Venting on malpractice. “Many doctors consider ‘offer of settlement’ a euphemism for ‘offer of extortion.’ It should be eliminated.

The public is generally unaware of these methods, yet ultimately pays the price because to ward off frivolous lawsuits, doctors are forced to order many tests and consultations to prevent allegations of neglect.

This is why a visit to the doctor for a simple headache can end up costing thousands of dollars for CAT scans, X-rays and much more.”

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  • Anonymous

    There are times when it makes sense to settle. I was once hit with what seemed to be a business as usual, run of the mill meritless lawsuit that my insurer wanted to fight in court. Normally I would’ve been in favor of this but the insurance co. stuck me with an incompetent lawyer who was so bad that I had to hire my own lawyer to defend me from the incompetence of the insurer’s lawyer. She tried to get the insurance to switch me to a competent lawyer but they wouldn’t do it so we had no choice but to push for a settlement. What a joke this whole malpractice charade has become.

  • Anonymous

    People don’t go to the doctor for a “simple” headache. They go to a doctor for excruciating and or prolonged/chronic and debilitating headaches, or headaches associated with other illness. Workup is prudent and appropriate in selected headache patients, and not because you might get sued. You are being paid to figure out what the matter is!

    Failure to order an abdominal CT, or even just a cheap ultrasound, in a female patient of reproductive age and getting her out of your ER cause she’s black and poor and “probably” has some kind of STD will probably come back to bite you if her appendix ruptures in the next 24 hours, especially when you forget to even check for psoas sign, or a rectal, and the pelvic is negative except for some slight cervical motion tenderness (in a married patient who had an ectopic following a tubal ligation, and thus has some adhesions). By all means, lecture this patient about condom use with her own husband. See what happens when she has to have her ruptured and gangrenous appendix out
    in the next 24 hours, and has complications.

    Failure to advise your patient, who has a history of colon polyps, to have a follow-up colonoscopy any time in the ten years he has been your patient, and then advising him to make only dietary changes when he comes in with “poop trouble” and then also telling him that he has an enlarged prostate when what he really has is a growing colorectal tumor mass, might also reasult in you having to make an offer of settlement.

  • Anonymous

    ” People don’t go to the doctor for a “simple” headache. “

    Clearly you have never worked as a doctor in an ER before or else you are very naive.

  • Anonymous

    “Failure to order an abdominal CT, or even just a cheap ultrasound, in a female patient of reproductive age and getting her out of your ER cause she’s black and poor…”

    It is apparent that you are not a physician in clinical practice. I agree that a thorough history and physical exam should be done not only in this type of patient but in all patients presenting with abdominal pain.
    To suggest that by doing an abdominal CT and ultrasound will rule in or rule out acute appendicitis and therefore avoid
    a malpractice lawsuit shows your lack of knowledge of the sensitivity and specificity of these imaging studies.
    You sound like you obtained your education from the internet.

  • Anonymous

    “Workup is prudent…”

    You’ve got to be a lawyer. Trial lawyers like to use the word “prudent”.
    So you are a lawyer with no medical schooling or training telling M.D.’s how to examine and work-up a patient with abdominal pain in the ER. You have no credibility.

  • Anonymous

    And many cases are settled because the negligence is so clear that the physician does no dare go to a jury with it. Coupled with the typical arrogance of a physician, they settle because they know that with clear negligence coupled with that arrogance, the result could be much worse.

    Anyone who thinks insurers are in the business of settling meritless claims has never dealt with an insurance company. Or is perpetuating a lie for their own ends.

  • Anonymous

    About $50K per doctor is the cost to defend a typical suit, and an insurance company may have several docs in the same case. So yes, they do settle cases with little merit, especially if the circumstances involve a grieving mother/wife, and an inner-city jury.
    Only a tool of the lawsuit industry would suggest otherwise.

  • Anonymous

    Anyone who thinks insurers are in the business of settling meritless claims has never dealt with an insurance company. Or is perpetuating a lie for their own ends.
    A lot of insurers settle meritless claims not only in malpractice, but in any kind of tort cases. Car or house insurers would prefer to pay than to go to court if the former is cheaper. It is a simple matter of economics. The insurers are in business of making money, so I find it hard to believe that they will spend money defending anybody if it is cheaper to settle.

  • Anonymous

    “About $50K per doctor is the cost to defend a typical suit,”

    Maybe, MAYBE, all the way to trial and it will be the rare trial that is the case. Or you may be including the adjuster’s salary, the CEO’s salary, etc. in there. What’s the source for this claim?

    “So yes, they do settle cases with little merit, especially if the circumstances involve a grieving mother/wife, and an inner-city jury.”

    This is based on. . . ? Your opinion from reviewing how many cases? Considering nearly everyone has a grieving mother/wife, your comment is pretty ignorant. But that’s par for the course.

    Keep up the solid work.

  • Anonymous

    “A lot of insurers settle meritless claims not only in malpractice, but in any kind of tort cases. Car or house insurers would prefer to pay than to go to court if the former is cheaper. It is a simple matter of economics. The insurers are in business of making money, so I find it hard to believe that they will spend money defending anybody if it is cheaper to settle.”

    How many cases have you settled with an insurer? How do they treat physicians on reimbursements? Why do you think they’d be any different for anyone else? Particularly when most of their clients aren’t as well educated as physicians, nor in the financial position to fight them?

  • Anonymous

    12:26 PM An appendiceal CT or abdominal with contrast can be very useful in ruling in appendicitis in a female patient. Ultrasound CAN be useful and it’s cheap.

    Cheapest of all would have been to keep this patient in the ER to observe and reexamine, instead of discharging her with pain killers and an inadequate script for PID.

  • Anonymous

    If you are going to tell me that helical CT, ultrasound, or traditional abdominal CT with contrast is not useful and appropriate in patients with an equivocal diagnosis by history and exam, especially in females and kids, you are full of crap.

  • Anonymous

    Importantly, appendiceal CT AND ultrasound (plus lots of stupid expensive labs) to rule out Appendicitis in a patient does one other thing: If you send the poor schmuck home “with pain killers and an inadequate script for PID” and they come back with a ruptured appy, even if they die (apparently it’s better if they die in this legal system) you’ve proven you’ve practiced defensive medicine and thus are less likely to be sued and lose. I scan every belly pain, no matter how ridiculous, just to cover my assets. And I’ve been sued for “observing” a belly pain that turned out to be an appy. Observation is what you do in a Strip club, in the US you order expensive tests to cover your ass.

  • Anonymous

    “(apparently it’s better if they die in this legal system)”

    If you had a clue about what you were pontificating on, you’d know that a grotesque injury is more likely to be settled for a higher amount.

    “you’ve proven you’ve practiced defensive medicine and thus are less likely to be sued and lose.”

    What’s funny is, that if you are to be believed that litigation AND defensive medicine are at record highs, then that statement wouldn’t be true. More excellent deductive reasoning on your part!

  • Anonymous

    “If you are going to tell me that helical CT, ultrasound, or traditional abdominal CT with contrast is not useful and appropriate in patients with an equivocal diagnosis by history and exam, especially in females and kids, you are full of crap.”

    Nobody said they’re not useful. These imaging studies will help one arrive at the diagnosis. These should be used as adjuncts to clinical examination and clinical judgment. However, if you rely only on the Radiologists’ interpretation of these studies, one can miss acute appendicitis, a case of false negative interpretation(3 out of 663in a study at Massachussetts General Hospital recently published in AJR). One has to rely on his clinical or surgical judgment whether to operate, observe in the hospital or send home and return for re-evaluation in 8 to 12 hrs. The problem occurs when the Radiologist reads it as negative(i.e. appendix not seen, no stranding, no fluid) and the ER doc and surgeons agree that it’s negative and turns out to be positive and have a ruptured
    appendix on re-evaluation. Then there are the false positive cases
    (19 out of 663 in same study at Massachussetts General Hospital). Again, one has to use clinical judgment to decide whether to operate on any of these cases. The point I’m making is that these imaging studies are very useful but they don’t necessarily get you out of a potential lawsuit and one has to rely on his clinical experience to make a decision on the patient’s disposition.
    For those doctors and lawyers interested here is the link to the Mass. Gen. Hosp. study
    http://www.ajronline.org/cgi/content/full/184/6/1802?linkType=FULL&journalCode=ajronline&resid=184/6/1802

    Sonography is less sensitive and less accurate…”The accuracy was 92%; sensitivity, 83%; and specificity, 95%. The positive predictive value was 86%, and the negative predictive value was 94%.” link is: http://www.ajronline.org/cgi/content/full/184/6/1809?linkType=FULL&journalCode=ajronline&resid=184/6/1809

  • Anonymous

    “What’s funny is, that if you are to be believed that litigation AND defensive medicine are at record highs, then that statement wouldn’t be true. More excellent deductive reasoning on your part!”

    You really seem to have your hand on the pulse of what’s happening in the nation’s emergency rooms and hospitals. How many hours a week do you spend in the ER watching defensive medicine being practiced? And do you do this observation jerking with your right hand or your left hand?

  • Anonymous

    I know here in the judicial hell hole of the uS, Madison County IL, that alot of docs around here settle. Why because it is cheaper to settle out of court. And less hasssle. Around here, to go to trial, the cost is averaging $80-100,ooo. When most of these frivolous jokers are settling for $100,000 or less.

    Your naive, very naive, to say that defensive medicine isn’t being practiced because of frivolous lawsuits. Maybe you need to volunteer in your local ER. Get a real view of life instead of the bits and pieces you get from your frivolous clients.

    Tests, such as CT Scans, Ultrsounds, etc. are valuable tools in diagnosing. But you have to look at the entire picture. History/Physically, Exam, and tests. Practicing medicine is an art that has definately turned into cover your ass medicine. Tests are most definatley ordered defensively. When they aren’t necessarily needed.

    Its funny how attorney’s, with no medical education or hands on experience, think they know how to practice medicine. I yet to see patients line up at attorneys offices to get healthcare. Your only making an ass out of yourself. Like all your other friends. Go read some more cases, better yet, turn the tv on and watch a few more episopdes of ER.

  • Anonymous

    “You really seem to have your hand on the pulse of what’s happening in the nation’s emergency rooms and hospitals. How many hours a week do you spend in the ER watching defensive medicine being practiced? And do you do this observation jerking with your right hand or your left hand?”

    Your personal insults don’t change the fact that your logic is faulty. If you contend that litigation is at an all time high, AND defensive medicine is at an all time high to prevent litigation, that is. Excellent diagnosis, doctor.

  • Anonymous

    “I know here in the judicial hell hole of the uS, Madison County IL, that alot of docs around here settle. Why because it is cheaper to settle out of court. And less hasssle. Around here, to go to trial, the cost is averaging $80-100,ooo. When most of these frivolous jokers are settling for $100,000 or less.”

    Got a source for such a claim? This is based on. . . ? It’s funny how on the one hand you accuse attorneys of trying to practice medicine, you claim to be so familiar with how the legal and insurance industry work.

    “Its funny how attorney’s, with no medical education or hands on experience, think they know how to practice medicine. I yet to see patients line up at attorneys offices to get healthcare.”

    Strangely, not a single attorney who has posted here has attempted to make a medical diagnosis. What’s really amazing is how comfortable you are making bold pronouncements about an industry you clearly know nothing about.

    I’ve yet to see anyone call a physician when an insurance company jerks them around. The physicians don’t want other people to call attorneys, but they sure don’t have a problem calling attorneys when they want some money, do they?

    ” Your only making an ass out of yourself.”

    I’m afraid, my friend,that your own lack of knowledge on issues you are pontificating on is making an ass out of you. Sad to see, really. I hope your deductive reasoning skills are better in medicine than they are outside of that realm.

  • Anonymous

    “The physicians don’t want other people to call attorneys, but they sure don’t have a problem calling attorneys when they want some money, do they?”

    Let’s just agree not to exchange services. Let lawyers see lawyers for their medical problems (because they know Medicine). And let doctors consult each other for legal problems. Yes, these lawyers will be dropping dead like flies.

  • Anonymous

    “Sonography is less sensitive and less accurate…”The accuracy was 92%; sensitivity, 83%; and specificity, 95%. The positive predictive value was 86%, and the negative predictive value was 94%.”

    Why are you posting that statement here? Trial lawyers won’t understand it. There are no $ dollar signs anywhere.

  • Anonymous

    “Your personal insults don’t change the fact that your logic is faulty. If you contend that litigation is at an all time high, AND defensive medicine is at an all time high to prevent litigation, that is. Excellent diagnosis, doctor”

    I am no doctor or lawyer but it seems this would directly correlate. How would you explain otherwise? If there is a heat wave you would expect more air conditioning use. If there was a SARS outbreak you would expect sales of face masks to increase. If doctors face more frivolous lawsuits and skyrocketing premiums there will be a reaction.

  • Anonymous

    The premise was that you must do defensive medicine to protect against lawsuits. (the assertion that they are frivolous is ridiculous since no one here has reviewed the records). Yet the claim is that there is more defensive medicine than ever AND more lawsuits than ever.

    Clearly, the wrong treatment is being applied to the alleged disease.

  • Anonymous

    “Why are you posting that statement here? Trial lawyers won’t understand it. There are no $ dollar signs anywhere.”

    Of course, physicians work for free. You don’t get to be America’s highest paid profession without ample amounts of charity, do you?

    It’s funny when physicians try and impugn others by saying their motivation is money. Particularly when the whole reason for the malpractice “crisis” is because they want to save some money on their insurance premiums. And because they don’t hesitate to run to lawyers when they want to get a buck they think they deserve. Hypocrite.

  • Anonymous

    Frivolous lawsuits are applied in many cases to normal expected outcomes. Besides Moses, Elija, and Elisha everyone eventually has a bad outcome (death). However, the culture has become that it must be someone must be at fault. Defensive medicine does not decrease these lawsuits. However the process of these lawsuits is so annoying that it leads to more defensive practice for subsequent patient encounters to “ward off” the unpleasantries.

    Lawyers are not that bright, only a small percentage of cases are won for the plaintif because the lawyers do not understand the complexity of medical practice. I have several lawsuits that are going to go all out to the courtroom. The plaintif has no chance once the facts are explained because the attorney doesn’t grasp it. I would relish the trial if it were’nt for the time and money that it is going to involve. Unfairly the plaintiffs family will be put through the emotional roller coaster that should never be ridden.

    Even though the trial attorneys lose more often than win in med mal cases I view it similar to a gambling addiction. John Edwards is the ideal and every once in awhile you might win big. In the process they cause a lot of grief for the defendant and for their own plaintiffs for suggesting that their is some other life reality.

  • Anonymous

    Of course, you know how the plaintiff’s side works from. . . . . ?

    Oh, that’s right, you have no idea at all what you’re talking about. Par for the course once physicians leave the medical field.

  • Anonymous

    “It’s funny when physicians try and impugn others by saying And because they don’t hesitate to run to lawyers when they want to get a buck they think they deserve. Hypocrite.”

    WOW I didn’t even go to law school and I can figure out the fallacy in this one. It’s like “Jews don’t like being called greedy but I think all jews care about is making money.” “Greedy Jew Bastards”

  • Anonymous

    “Of course, physicians work for free. You don’t get to be America’s highest paid profession without ample amounts of charity, do you?”

    Another statement from a lawyer with no supporting data. Another one of those claims without merit.

  • Anonymous

    “If there is a heat wave you would expect more air conditioning use. If there was a SARS outbreak you would expect sales of face masks to increase. If doctors face more frivolous lawsuits and skyrocketing premiums there will be a reaction.”

    Sounds like a fallacy in logic I learned in high school. (Post hoc ergo propter hoc).
    This is actually the fallacy in a lot of frivolous lawsuits. For example, a doctor delivers a normal looking baby who turns out to be deaf. Therefore, the doctor, caused this deafness. He then gets sued.

  • Anonymous

    “Another statement from a lawyer with no supporting data. Another one of those claims without merit.”

    Dept. of Labor statistics. Try again.

  • Anonymous

    “This is actually the fallacy in a lot of frivolous lawsuits. For example, a doctor delivers a normal looking baby who turns out to be deaf. Therefore, the doctor, caused this deafness. He then gets sued.”

    Of course, you know this from your extensive review of the medical records in malpractice claims, right? Right?

    Or maybe you just believe everything the AMA tells you without thinking about it. No wonder the drug companies spend so much on marketing. They know how easily swayed you are.

  • Anonymous

    It;s better they spend it on us then you win it in one of these ridiculous Vioxx circuses. What would you do with that kind of play, put 20% up your nose, some hash, 25% on a black callgirl, maybe a little bondage session, buy a smith and wesson to protect yourself from some of the slime you’ve screwed over.

  • Anonymous

    Of course, you know how the plaintiff’s side works from. . . . . ?

    Oh, that’s right, you have no idea at all what you’re talking about. Par for the course once physicians leave the medical field.

    Likewise, you know what it is like from the physician defense side because . . . . ?

    Apparently you don’t know much becuase I have gone to court 8 times over my career to defend myself. Every time the plaintiff attorney ended up looking like a jackass. The plaintiff or plantiff’s family was put through a tragic charade of your making.

    Par for the course for lawyers in their own field

  • Anonymous

    “It;s better they spend it on us then you win it in one of these ridiculous Vioxx circuses.”

    Really, do tell us – how much of the Vioxx evidence have you reviewed? Or were you able to pull your eyes away from the Merck salesgirls chest long enough to hear what she was saying?

  • Anonymous

    “Sounds like you’ve hurt a lot of people! Congratulations. I’m sure caps on damages will be a big help.”

    Wow, you can deduce negligence from a blog sentence. I take care of critically ill and dying patients all day long. You are an ass.