and have published a few articles about disrespectful behaviour in hospitals, including one in Hospital Quarterly. To me, this is a pretty fundamental example of disrespectful treatment of employees by those in positions of control and power. For hospital administrations to have insufficient trust in people who take on the responsibility of protecting human lives every day presents a set of contradictions to say the least. We are apparently responsible enough to take the care of human lives in our sphere of responsibility, but too irresponsible to control our urges to engage in activities which might waste time and/or might appear unseemly for healthcare providers to be engaged in. The irony appears overwhelming, doesn't it? It reminds me a bit of the quite ridiculous situation in some American states and all but three Canadian provinces and territories, where the legal drinking age is 19, but the age for military service (either voluntary or by conscription) is 18, so a young man or woman can be old enough to fight and die for his/her country but not old enough to legally have a beer.

I am truly disappointed by what I consider a demeaning form of censorship by hospital administrations. While there is always some validity to every argument and decision made, especially by those who perceive a high level of responsibility and accountability for the behaviour of a large group of people, there are unacceptable downsides. The use of power to block Internet access in hospitals results in a clear expression of disrespect toward dedicated healthcare workers, who are more than ever feeling undervalued. Furthermore, I strongly doubt it serves its intended purpose. If employees wish to waste time, they will surely find a way to do so.

I believe a strong ethical argument can be made against hospital administrations blocking Internet sites from nurses, doctors and other healthcare workers. A prohibition on Internet censorship just seems like the right thing to do.

About the Author

Mark Bernstein, Toronto Western Site,
University Health Network.