An ER physician talks defensive medicine.
So it makes me a little crazy when it’s claimed that doctors aren’t motivated by fear of lawsuits — we are. Now if you want to claim that the overall fraction of healthcare dollars spent on defensive practice is low — 1-2% of all spending — I might agree with that. But bear in mind that the healthcare expenses in the US are in the trillions of dollars, so we are talking many billions spent on unnecessary care. If you want to argue that tort reform won’t change doctor’s practice patterns, I would be open to the possibility — doctors don’t want to be in the NPDB whether it’s for a million dollars or for fifty thousand. But don’t tell me that defensive medicine doesn’t exist.
So true. It doesn’t matter whether defensive medicine “works” in preventing lawsuits or not. You can never design a study to prove that. All that matters is the physicians’ perception of the lawsuit threat. If the perceived threat is there, defensive medicine will continue to run rampant.
The solution? No-fault malpractice, health courts, caps – it doesn’t matter. Any one of these options will go a long way in reducing the perceived malpractice threat, and subsequently decrease the amount of defensive medicine. That’s the reality. (via Grand Rounds)
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{ 60 comments }
I’m struck by KevinMD’s unfathomable arrogance. Yes, if the penalty for mistakes is decreased, doctors will take fewer precautions. So what? You can’t tell me what the “optimal” level of precautions are–so all we are left with is doctor’s own estimations of their motivations. Utterly unreliable evidence. That doctors believe that their little impressions & strange, un-empirically demostrated hunches (sorry the Kessler study doesn’t do it) should be the basis of policy goes a lot to show what unscientific, arrogant hacks most doctors are.
Tell ya what, anon, let me do a defensive, medically unnecessary spinal tap on you (and I’ll use the big needle so you get a post-LP headache), and then we can discuss what degree of certainty is necessary in medical care. Don’t equate ‘more care’ with ‘better care.’
If the science were easy, it would have been done. But it’s subjective and covers a huge range of diseases and is hard to measure. In the absence of definitive data, our “little hunches” formed from years of experience are the best information upon which to base public policy.
And by the way, I have to commend you on your courage, showing up and throwing hand grenades about arrogance and hackery . . . anonymously.
Twit.
Thank you for your comments.
I would like to ask if you have another solution. “Don’t make mistakes” doesn’t count – since having 100% accuracy in the medical world is impossible.
Thanks,
Kevin
“un-empirically demostrated hunches”
I don’t have time to make hunches. MY ER is constantly over-run with patients. Hunches is for people with time to spare. I see 40-50 patients in an 8 hour shift. All I have time to do is order defensive tests. I try to order these tests equally, irrespective of race, color or creed. I figure if I do it that way I won’t miss the pre-menopausal woman with an MI so easily. As they say in sport, “DEFENSE”, DEFENSE!”
The most sensible part of the original post was the no-fault system.
Shit happens all the time, sometimes it is the result of poor practice, more often it is just fate. Mortality is still 100% in the end, all diseases are terminal and that’s not about to change.
Only the lucky get remunerated presently.
Those with a poor outcome but no fault, or at least no case that a lawyer wants to take, get nothing. Those with the same poor outcome having resulted from an occurance that could play well in court and gains the interest of a lawyer can get cash. Same clinical result, different financial outcome depending upon the road to the clinical outcome.
In a no fault system patients would get compensated for poor results when the outcome differs substantially from the norm. The compensation would be sufficient to cover direct costs and would cover far more people than are compensated under the present system. No supersize Lotto like payout for a few, but a reasonalble size compensation for all with a real injury.
“So it makes me a little crazy when it’s claimed that doctors aren’t motivated by fear of lawsuits — we are.”
Serious question for you guys. What do you think the risks are if you get sued, and what do you think is your realistic exposure to them?
The risks for me if I get sued is that my employer will be uncomfortable paying for my malpractice if it gets high enough and I’ll have to find another job or move. Those who gets sued frequently (ob, neurosurg) sometimes have to stop doing certain procedures not because they don’t want to, but because they can’t find the malpractice insurance at a rate reasonable enough to pay the light bill. As I live in florida, I know that no one will take my house, retirement assets, or assets I own jointly with my wife, unless they can prove I knowingly tried to harm someone.
As it is rare that I commit gross negligence, my exposure to lawsuits is a ratio as follows:
patient and family anger X severity of illness X number treated
____________________________________________
rapport with patient and family X quality of documentation
b
The cost of defensive medicine is way more than 1-2%. Probably more like 20-40%.
12 Effects Malpractice Litigation has on Physicians
Punta Gorda, Florida – February 14, 2006
In his recent State of the Union Address, President Bush said doctors and nurses must be put back in charge of American medicine, instead of those in charge now – bureaucrats, HMOs, and lawyers. He urged Congress to pass medical liability reform because one of the major causes of the high cost of health care is the threat to physicians from medical malpractice litigation.
There are not too many career events as stressful to a physician as being accused of medical malpractice. Physicians’ reactions have been compared to the normal stages of grief – denial, anger, bargaining, depression and acceptance. Other responses include:
• Shame
• Isolation
• Second guessing care decisions
• Feelings of unworthiness and inadequacy
• Doubt of skills, capability, self-worth, and professionalism
• Future uncertainty
• Withdrawal
• Fear for their career, reputation, and finances
• Reduction of services
• Giving up the practice
• Practicing defensive medicine
• Physical: insomnia, loss of appetite and energy, decreased libido, moodiness, headache, irritability, gastrointestinal distress, cardiac problems
These reactions ebb and flow over the course of the lawsuit and exacerbate during periods of change and new developments. They hope it will go away, but it doesn’t – and events will inevitably affect every aspect of the physician’s life.
The Death of Mammography
Rene’ Jackson RN BSN MS
Alberto Righi, MD
Caveat Press 2006
Read the press release, reviews,
and excerpts from the book at:
http://www.rjacksonrn.com
rene@rjacksonrn.com
“It is an important work addressing a crucial issue in women’s health”.
Pam Seay JD, Associate Professor, Division of Justice Studies
Florida Gulf Coast University
“Thank you, thank you for your efforts! We need to get this message out!!”
Debra Copit, MD, Director of Breast Imaging
Albert Einstein Medical Center
Pennsylvania
“the truth is that it is completely unquantifiable. Physicians won’t admit to unnecessary tests because they’re admitting to insurance fraud. “
Then the entire profession of Emergency
Medicine is frauding insurance companies, because all I (and my colleagues) do 24 hours a day is practice defensive medicine. On a typical day at least half the tests I order are defensive, and have a less than 1% likelihood of being positive.
Which is why you remain anonymous.
“President Bush said doctors and nurses must be put back in charge of American medicine, instead of those in charge now – bureaucrats, HMOs, and lawyers. He urged Congress to pass medical liability reform because one of the major causes of the high cost of health care is the threat to physicians from medical malpractice litigation.”
President Bush talks a good game, but where is he when it comes time to give you something that is guaranteed to help your bottom line? Is he cutting Medicaid or is he fighting for higher reimbursements?
His “reform” is primarily designed to help pharma and medical product manufacturers. But he knows they can’t be the face of it.
Considering the cost of health care in those states that have enacted tort reform hasn’t changed much, if at all, and he likely knows that, you have to ask, who benefits from his “reform”, because it ain’t patients.
I’ve experienced rational ER patient management twice in the past. Initially at the West Admit Room at Charity Hospital in New Orleans in the 1980’s, and second at the 15th Evacuation Hospital in Saudi Arabia during Gulf War I. Both were war situations.
Military triage. Critical but salvagable gets priority. None of this “I need to be seen to get a refill,” or “My doctor told me to come in.”
When will it happen? It will have to when a dirty bomb closes East Coast shipping, or oil hits $286 per barrel, or 22% of North America has bird flu. Might be sooner than you think.
If the poor care that is provided by many ER’s is in an environment of defensive medicine I cannot imagine how bad the care would be without it.
Does anyone really believe that defensive medicine is anything other than baloney being sold by tort reformists?
I agree with you Greedy Trial Lawyer. I’m going to do an extra Lumbar Puncture and Cat Scan in your honor today, just out of respect for the “baloney” comment that all trial lawyers seem to believe. Keep practicing that outstanding retrospective emergency medicine. Maybe you can sue the allies in defense of holocaust victims since we didn’t bomb the rail lines that led to Auschwitz. It’s so easy to figure it out; in retrospect.
Greedy Trial Lawyer: You’re basiung your comments on how many ER patients you’ve seen? I’ve seen 50,000, I don’t consider ER care “poor”. How would you like it if someone came into your house and commented on how you raise your kids? I have about as much knowledge of your ability to raise children as you have of Emergency Medicine’s ability to care for patients.
Without disrespect to anonymous, whichever one you are, my (pediatric) patients do indeed receive bad car in our local EDs, including the EDs in the big city (Boston).
I’ll give an example which is virtually indistinguishable from thousands just like him. It happens to be the most recent for me.
Three month old boy with URI symptoms, no fever. No respiratory distress or poor feeding. Went to ED where CBC, BCX, cath U/A, UCX, RSV swab, and chest x-ray were done. ED doc called me at 1:30 AM because “the heart looked unusually large to me” (it was the normal appearance of a 3 month’s heart on CXR, which she is not accustomed to seeing.)
Absolutely NONE of this was necessary or even indicated. Exception? Anecdote? Not by any means.
Here’s the punchline: now this mother believes that her child’s URI requires emergency level of care! Just look at all those tests that needed to be done!!!
best,
Flea
What do you tell your patient’s when they call after hours? Go to the ER. I will have more respect for your comments when you tell the lady over the phone “it’s just a URI don’t worry about it”. But instead you practice CYA medicine like everyone else and tell them “go to the ER”.
PS: I am not an ER doc.
Why is it that the concern is always for the physicians or the lawyers? You’re all missing the most important aspect of your actions. “The Patients’” remember us? We are the ones who come to your ER’s at all hours of the day or night. Something has happened to make us think we need your years of education and expertise to make us well.
You are a stranger to us, and yet, at our most vulnerable, we are willing to place our lives in your hands. More important ,we willingly place our loved ones care in your hands.
Most of us don’t get it that when you enter our room, you couldn’t care less.
We are stupid of that fact. When you tell us we need a test or procedure, be believe it to be some unspoken law that “WE MUST HAVE THIS TEST.” Our life depends on it. The reason our life depends on it all because YOU said so.
Imagine what will happen when we ALL get on to the fact that we are pawns in this game of Physician’s vs. Attorney’s? When we no longer trust or believe in you? When we rebel and ask for through explanations as to why you need to do this test or that procedure? Are you going to tell us “it’s because I’m practicing defensive medicine, you REALLY don’t need this test, I’m just looking out for number one, who by the way happens to be me, not you!” Of course you won’t, what you will do is further our stress and anxiety ,by convincing us that we should trust your judgement. So we sit and wait while those tests are being done for our loved ones. We worry, and as and you walk by the room you look in and smile at us. You know what we are going through, inside you laugh at us and you think, “What dumb ass fools these people are.”
Why are you doing this and tearing down a profession that you have worked so hard to accomplishment?
Dear Friend,
I can see why you would feel that doctors and lawyers are using patients as leverage against each other. You read this blog. I’d like to gently remind you and the readers of this blog that the events and people depicted here (and on prime time television) are caricatures and I suspect exaggerations.
Very few doctors smile at their patients and think they are “dumb asses”. I smile at my patients and hope they are comforted and will meet with a speedy recovery. If an ER doctor overreads a pediatric chest xray, he is not doing that intentionally to harm the patient or wake up flea. He is cautious. That person will be continue to be cautious as that is a rational response to his situation. He will stop being that cautious when health care is rationed.
b
If an ER doctor overreads a pediatric chest xray, he is not doing that intentionally to harm the patient or wake up flea. He is cautious. That person will be continue to be cautious as that is a rational response to his situation. He will stop being that cautious when health care is rationed.
But was this x-ray even necessary? If I understand it correctly, children get URI all the time. When I was growing up I had a few every year – thankfully it was in a different country and a lifetime ago. If you do X-rays on every child every time he/she gets a URI, wouldn’t all these X-rays harm them in the long run? These are very young kids and they are very sensitive to radiation. So even if it is a very low dose, wouldn’t it add up? And what about all of the unnecessary catscans? Just because you are being cautious (or afraid of law suit) you are increasing some child’s risk of cancer later in life. Then, there is also a minor issue of the time off work mother lost and the stress she experienced while waiting for results. If the test is necessary, this is nothing. But if it is unnecessary these minor things count as well.
The mother and the child are innocent. They might have never sued a doctor, and since most people don’t sue, the probability is they never will. Yet, because of your fears and “caution” they are suffering.
Am I the only one who thinks there is something morally wrong here? I do understand that you may be afraid of a potential law suit, but be honest – would you order less tests if there had been malpractice cuts? If a patient were to ask you “is this test really necessary or is it defensive?” would you give an honest answer?
I think next time I am going to be sent to some test, I’ll ask this question as an experiment.
I am just speaking personally here, and not for all physicians (although many may agree with me).
“Would you order less tests if there had been malpractice cuts?”
Yes. If there was appropriate malpractice reform – such as health-courts, no-fault, caps – I would only order tests that is backed by medical evidence or guidelines, significantly decreasing the amount of “defensive” testing.
“If a patient were to ask you ‘is this test really necessary or is it defensive?’ would you give an honest answer?”
Yes, and I do all the time: “I cannot properly evaluate you over the phone. Because of liability concerns, I recommend you go to the emergency room.”
I then document that phone convsersation.
Thanks,
Kevin
What do you tell your patient’s when they call after hours? Go to the ER. I will have more respect for your comments when you tell the lady over the phone “it’s just a URI don’t worry about it”. But instead you practice CYA medicine like everyone else and tell them “go to the ER”.
Beg pardon? You talking to me? If you are, you’re wrong. I do not say “go to the ER”, I do not practice CYA medicine.
So there,
Flea
So then flea what did you say to the mom of the kid with the URI symptoms or did she just blow you off directly and go staight to the ER. I find your statement “I don’t practice CYA medicine” hard to believe at the very least.
Anonymous,
I feel sorry for you. You can’t believe that a doctor doesn’t practice CYA medicine. How crappy must be the medical care you receive!
This mom never called me. She just went to the ED.
People do that, you know.
Flea
“When you tell us we need a test or procedure, be believe it to be some unspoken law that “WE MUST HAVE THIS TEST.” Our life depends on it”
Our risk managers tell us if we want a patient to be able to refuse a test, we legally need to tell them they HAVE to have the test, and if they refuse, they need to be knowledgable of the risks, including death, and understand the risks. If we do not we can be found negligent in a court of law for misleading a patient.
“If a patient were to ask you ‘is this test really necessary or is it defensive?’ would you give an honest answer?”
Yes, and I do all the time: “I cannot properly evaluate you over the phone. Because of liability concerns, I recommend you go to the emergency room.”
This is not quite what I asked. I asked if a patient who is already in your office or in an ER and you are about to order a test and the patient asks you “is this a defensive test?” or “would you still order this test if you were not afraid of my suing you?” would you give an honest answer? If I were to ask “would you order it for yourself or your wife?” would you lie or give an honest answer?
Or, shall I, as a patient, be more specific and ask “why are you ordering this test?”, “what is the probability that I have the condition you are testing me for?”, “are there any risks of this test and what is the probability of it?” “what is the false positive rate?”, etc. etc. etc. Will you a) answer me honestly b) brush me off or c) brush me off and/or consider me a bitch (oops, let’s be politically correct – a “difficult” patient).
Another question. How can we trust you? It seems that the only thing we can do is to tell you “we’ll think about it” every time you order a test then try to get as much information on it as possible and decide…
I generally do not lie to my patients.
If someone point blank asked me if this was a “defensive test”, or if I would order it for my family, I would answer truthfully.
If someone asked me why I would order this test, I again would not lie:
“Why are you ordering this head CT for my headache?”
“I think that your headache is a simple tension headache, but we can get a head CT just to ensure there is no evidence of the unlikely event of a brain tumor or bleed.”
“Isn’t that a defensive/CYA test?”
“It certainly can be viewed that way, but unfortunately this is the environment we are currently practicing in.”
After discussion of the risks and benefits, any patient refusal of the test is documented.
Thanks,
Kevin
Actually flea you can keep your sorrow to yourself. I am a doc. I also suspect one of two things that you have not been practicing medicine very long and/or you never sit in at a deposition.
How much of a role does defensive medicine play in the fact that there are now many people in the United States that are uninsured? They can’t afford any tests, procedures, surgeries or medications, regardless of the cost.
We come to you, you practice defensive medicine. It drives our insurance premiums up, it causes our employers to cancel or cut our benefits, it means I can’t get healthcare for my child when he needs it. Also,if I have a pre-existing condition, there isn’t an insurance company on the planet that would take a risk on me.
By participating in this defensive medicine practice you are asking and taking alot from your patients.
If I come to your ER with stomach pains, please give me protonix and a GI cocktail. If that relieves my symptoms don’t tell me I need a scan of my GI system. Tell me you could offer me a scan of my GI system, but, that you don’t expect it to show anything. Let me make the decision. If you want me to sign a release, stating that if later I’am diagnosed with stomach cancer, or whatever, I won’t hold you responsible, then have the notary on hand, I will sign your paper.
“By participating in this defensive medicine practice you are asking and taking alot from your patients.”
Last time I checked, you aren’t paying my malpractice insurance. So don’t tell me what tests to order to protect myself. Do I tell you how to do your job? Assuming you’re a teacher, do I tell you it’s OK to teach outside the normal curriculum so my kid can learn more, even thought these days school districts can be sued for the simplest slipup. If you own a Greek coffee shop, do I tell you not to lower the temperature of your coffee so you won’t get sued for hot coffee burns? I’m happy to tell my patients it’s extremely unlikely their tension headache is a bleed, but I’m still going to order a CT scan and lumbar puncture them unless they want to sign out AMA. We are now trained that for every patient in the ER, there is a lawyer behind them in the waiting room.
I don’t know what you do for a living, but do your customers threaten you regularly that “I’m calling my lawyer”?
“How much of a role does defensive medicine play in the fact that there are now many people in the United States that are uninsured? They can’t afford any tests, procedures, surgeries or medications, regardless of the cost.”
You do realize that the reimbursment in most ER’s is in the neighborhood of 40-50% (or less). You talk to any of the old burned out ER docs/nurses they will tell you self pay=no pay. These are often the same people who will crucify your a$$ if God forbid you miss something.
“If I come to your ER with stomach pains, please give me protonix and a GI cocktail.”
Attorney’s love the “GI Cocktail”. If I even think of ordering a “GI Cocktail”, the patient is having an inferior wall MI and is getting admitted. You have to understand our training: You give us a symptom, we assume the worst. A “sore neck” = meningitis until proven otherwise. Welcome to American medicine.
Anonymous,
I have been practicing general pediatrics for 5 1/2 years and I’ve been sued twice.
Not long enough for you?
Haven’t been sued enough?
Face it, anonymous. You know nothing about me.
The tests I order most often are the following:
1. Hemoglobin (at one year physical)
2. Pb (also at one year physical)
3. Strep screens (only in instances of patients with pharyngitis and no obvious source, in whom the rapid was negative).
4. Urine Culture (in patients with fever and/or dysuria).
If that’s CYA medicine I give up trying to argue with you.
Flea
I respect and admire your sticking to your ethics and dedication. But 2 hits in 5 years, and you’re bragging about “not practicing CYA medicine”? In a lower risk specialty like peds. Flea, I mean no disrespect by saying this, but in the ER we have a phrase for “not practicing CYA medicine”
We call it “”giving it away”
You’re just giving it away to the lawyer sodomites for free.
“Last time I checked you aren’t paying my malpractice insurance.”
What Doc, you got a little game going on the side that covers your ins.? If not, then think again, of course I’m paying your premiums. Myself and every other pt. that you over test and over procedure is paying your premiums.
You really are pathetic!
Since you have been mainly practicing outpatient medicine for a short period of time on a population that frankly “in general” is the healthiest in our society, maybe you need to not sit in judgement of those of us who don’t have that luxury. You are right about one thing I don’t know you (anymore than you know me) so how about keeping your pontificating about your lack of understanding of defensive test ordering to yourself.
“Myself and every other pt. that you over test and over procedure is paying your premiums.”
90% of my patients are “free care”. You are paying my malpractice premiums like you’re paying for the war in Iraq, or for the $900 toilet seats the pentagon orders. If you really want me to stop ordering tests, get your politicians to stop making me feel like my career is on the line every time I discharge a patient without a million dollar workup.
You also just don’t get it. Defensive medicine is SO ingrained in what I do Emergency medicine), it’s the only way alot of us know how to practice. If laws were passed that got the lawyers out of our faces, alot of us including me) would have to go back to school and learn how to practiced non-defensive medicine. I would be happy to do that, I hate having to cover my ass every day.
“You really are pathetic! “
And what would your boss at your job and your risk manager, if you have one) call you if you walked into work tomorrow and said you were no longer interested in protecting his capital and investment and you were going to start taking risks?
“If laws were passed that got the lawyers out of our faces, alot of us including me) would have to go back to school and learn how to practiced non-defensive medicine.”
Short of complete immunity, what law would do that? Are you really going to order fewer tests because while you might get hit with an million dollar economic loss judgment, the non-economics are capped at $250K?
“Yes. If there was appropriate malpractice reform – such as health-courts, no-fault, caps – I would only order tests that is backed by medical evidence or guidelines, significantly decreasing the amount of “defensive” testing.”
Kevin, those are three very different “appropriate” reforms. Which one would have the most effect and why?
“Are you really going to order fewer tests because while you might get hit with an million dollar economic loss judgment, the non-economics are capped at $250K?”
Absolutely. Why is it so hard to understand us docs get “shook up” when we read about these John Edwards types winning 40 million dollar judgements when we have 1 million dollar insurance policies. You probably have a relative, a cousin or uncle, who drinks alot, maybe has a gambling problem, basically is irresponsible (I know I do.) If he comes to you and asks you to co-sign a million dollar loan, will you feel comfortable doing that?
“Absolutely. Why is it so hard to understand us docs get “shook up” when we read about these John Edwards types winning 40 million dollar judgements when we have 1 million dollar insurance policies.”
You do realize that the largest dollar amounts in most awards are for economic damages, don’t you?
In Edwards’ biggest case, a $25 million verdict against a drain cover manufacturer of a little girl who had her intestines sucked through her rectum by the force of the city pool drain, the economics were in excess of $10 million.
Maybe you don’t think she even deserved that, though. Especially if you think her lifetime of pain from this injury is only worth $250K.
“Maybe you don’t think she even deserved that, though. Especially if you think her lifetime of pain from this injury is only worth $250K.”
According to testimony reviewed by multiple experts regarding that case, the cover to the pool drain was removed by vandals at an outdoor pool, a common problem at public pools. Of course the little girl needs money for a lifetime of medical care, but is someone else always at fault? So if she had lost her intestines due to a congnital malformation, and the surgeon who tried to save them in an operating room was unsuccesful, do you automatically sue that surgeon because “Maybe you don’t think she even deserved that, though. Especially if you think her lifetime of pain from this injury is only worth $250K.”
Anon 6:31, I take risks in my job everyday. Sometimes they work and sometimes my a** is in a world of trouble. My boss trusts me to make educated decisions and he knows I have the best interest of our company, always at the front of my mind.
As anon 6:28 says, most of us laypeople don’t understand the extent of this uprising, between physician’s and lawyer’s. I’ve never filed a lawsuit against a physician, in fact,I’ve never even thought about it.
If it is as bad as what some of you say. If it effects your jobs to the point of CYA in every interaction with your patients, then why not do something to change it? It’s because you can’t. It’s a catch 22 and your stuck in it. To change it would mean you would have to come clean and admit to unnecessary tests and procedures. Ins. companies would be p*****..So, while you aren’t happy with the way you are practicing you know there is no way out. It seems like only one solution would work. One that I don’t want and I don’t imagine you do either. National health care.
There are just to many people who can’t afford ins. and people going without medication to allow this system to continue. Equal (bad) coverage for all is better than only a few getting treated and nothing for the rest.
When it happens, be sure and take your share of the blame for your part in practicing defensive medicine and breaking our ins. system
No, which is why we don’t compensate for accidents, but if you take something from me because you failed to take the proper precautions, be they in your job, in your car, or in your design of a product, or failed to remedy a situation you knew existed, you ought to have to pay for what you took. John Edwards I imagine can appreciate that accidents happen and sometimes no one is at fault, considering he lost his teenage son in one.
As for your vandals defense, there were two other children killed the same way, and there were at least 11 other cases the company quietly settled where the injury occurred same way. But instead of simply requiring them to be screwed in, they gave no warning nor enclosed any screws with the package. Rather, they continued to ship them as snap on covers. Were vandals to be blamed in all those cases as well?
Where did I pontificate about not ordering CYA tests?
Does it matter that my two lawsuits had nothing to do with my failure to perform CYA tests?
Who are all these people called “anonymous”?
Flea
“Who are all these people called “anonymous”?”
A bunch of paranoid doctors who think if we put down are real names the lawyers will find us and have another excuse to depose us.
Flea:
re: pontificate
Please read your 10:47 AM statement
The fact is after-hours while
you were in bed the ER doc was seeing your patient for you (again I am not an ER doc I just respect the $hit they have to deal with)
BTW I wouldn’t be bragging about two suits in a low risk specialty like peds in your relatively short term as a doctor.
PS: Calling yourself Flea gives yourself the same level of identification as CJD. If you printed your name then that is a different story.
Flea, is that REALLY you in the picture?
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