I came across this case from JAMA in January, 2004. Here are the basics:
1) A third-year resident, Dr. Merenstein, saw an educated 53-yo man for the first time at his resident clinic. A PSA level had never been done before.
2) A documented discussion about the risks and benefits of screening was done, and the patient was enouraged to consider the information. He was never seen by Dr. Merenstein again.
3) The patient was later seen by an older doctor who, disregarding current clinical guidelines, ordered a PSA without discussing the risks and benefits.
4) The PSA came back high and the patient was diagnosed with incurable advanced prostate cancer.
5) Dr. Merenstein and the residency program were later sued, with Dr. Merenstein being “exonerated” and the residency found liable for $1 million.
The physician’s actions are supported by the USPSTF and the ACP’s guidelines for prostate cancer screening.
Unfortunately, the concept of evidence-based guidelines did not stand up well in court:
. . . A major part of the plaintiff’s case was that I did not practice the standard of care in the Commonwealth of Virginia. Four physicians testified that when they see male patients older than 50 years, they have no discussion with the patient about prostate cancer screening: they simply do the test . . .
. . . It is often claimed that malpractice is a mechanism for holding physicians accountable and improving the quality of care. This case illustrates quite the opposite: punishing the translation of evidence into practice, impeding improvements to care, and ensconcing practices that hurt patients. In our legal system, the physicians who are slow to change are the winners . . .
. . . During closing arguments the plaintiff’s lawyer put evidence-based medicine on trial. He threw EBM around like a dirty word and named the residency and me as believers in EBM, and our experts as the founders of EBM. He defined EBM as a cost-saving method and stated his belief that the few lives saved were not worth the money. He urged the jury to return a verdict to teach residencies not to send any more residents on the street believing in EBM . . .
Think about that last statement for a moment. Do physicians tell lawyers how they should be trained? I find it disturbing that lawyers feel they are entitled to dictate how physicians are trained.
Dr. Merenstein sums up the moral of the story perfectly:
During that year before the trial, my patients became possible plaintiffs to me and I no longer discussed the risks and benefits of prostate cancer screening. I ordered more laboratory and radiological tests and simply referred more. My patients and I were the losers.
Related posts:
- Prostate cancer screening in men over 75
- Should I get a PSA test for prostate cancer? A new study shows that screening for prostate cancer doesn’t necessarily save lives
- Prostate cancer screening in blacks, and the lack of balanced information
- Should prostate cancer screening stop after the age of 75?
- Will patients accept the limitations of prostate cancer screening?
- Confusion surrounding prostate cancer screening
- Who’s not happy with the new prostate cancer screening recommendations?
{ 9 comments }
I got pretty worked up about this as well. Here is what a local medical malpractice attorney told me after I sent him the article: “I also read the articles you attached. Both highy interesting. I can understand the disappointment shared by the EBM community. One bad result is no more than one bad result. I am curious as to how the physician could have been exonerated but the institution for whom he worked not. Maybe the thought was that he did what he was taught and believed but the EMB concept taught by the institution was flawed? Most unusual verdict.”
individual resident md’s are typically dropped from the suit (no savings) when they go for the deep pockets (residency & hospital). At least that’s how they do it here in the UC system. (univ of california)
Kevin, I’m not sure you’ll read this, but if you do: I’m having trouble opening the JAMA article you cited (I think it’s my computer, not your site), so I was wondering if you could tell me what article’s title was, or which issue so I could dig it up mysef. Thanks!
You need Adobe Acrobat to read it since it’s a .pdf file. The article is entitled “Winners and losers” from the January 7th, 2004 issue of JAMA.
Was the plaintiff attorney’s name John Edwards?
This is far worse than just lawyers feeling they are entitled to dictate how doctors are trained. This is legal extortion. Other lawyers can blow it off as just a bad result but it’s endemic and getting worse all the time. I have a case here where a general surgeon and oncologist were successfully sued for causing a young woman to die of breast cancer when in fact they did everything right, the patient herself would have never sued them, and the primary care doc who might have actually had some responsibility for delaying the diagnosis wasn’t sued because he had no money.
We will indeed pay for this insanity. The residency programs are folding here and we will are losing the battle with both older docs like this one as well as with the new ones. Our best and brightest don’t go to medical school these days. The science is too hard and besides they can make millions while saving society by going to law school.
Oh, and tell the plaintiff attorney, next time he’s really sick, go to a naturopath or a lawyer for treatment.
No, really, don’t treat trial lawyers!
See this:
http://seattletimes.nwsource.com/html/localnews/2001955494_ama14m.html
I don’t treat trial lawyers specializing in medical malpractice. Natural selection will do the rest.
C’mon. That’s just silly. Not treat trial lawyers- Natural selection is an interesting analogy. Who’s to say that the environment in which we practice is not naturally supposed to have patients that don’t like us or are even preditory to us. I think it’s naive to get into this buisness and say that no one ever told you its going to be hard. When I teach, I tell students that part of the dignity and respect that we have in this profession is to rise above the pettiness and judgements that others can easily afford. You treat what you get.
Oh, by all means, treat the bastards. And just to make sure they get ALL the tests (just to be sure), they’ll need an LP, and a colonoscpy, and an Upper/Lower GI series, and an IVP, and a DRE, and every other unpleasant procedure in the book, every time.
After all, thats what they want, right?
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