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Wednesday, January 12. 2011
Unlike all of the amateurs with their pet theories about why somebody would kill strangers, I offer no opinion. I don't know the guy. I would rather post about something else.
This post was prompted by this case in the UK: Fattest man in the world suing NHS for "letting me grow."
If a patient of mine got fat, or killed people, can I be called liable? I have been twice named in medical malpractice lawsuits. It is an appalling, demoralizing, painful, and time-consuming experience. It makes you want to quit medicine.
The first case was a teenaged gal who got herself knocked up. The claim by the teen and her anti-abortion parents was that, since she was an impulsive kid, it was my medical duty to make sure she used birth control. I had mentioned it to her, but I had not written that down in my deliberately-sketchy notes.
My second was a guy who cut his wrists in a suicide attempt (or gesture?). He and his wife and lawyer decided that they could make a case that I had prescribed an inadequate amount of antidepressants to prevent him from doing this. Even though the guy's main problem was a personality disorder, they found a psychopharmacologist to testify that the fellow's mood swings and tantrums represented Bipolar Disorder. He was wrong, but that didn't matter.
Both cases sued me to triple the max of my insurance. The first case was a charity treatment case, in a clinic to which I donate one day per week. I suspect they figured out on Google that my husband is a banker. Both plaintiffs lost in trial, but both experiences left me feeling dragged through a sewer, slimed. A trial lawyer can always find somebody to pay to say you did something wrong. In my field of work, everything is a judgement call, and there is rarely or never a right and wrong.
I had felt, with both patients, that I had had a good, constructive, and friendly relationship, and that I had helped them quite a bit. Interestingly, both sued me for their behavior and their behavioral choices, as if I were responsible for those - as if I were God.
Like most docs I know, I try to do the best that I can to help the people I see, but my powers are limited. Still, lawsuits are always in the back of every doctor's mind in the US. My guess is that about half of medical tests are done with lawsuits in mind (eg $700 CT scans for tension headaches). Lots of hungry, parasitical trial lawyers out there, and plenty of people who are willing to toss away a relationship with a doctor if they think they can hit the jackpot by doing so. They can always find another doctor (although few doctors are willing to see litigious patients. I will refuse to treat anyone who has sued a physician. In other ways too, I select the people that I am willing to help. It's my prerogative.).
The lesson: Evil lurks in human hearts. No doubt about it.
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Thanks for trying to move discussion, Doc.
Yall's first case reminds me of a young girl in the hood who came up pregnant.
When I remarked on it she unabashedly said it was her Doctor's fault.
Then she said, "It is most certainly his fault because he told me I couldn't get pregnant."
People wouldn't sue others on the theory that others are responsible for their own behavior if juries routinely threw such cases out. Unfortunately, juries increasingly share this attitude, as a natural consequence of having been taught all their lives that people are just pushed around by their circumstances and aren't responsible for anything they do, let alone anything that happens to them.
I hate reading that you were put through these travesties. It's just wrong. My automatic response to a lot of stories like this is, "Boy, they wouldn't want me on that jury." It's up to all of us to be the jurors they wouldn't want.
Re: "My guess is that about half of medical tests are done with lawsuits in mind"
And how many doctors leave their practices before they otherwise would? My guess is it is not an insignificant number. It's a tough time to be successful and a tough time to try to help people. It's even tougher to do both. Good luck, Dr. Bliss
Oddly, I remember, from about 45 years ago, a circus fatman suing a hospital for putting him on a diet following a heart attack. The weight he lost while in the hospital "endangered his livelihood", according to his lawyer. The newspaper of the day documented his former daily food consumption, which would have fed a family of ten. The hospital had to strap two reinforced beds together to hold him. I recall thinking what a nasty back-breaking job the nurse's aids had giving this lump a bed-bath and clean sheets, much less getting a blood pressure cuff on him, or drawing blood.
Remember, doc, Gomers can always hurt you more.
Perhaps the biggest turnoff for me about ∅bamacare was that there was no tort reform, just an intent to study the issue.
These malpractice stories have not changed my mind. Those who assume that the physician is responsible for a patient's poor choices should not be indulged with the ability to wage malpractice suits, but scorned.
While many malpractice lawsuits view Physicians as either Gods or lottery tickets - or both- physicians are neither.
"The lesson: Evil lurks in human hearts. No doubt about it."
Ha. There's the fallacy. You're assuming lawyers are human.
This case is a bit different. The man went to his doctors with requests to assist him in loosing weight, his doctors (on orders from the NHS) refused to provide treatment even after agreeing there was medical indication treatment was needed.
That's gross and deliberate negligence, and needs to be dealt with accordingly.
It's little different than when you go to a doctor, he diagnoses cancer, than tells you you won't be treated because he's too busy planning his next golf trip to Hawaii.
I haven't read the particulars of that case, but I have seen the NHS up close (my family & I spent 8 yrs in Britian). When the "NHS Authority" decides that it would reduce costs NOT to provide certain treatment, this case is the result.
And we are on our way to just such a system with the provisions mandated by Obamacare. I think it's especially indicative of the philosophy behind Obamacare that the lawyers in Congress refused to deal with medical tort reform at all
My first malpractice suit was for botching a procedure [ I hadn't even done], but it still cost me time, money, and anxiety. I've only had one other, in which the patient [refused to see me.] Yet I'm somehow responsible for the outcome. A pox on trial lawyers.
One alternative to the current medical malpractice system we have is to implement a system like Workers’ Compensation. Eliminate the need to prove fault and only require a proof of causation and then limit recoveries to reasonable compensation for things like lost work time, temporary disability, and permanent disability.
The physicians would need to have the procedure thoroughly evaluated as to appropriateness and standard of care by the appropriate medical examiners board(s).
The current system would only apply in the event of intentional injuries.
The result would be quick medical care, time loss, temp and permanent disability payments and complete elimination of the huge awards we see today. Problem physicians would be more noticeable because they would be evaluated more commonly by the licensing board and the board would be able to evaluate the problem and provide corrective discipline.
Attorneys would be left in the cold since the attorney fee agreements in these cases are not based on a percentage of award but are set by the court and are a tiny fraction of the awards we see in the large contingency fee cases.
If employers and employees could reach these arrangement decades ago we should be able to reach it today in the physician patient arena.
I love the idea but it won't fly for two reasons:
1. It makes far too much sense.
2. Trial lawyers lobby.
Then you can imagine what it's like for doctors at state hospitals with industrial-strength borderlines. The added tragic irony is that they end up getting treatment that isn't best for them, because what they need involves too much exposure to liability.
For those interested, New Zealand operates an "Accident Compensation Corporation" (ACC) scheme. This almost completely ensures a "no-fault" compensation system for patients who befall accidental injury, medical malpractice or negligence. Although bumper payouts (AKA jackpots) are incredibly rare, the general payments are made to ensure all ongoing medical care is paid for as well as compensation for lost earnings (at around 80% of pre existing earnings). The system should prevent the dangers of defensive medicine - but interestingly fails to do so. As a radiologist I encounter countless cases of pointless imaging daily. Whether this is the influence of the US "system" (AKA chaos) we see on TV I don't know but sometimes it beggars belief. The NZ system is better than the US madness IMO.