I just completed another shift in the emergency room (which I do about once per month), and it continually amazes me the amount of non-emergent cases that comes through – but that’s for another rant.
So I’m reading that the family of John Ritter is suing the hospital for misdiagnosing his ascending aortic aneurysm. Galen certainly has some tough words for this. I’ll reserve opinion since I’m not familiar with the case.
We’re taught there are generally four causes of chest pain that can result in sudden death. They are myocardial infarction, pulmonary embolus, aortic dissection, or tension pneumothorax. According to the story:
He was initially misdiagnosed with an acute myocardial infarction, then with pericardial tamponade, the suit states.
Generally, an aortic dissection needs to be suspected in order to be diagnosed – Medpundit has written about this today. 96 percent of dissections can be identified based on some combination of these symptoms:
1) Immediate onset of aortic pain with a tearing and/or ripping character,
2) Mediastinal and/or aortic widening on chest radiograph,
3) A variation in pulse (absence of a proximal extremity or carotid pulse) and/or blood pressure (>20 mmHg difference between the right and left arm).
Working in the ER, the first priority would be to ensure the cause is not one of the four “sudden death” causes. If the pattern didn’t fit an MI, a chest X-ray (routinely performed) would rule out a pneumothorax. That leaves dissection and pulmonary embolism as causes next to rule out. Chest CT would be the key test that would have caught the dissection (98 percent sensitivity). If PE was suspected, a CT angiogram would have been ordered.
Since the hospital’s working diagnosis was acute MI, and then pericardial tamponade (likely diagnosed via echocardiogram), I suspect that the chest CT wasn’t performed quickly enough, since dissection wasn’t high enough on their differential diagnosis (again, I’m just speculating).
I can only sympathize with the emergency room that night. With an acute aortic dissection, seconds count, and it was an unfortunate event for all concerned. Was it malpractice? Tough to say. The question I’d be interested in would be how long it took for the ER to order that chest CT scan.
Similar Posts:
- Radiation exposure from excessive imaging tests after a heart attack
- Using CT scans to diagnose chest pain in the ER
- New troponin tests to better diagnose a heart attack
{ 43 comments }
What amazes me is the fact that we as emergency physicians get sued for missing disease entities that simply cannot be made at initial presentation. Acute aortic dissection can be extremely difficult to detect, and guess what, it is lethal-sometimes no matter what we do. But, with the lotto mentality of the US, it really doesn’t matter what we miss-if there is a bad outcome it will result in a suit. Could John Ritter’s case of dissection have been picked up earlier? It is possible. Would it have made a diference? Unknown. It is a good reminder, however, to avoid tunnel-vision in our workup of chest pain patients and to consider ALL deadly diseases and rule them out appropriately. As I teach our emergency medicine residents, picking up the diagnosis of acute aortic dissection may very well rely on how frequently you consider the diagnosis.
Rob Rogers, M.D.
Assistant Professor
Emergency Medicine & Internal Medicine
The University of Maryland School of Medicine
Re: aortic dissectiion
While I understand the difficulty with such a diagnosis as aortic dissection, would not factors such as the patient is carrying a card informing the ER that she has a dilated aorta and aortic insufficiency, as well as a mother who died of an aoritc rupture, be significant?
My sister died of aortic dissection 12 hours after arriving at the ER with severe abdominal pain, back pain radiating into the legs, vomiting and nausea. The ER never ordered a CT scan. They did an EKG, gave her an enema. Her pain subsided, then increased again. She arrived at the ER 6:30 in the morning, died at 6:30 PM never having had a chest x-ray, or a scan or seeing a cardiologist. I don’t understand this.
I understand that there is no guarantee that my sister would have survived surgery but had she been scanned early, I believe she did have a decent chance at survival. We have been told by some attorneys that the “standard of practice” has been followed As a person who also has a dilated aorta, who now has a history of mother and sister dying from aortic dissection/rupture, what chance do I have if that was the standard of care?
On Decembwer 21, 2004, my brother entered the ED at 10:30am. He had sudden onset on severe chest pain.
The EKG was normal as was the chest Xray, (not yet
read by radiology, so we don’t really no what it showed.
He continued to complain of chest pain and despite a
normal ekg they started a nitro drip and morphine. Neither worked for the pain and it kept getting worse.
My brother arrested at 12:32pm, 2 hours after entering the ER. The Post showed ruptured aortic dissection and
cardiac tamponade. None of these was suspected. In fact
the ED doc told me my brother had some seizure activity?
Seizure activity I asked. He said yes his eyes rolled back in his head and he fell backwards. That’s not
seizure activity. Thats a cardiac arrest. That is when
my brother arrested. The monitor still showed a rythm
but no pulse. They worked on him for 20 minutes then called the code. They never suspected dissection and
they should have. It may have saved my brother. He was
only 49 years old, in execellent health, never smoked,
never drank alcohol, exercised and ate right. He was even a former Mr. Michigan in body in the 1980’s.
Something has got to be done to educate these ED docs.
Maybe add it in the algorythms of ACLS. Maybe then it
will stick in there heads.
On Decembwer 21, 2004, my brother entered the ED at 10:30am. He had sudden onset on severe chest pain.
The EKG was normal as was the chest Xray, (not yet
read by radiology, so we don’t really no what it showed.
He continued to complain of chest pain and despite a
normal ekg they started a nitro drip and morphine. Neither worked for the pain and it kept getting worse.
My brother arrested at 12:32pm, 2 hours after entering the ER. The Post showed ruptured aortic dissection and
cardiac tamponade. None of these was suspected. In fact
the ED doc told me my brother had some seizure activity?
Seizure activity I asked. He said yes his eyes rolled back in his head and he fell backwards. That’s not
seizure activity. Thats a cardiac arrest. That is when
my brother arrested. The monitor still showed a rythm
but no pulse. They worked on him for 20 minutes then called the code. They never suspected dissection and
they should have. It may have saved my brother. He was
only 49 years old, in execellent health, never smoked,
never drank alcohol, exercised and ate right. He was even a former Mr. Michigan in body in the 1980’s.
Something has got to be done to educate these ED docs.
Maybe add it in the algorythms of ACLS. Maybe then it
will stick in there heads.
12 hours…try a week. My grandfather had his tearing…he had FULL cardiac arrest in a church during a Priest Anniv. ceremony! Tons of Doctors in there as you would expect. They actually revived him prior to the ambulance arriving & told the ambulance people it was Full arrest. The ER doc. did not believe it! They came in & brought letters signed it was full! They had him laying in Intensive Care for a week, ordering tests & then canceling them. He was filling up with fluid, looking grey & they said it was just because he was laying around…RIGHT! I always do when I get the flu or a cold! They release him FROM intensive care! My mom says, Hell NO , & takes him by ambulance to his regular hospital/doctor. One test & they find out what was wrong. He made the surgery, they actually repaired it but they had to scrap off tons of blood clots off the outside of his heart from it leaking for a week. His heart could not take that! It is just ridiculous! My parents should have sued & if it was me I would have! They were just grieving too much to do so! It would not have brought him back I know but we all know that money is really what talks & when you have a week & you cancel tests that is just crazy!
I have an abdominal aortic aneurism, 7cms. Today is Tueasday, and I am going into surgery on Monday. The surgery is being done at Columbia Presb. in NY. I am walking around very scared, sought of like a ticking time bomb. Whenever I get a painm in my chest, I get scared and say this is it. Just wanted to share this with you.
Ron
ronran@optonline.net
Reagrding the Ritter family lawsuit, I can say that I too survived an initial misdiagnosis of a dissected ascending aortic anerysm. The ER doc (who ironically is now my primary cardiologist) decided that I had acid reflux. Thankfully a second ER physician remembered John Ritter’s case and requested a CT scan. Instantly it was apparent what was wrong, but I spent four hours in ER and was dressing to go home when they changed their minds. I would have gone home and died in front of my wife and five year old son. I didn’t consider suing, nor do I think that our society is correct in suing at the drop of a hat, but in John Ritter’s case, the symptoms should have been self evident in my opinion. Why after all these months of hearing similar horror stories do ER docs ignore the big warning signs? Ripping chest pain, dizziness, acute abdominal pain that presents into the back as well? A CT scan, while expensive, is a no-brainer that would allow instant diagnosis. Early diagnosis admittedly will not save every life, but how many thousands die each year that could still be around to raise families, enjoy life and educate others? Those are my joys right now, and I nearly lost them due to, likely, an overworked ER doc who saw what he expected to see.
I understand griel and anger.
But I disagree that “all ER docs are this or that and you have to stick that in their heads”.
Diagnoses are always cristal clear … AFTER. What is overlooked is that you cannot and must not do a CAT scan for every patient with chest pain in the ED.
Docs will make mistakes , some humans working as doxtors may be sloppy. This is not the generalcase. making those diagnoses is really notr as easy as is written here, often the full blown clinical picture is not present at presentation.
Now I’m not saying all docs are pefect.
On 12-04-04 I was admitted to the ER for severe chest pain. No classic symtoms of a heart attack. TWO hours later after my wife (PA-C) mentioned to the ER doc that my father had a Type A dissection, they did a CT and found my dissection (Type B Class III) I hope I never experience such a medical nightmare from hospital staff ever again! They probably could’nt find their ass using both hands!!! I pray the Ritter family WINS their suit!!!!!!!!!!!!
All I am hearing are very sad and bitter people. The expectation in this country is rediculous. Doctors aren’t supermen and people who don’t actually work in a emergency don’t actually know what’s going on. There are many things to consider when deciding who gets a CAT scan and who doesn’t. In my ER about 20-30% of the patients complain of chest pain. That’s about $100,000 for 30 CAT scans not to mention the risk of dye allergy and kidney damage. About 50% of the patients are uninsured so thats a $5000.00 ER bill the patient will have to pay or get there credit ruined. If your grandfather went into cardiac arrest because of an aortic dissection well then it was his time. Cariac arrest patients never walk out of the hospital. You don’t CAT scan dead people. Sorry, you don’t live forever! There is so much medical waste the last few months of peoples lives it’s absurd. (A different topic)
If your brother was young, healthy, didnt’have any medical problems didn’t smoke and had a dissection well he must have bad luck. He doesn’t have any risk factors for aortic dissections. Did the doctor consider it? I don’t know. Do I consider it? On every patient, but I also consider the type of presentation, risk factors, etc. It’s not supposed to be that common, but in our ever expanding overweight out of shape society maybe young healthy and no risk factors should be risk factor. Since I finished ER training 7 years ago the amount of crap that has clouded working in the emergency room has just continued to grow. You have patients who don’t respect you and are willing to sue for anything regardless of whether anything was done wrong, hospital administration that want you to transer or dischage (even if sick) every uninsured patient, ER administration that keeps track of how many patients you see, how much you bill, how nice you are etc. ER doctors are like everyone else just trying to do the best job they can with about 100 times the pressure.
LA ER DOC
I am an ER doctor and I am horriefied by you fucks who think it is “self evident” or “obvious”. You don’t tknow what the fuck you are talking about. I happened to catch rwo in one night and I can tell you it is fucking hard to diagnose one every four years OK. Sometimes EVERYTHING can be normal and you will only catch it if you order a CT scan. Sometimes ordering a CT scan is contraindicatied because of allergies or renal failure. But “educating” ER doctors is not going to solve the problem. That really pisses me off. First of all – Mr. Ritter presented with an ST elevation MI and a normal CXR. IF you don’t tknow what the fuck that is shut up. He got thrombolytics and decompensated and thats why it got diagnosed. So it is VERY hard to catch this disease. There is no cookbook “1-2-3″ in medicine. So I am sorry this bad disease happened – but the survival rate is dismal and the ER doctor did not GIVE them the disease OK. Bad things and tragedies happen to all of us so blame GOD or whoever you think gave you the bad genetics. But to think magically you would walk out and healthy and rescuing kittens and feeding the homeless – fuck off. I feel bad when things get missed but literally it is a disease that is a needle in a haystack with the hay screaming “me first” yadda yadda yadda – “I want to go home”…”when are my tests results back”…”why are things taking so long”…
You are fucking lucky you live in America where almost every ED has a Helical CT. You know what happens in EVERY other country – especialy with socialised medicine like CANADA (witch has better outcomes than the USA across the board)…people just keel over and die. You assholes who watch too mutch TV and think that just because you walk into an ER means you are going to walk out healthy, youthful, and playful – you are living in an illusion. There is a miss rate for everything! Blame the docs…give me a break!!!!
LA ER DOC – 2.
My mom went to the ER with chest pain, dizziness, and extremely low blood pressure on November 6, 2005. A CT scan was performed and analyzed and she was admitted into the hospital in the cardiac ward. She was sent home 3 days later with diagnosis of pneumonia. She had a follow up EKG done on November 17 but had no recollection of it the following day. She was taken back to the ER on November 18 and passed away on November 20. We ordered an autopsy and the result was that she died from an aortic dissection. In our meeting with 2 cardiologists and her primarty care physicians that were in her care for these 2 weeks they expained the autopsy and explained what an aortic dissection is. They also apologized that the cardiologist and radiologist had overlooked the CT scan and that it did show the tear in her aorta which was the cause of her being brought to the ER in the 1st place. How am I supposed to feel when doctors can’t even read the fucking scan that could have saved her life!!!
Please don’t try to generalize all doctors together. What do you do for a living? Do lives hang in the balance? Maybe all docs should go on strike due to all the lawsuits and then we’d see what you screwballs have to say. Sure there is malpractice that happens, but every single situation is unique, and as stated above, there is NO COOKBOOK for medicine. For those who have lost family members, I am truly sorry, but you still don’t have the right to lump all docs into one pile.
LA DOC-2
Love your work- could not have said it better myself!!
Australian GP
Wow, I wonder if it is any coincidence that the more profane and self-righteous posts are all from “doctors” in LA. Nice language “doctor”. I agree that everyone dies sometime, and no doctor or hospital can find or cure everything. But those of you who only see the dollar signs are a symptom of an over worked system that produces jaded assholes like yourselves. I am thankful I had the good fortune to live not just in the Midwest, but as far from the land of Plastic People and Plastic Surgery as I do. I don’t delude myself into thinking that every test should be run on every patient that comes in with a stomach virus, but not even taking the symptoms into account and telling someone they have acid reflux and telling them they can leave is a nuisance until it happens to you, then it is more than just a pain in the ass, it is your life. And you are correct, a lot of us do not understand your medical jargon, but evidently, neither do a lot of you Doctors.
I am an ER doc in the Midwest. It’s hard to pass judgement on cases without all the data. Aortic dissections are rare and often don’t present like the textbooks say they should. I’ve seen a total of 3 — one of which I missed. This one presented with vague abdominal pain and a normal chest xray (abdominal series). I don’t think the lay public understands the pressure ED docs are under every hour they work and how little “thinking” time we have to devote to each patient. We see a ton of chest pain and are actually very well educated on life threatening causes of chest pain (including dissection). The fact that we miss dissections is related to the rarity of this disease, the number of atypical presentations and the fact that we are human. It’s easy to look back at a case and say “well obviously this is a dissection”. It’s not so easy when you’re seeing 12 patients at a time and run into a poor historian who has an atypical presentation. Problem is, Americans don’t accept that bad outcomes occur — and if an ER doc makes a mistake we assume that he has committed malpractice and should pay. We like to blame when bad things happen. Our culture doesn’t accept death. But ER docs, no matter how smart or educated are going to make mistakes because they are human, they are under a great deal of stress, the are under severe time constraints and medicine is not nearly as easy as some people think.
Dr. Rogers, Can you imagine being sent from one hospital to another hospital with paper work in hand informing the second hospital, but not the patient or their love one, that an aortic dissection condition had been confirmed. Upon arrival at the hospital the patient is escorted to a room with no doctor or nurses in sight and just told to wait until teams of doctors arrive to perform some kind of surgery. Unfortunately these teams never arrive and the patient who thinks everything is just fine dies a few hours after he arrives. So I ask you what good does it really do if we are fortunate to find an expert in his field capable of avoiding tunnel-vision and appropriately diagnosing this disease if our hospitals are not staffed properly to handle the emergency when it accrues?
On 2-11-01 I had an etremely complex aortic dissection. It took in excess of 48 hours to diagnose it and surgical repair could not be done for 12 additional hours. Yet here I stand. Medical malpractise and incompetency are very serious aqusations.
In my case I went to my local regional medical center that does not have an ope heart program and isn’t even close to having a trauma center approach. I went there because I knew that something deathly was wrong and that they could keep me alive and get me to the place or person that could save my life. The way I felt that night I would have gladly gone to a vetenarian if that was all that was available!
Seriously, in my case the ER physician was the only MD in the hospita at that time of night and his help was one 1st year med student learning to take HnP’s and a first year resident. My case was being approached as an epigastrict tear due to the pain description, the ipslateral BP’s and High BP was accepted as an adjunt to other morhology. CT scan/Barium swallow was done within a few hours of admit and ruled out an E-G tear, however…this was a wet read by the ER MD and his students because no radiology MD’s on duty for the overnight. Next day now new admitting doc wants his own CT scan, and hasn’t bothered to read the Rad report or maybe it hasn’t reached the chart yet. Luckily the CHief of radiology was there when they wheeled me in for second CT scan, and he stopped this parade and demanden that I be transfered out for emergency surgey.
5surgical centers turned down the case. The surgeon that accepted the case neede 12 hours before he could do my repair due to his performing a AAA at the time of this hospitals call.
Well I was heavily sedated, and BP lowered to almost nothing for twleve hours and then packed up and sent to this other Heart Transplant Center where a successful ascending graph and A-valve repair was done.
My feelings…This disease as much as we want it to be a no brainer to diagnose, is not. It is now being diagnosed more often and the appearence in the general population is increasing. This is only due to advances in imaging technology. Succesfulr repair statistics have not changed much in 5 years its still has a morbidity of 2% per hour will die from onset no matter what is or is not done. Surival from leaving the OR is not much better. Less than 10% survive the surgery better than a parapalegic or brain dead. So unfortunatel for the Ritter family, His chances of survivng even if every thing went in his favor are slim to none. Finally you must also examine the patients that have been fortunate to survive a dissection repair, most are under 6 feet tall younger than 45 and none are overweight ( greater than 180-190 lbs.) Per the above Ritter unfortunately was not going to survive an emergent surgical repair for an A-dissection.
The question of the doctors being incompetent and there being malpractise. Probably not.
In my case was there malpractise maybe/maybe not the key question for a jury would have been beyond a reasonable doubt had he been harmed or damaged by anything the doctor did or did not do, no, because I’m Still alive! case closed.
For the Ritter family ask the same question, and his outcomre no matter what was sure death.
Obviously, there are two sides to every story — but I am outraged and offended by the LA doctor who finds it necessary to curse out all of us who have lost people due to ER misdiagnoses regarding aneurysms — and YES, that’s what they are –misdiagnoses. My healthy, 64 year old father was sent home from an ER on 10/31/06, still complaining of the chest pains he walked in with, and 10 hours later, had a thoracic dissecting aneurysm, “coded,” and was brain dead. So to all of you doctors who think that you are “only human,” yes, that is true, that goes for all of us. But we don’t put our trust in the mailman or the garbage man — we put our trust in YOU — YOU, who are supposed to know these types of things. We’re “lay people;” we don’t know any better. That’s why you have the medical degree, and I don’t. But I do know when a man is in excruciating pain — you don’t have to go to 10 years of med school to see that. Furthermore, who gives a damn about the cost of a CT scan or a credit score if it would have kept my dad alive? That is a ridiculous argument, and if you really believe that, why the hell are you a doctor? Hopefully, your loved ones will never experience the shoddy medical care that my family has been exposed to, and don’t be so defensive — it makes your case look weak. Hope you sleep well at night.
Five years ago, at the age of 48, I suffered an acute aortic dissection. I was taken to the closest emergency room where I spent the next 3 to 4 hours while the ER doc commenced with exactly the protocol referred to in one of the previous emails EKG, chest x-ray, CT scan. Let me tell you, the gods were lined up in my favor!
First, I live in a city with some of the finest medical care and THE finest trauma care in the nation – Seattle.
Second, my dissection occurred on a Tuesday evening – just one old drunk in the ER.
Third, it was a first rate neighborhood hospital that was connected with the finest hospital in the city. (By the way, the neighborhood hospital is going away.)
Fourth, a super-conscientious ER doc. I happen to have acid reflux and it would have been easy to connect my symptoms with that. My blood pressure, heart were all fine, although my father died at 50 from a heart attack.
Fifth, the ER doc knew just who to call so that my emergency surgery could get underway, pronto. (I never had any kind of surgery before in my life, and now I was facing open heart surgery!)
Sixth, after I was taken to the “big” hospital, where I had the best heart surgeon in the northwest to perform the 10 hours of surgery. (The surgery had only been available in Seattle for two years prior to mine.)
Seven, I spent a month in a medically induced coma due to my extreme reaction to the intubation – my blood pressure would skyrocket and I would struggle with the hospital staff when they attempted to wake me and remove the tube. While in the coma I nearly bit it several times due to a variety of complications – serious infection; near kidney failure; etc. Through it all, I had family near me and advocating for me nearly 24 hours a day. My mother moved from another city and stayed in my home, and my former mother-in-law even came to visit! Every bit of energy my mother, siblings, nieces and nephews, aunt and uncle – you name it – could muster was directed at my surviving.
Finally, I had phenomenal health benefits! Of everything, this is probably the single most significiant factor in my survival. There was no hesitancy to order a CT scan. There was no reluctance to send me to the finest hospital in Seattle. Great surgeon? – no problem. Month in a coma? – what else can we do for you? Three months in recovery in the hospital? – wanna make it four? How about when you leave the hospital? Hospital bed, PT, home nursing care, equipment, you name it. (Even the cotton balls.) It was all taken care of…no muss and NO FUSS! The entire business cost between half and three quarters of a million $. My out of pocket was less than, get ready for this…$1,000. This does not include my short and long-term benefits so that I could recover w/out worrying about bills. Am I wealthy! Let’s put it this way, I work in social services and I am a divorced, single female. What do you think? All I can say is that my experience should not be the exception. This is what we all deserve. I know I was very, very lucky and don’t think for one moment that I don’t know it. I am grateful for every breath I take and for every event I would have missed if I hadn’t made it (exception for current White House administration).
Nobody in this wealthy and brilliant nation should have to expect or receive substandard medical care. Unfortunately, the only means of addressing the issue is through the courts. When are we going to wise up and stop throwing people away when we know what needs to be done. We absolutely must have universal health care, and we double-absolutely deserve the best care there is to be had!
I’m a Registered Nurse. I understand the pressures ED Doctor’s have and I don’t believe in suing.
However, my husband had a dissected aorta a year and a half ago. He went into the ER by squad. He call the sqaud at 4:15 pm. EMS told the ED Doctor that he was having an anxiety attack. My husband told them he was having chest pain and that is what led him to calling EMS. He arrived at the ED at 4:45. He told the doctor his leg was in severe pain and burning. The doctor told him if he would just be quiet he would get him something for pain. When I got to the ED at 5:15pm he had a brief full of blood, the second one my husband told me. He was also vomiting blood. Still not seen by a doctor. I told the nurse at 5:30pm he had no pedal pulse and his foot was gray. Still not seen by a doctor. Approximately three and a half hours later the doctor came in, no pulse to his right leg. He called a surgeon. They finally did a CT scan. Shipped him to a bigger cardiology hospital. Did not know if he would make it.
He did make it. He is permanently disabled has no function of his right lower leg, constant pain, walks with a brace and cane. Permanently no function of his leg from the knee down. Could this have been prevented if they would have listened to the nurse wife and my husband yes. I asked questions I told them his pressure was erratic. I started low d/t him bleeding out I told the nurse he had no pulse. I think the doctor should have listened to my husband and myself.
Yes it is hard to ditect a dissection but if the doctor would have listened my husband may not be paralyzed from the knee down. Yes he is alive but there are days he wish he weren’t because of the severe constant pain.
Was John Ritter’s wife right to sue. YES, YES, YES!!!!!
Doctor’s need to look at a dissection immediatley with anyone who states chest pain but the EKG is normal and immediately order a CT scan.
By the way my husband had no idea he had any problems with his aorta. He worked all day everyday as a mechanic. He is now 50 this happened when he was 48.
your comments that every patient with a normal ECG with chest pain reflects a common misperception about the evaluation of chest pain in the emrgency department. Th fact is, and as unfortunate as your husband’s case was, thoracic dissections are rare. If you performed a Cat scan of the chest on every patient presenting to the ED with chest pain and a normal ECG you would actually kill more people than you would save. For every 3000 cat-scans of the chest a doctor orders one cancer is created in terms of radiation dosage. Given the millions of ED visits for chest pain, you would likely cause more malignancies that detect dissections. This is by no means to detract from your husband and your loss, it just is not a plausible strategy…thoracic/aortic dissections remain elusive and frequently are missed, but a shotgun approach to scan every patient with chest pain would likely create more problems than less, (not even counting the kidney failure from dye, allergies to dye etc…). If it were this easy we would scan every patient with chest pain and that would be the end of it. Emergency doctors don’t get more money by saving the hospital money by not scanning people.
“Walk a mile in my shoes, please…”
Friends, when you bash physicians consider these obvious truths…
I have never in my life met a person who never made a mistake.
I have never met a person who got a 100% score on every test he or she ever took from kindergarten through the end of school, and throughout life.
I have never met a doctor who never makes mistakes.
I have never met a surgeon who hasn’t caused complications from things done, or from things that “should have been done”, but weren’t.
This is because:
All humans make mistakes.
All humans make mistakes every day.
All doctors are human.
All doctors make mistakes.
All doctors make mistakes every day.
Most of those mistakes result in no harm.
Some of those mistakes cause mild to moderate harm.
A tiny percentage of the mistakes made by physicians cause disability or premature death in patients.
I believe it is likely that every single doctor who has ever practiced has harmed some of his or her patients, and has caused the premature death of some of his or her patients.
Is this “wrong” or “bad”? I don’t think so. I think this is simply the human condition. So am I “defending” malpractice? No, I am just trying to get everyone to understand that every single doctor malpractices, and probably every single doctor’s malpractice kills patients. Doctors do an awful lot of good, but every single doctor does a small amount of harm. Some people and probably most lawyers think doctors who “commit” malpractice must be punished. Well, the lawyers aren’t doing a very good job, because every one of us physicians is guilty, and you haven’t “caught” all of us.
Unfortunately, the only way to end malpractice is to end the practice of medicine. This is because it is impossible to train up even one perfect doctor, much less a nation or world full of them.
Instead of having lawyers and their clients punish physicians who get caught in their mistakes (and as I say, every one of us physicians are truly guilty, you just haven’t caught every single one of us yet), why don’t those people strive instead to replace us bad doctors by becoming themselves “perfect” doctors?
The answer is obvious. They can’t, and you can’t. NO one can. And so none of you try. It is just immensely easier to just complain bitterly about those of us who are actually ARE doctors, and try at every exposed opportunity to attempt to extort “justice” when you catch us.
Here is a solution! How about having the lawyers pass legislation making it illegal for anyone to become a physician without assuring the rest of us that he or she will never make any mistakes, and swear upon pain of death or imprisonment to promise to accomplish that impossible task?
Of course this will never happen. But if such a law were passed, every doctor who ever lived would immediately become a criminal for being incapable of obeying the law. In that circumstance, all doctors would have to immediately cease the practice of medicine. Paradoxically, if such a law were passed, the legal profession would have delivered an ultimate injustice to us all. America would be thrust back into a dark age where every disease and injury ran its natural course, maiming and killing literally millions of people. But we could all live happier having the satisfaction of knowing that no one would ever again have to suffer loss or death under the cruelty medical malpractice.
Is this what we want? Of course not.
Brothers and sisters, when will people realize these simple truths?
It is time to begin to understand that if we want health care, we have to accept that it is delivered by mere mortals, all of whom are imperfect. Any non-physician who doesn’t believe this to be true, is welcome to take upon himself or herself the daunting task of becoming a physician and then trying to never make a mistake, never harm anyone, and never inadvertently kill a patient. Any person who tried to do this would learn (just like all of us physicians already know) that it simply can’t be done.
Our current health care system does an immense amount of good. Brothers and sisters, please accept that our physicians’ inability to practice perfectly is not a reason to punish them for being unable to live up to humanly impossible standards. It is time for all of us to start applying the golden rule towards our physicians. It is time to have mercy on those people who are brave enough to try to help the rest of us by working every single day under the threat of having their entire livelihood taken away in a moment for any single perceived failure to perform to the impossible standards expected by non-physicians and their lawyers.
Instead of complaining bitterly about how bad physicians are, consider being grateful for the incredibly wonderful things that they often can do. Consider acknowledging that medical malpractice will never end as long as doctors practice medicine. Malpractice to a large extent is a myth. Malpractice is merely the reality of true medical practice performed by ordinary men and women.
Finally, please consider passing a constitutional amendment requiring all Americans to have mercy on their doctors who generally do a very good job in helping us all to live better, and to live longer.
Blessings to you all.
1) The sad fact is that good Doctors do make mistakes. Everyone does and good Doctors should not be punished for a simple mistake.
2) Sadder yet, there are Doctors and Medical Staff that are incompetent and/or do not care, they also make mistakes and or are negligent. The truly negligent medical personnel should be sued and jailed.
3) To make matters worse many Doctors are overworked and caring for too many patients at the same time.
4) Saddest of all, Due to the large number of malpractice suits and the huge settlements, we as a nation are driving more and more doctors and would-be doctors to leave medicine. This only makes the problem worse.
5) Worst of all, The high cost of medical care places quality health care out of reach for a large number of our citizens. The cost of medical malpractice insurance and these malpractice suits is a VERY large part of those medical costs. As a nation we will sue ourselves out of quality medical care in the near future.
No, we do NOT need a National government run Health Care system. Most politicians are Lawyers and we certainly do NOT need a bunch of lawyers deciding how health care should be handled.
Reduce the burden of malpractice suits on medicine by:
a) fining lawyers for frivolous malpractice suits
b) reduce the award levels in malpractice cases to reasonable levels (at least by 50% or more)
c) Reduce the lawyers share of the award to 10-20% based on the number of hours they have worked on the case
d) start aggressively prosecuting gross negligence and jailing the guilty, including administrative/management personnel that place medical proffesionals in impossible work conditions [long hours, short staffed (not enough people), inadequete staffing (inexperienced/undertrained), etc]
Compensating the family of patients who suffered gross negligence is the right thing to do. However, we do not need to be making them and their lawyers millionares.
Most Doctors and medical staff carry malpractice insurance so THEY are not the ones footing the bill. Everyone pays more for healthcare so they can pay for the high price of insurance, the insurance pays the price of the lawsuit and the lawyer who filed suit walks away with 50% or more. Who wins? The lawyers and the insurance companies. Who loses? The patients denied care, because they can not afford the high cost of health care and because there are fewer doctors.
Here in Illinois, the state legislature has put a cap on malpractice damages a few years ago. However, my doctor tells me that her malpractice insurance rates have not changed (ie not lowered). I think part of the solution is to legally rein in the greed of insurance companies.
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