I don't think he should be fired by any stretch, but that would really depend on whether the VA as an institution takes heat as a result of his actions. If simply telling him about how his actions have potentially caused some VA patients to lose some alliance with the him or the VA as a care provider is successful in causing him to experience remorse, then to me this would be just punishment and sufficient for him to modify his behavior in the future because he has learned from an error. This is assuming that this is an isolated incident, and there have been no prior concerns about his patient care or as a representative of the VA.
@senseamp I'll add some clarity. I don't want to be mean. I found your speculation about me amusing because I am an academic physician (psychiatrist) employed as an assistant professor at a university of similar (though lower) caliber than Stanford and make less money than he does (and I'm assuming also significant difference in benefits, e.g. student loan assistance), although the cost of living in my area is definitely much lower. I don't work at the VA, but have as part of training, and my patients I'm guessing are >50% Medicaid and disability recipients. I could probably sign a contract elsewhere tomorrow that would double my salary if I so chose.
To clarify also, obviously I represent myself as a physician here, so of course I do not believe that doctors should abstain publicly politically. There is some anonymity, but even that isn't absolutely necessary. My posting here does pose an ethical conflict. I hope that I represent my profession in a way that helps others be more open to its potential benefit and gain better ability and insight to care for themselves. I realize that every opinion I express or choose not to could also accomplish the opposite, and I know I haven't always attended to this like I should. I try to make sure, in ways in which I bring up my training and profession, I do so because that knowledge or experience is relevant to the topic at hand. It's important to me to speculate about things and the operations of the mind in others but steer clear of any actual diagnostic or therapeutic activity that might represent psychiatric care. I should not have a relationship here with anyone with whom I have a treatment relationship outside of here. To be honest, I did not have the same ethical awareness when I started posting here, and looking back I'm not sure if I would make the same choice in disclosing my profession again.
My concern with the ethics of this physician's activity are minor, and were largely based on a misunderstanding (that's still not clear to me) thinking he had made this photoshop publicly available to patients. Obviously, it has happened now regardless. Still, his opinions and activities were enacted without anonymity and with representation of being a physician and employed at the VA. I don't seen how these activities relate to being a physician or his employment. Additionally, since they have been exposed to people who have treatment relationships with him and the VA, he has introduced something that does not relate to his treatment and carries potential for harm. This is why I find the action unethical. But I should also underscore that I find the action minor.
