"No matter whether you win or lose, you die a little with every case"

Indeed:

Although 70 percent of malpractice cases are either dropped or dismissed by the plaintiffs, being sued exacts a terrible toll. I won my own case at trial in 2002 after six years of litigation, but not a day goes by that I don’t think about what I lost in the process in terms of the weeks spent reviewing, preparing, educating lawyers, being deposed and finally going to trial.

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  • Anonymous

    That doc says that whenever he scripts a med, he sits down and explains all the possible side fx and complications of hte medicine.

    I call bullshit on that.

    There is no freaking way you have time to talk about all the possible side fx. Maybe you have enough time to talk about the 5 most common ones, but most meds have a laundry list of at least 30-100 possible side fx. No doctor I have ever seen has talked about all those side fx.

    Lawyers love this fact, its a big lawsuit winner for them. They can argue that its the docs responsibility to thoroughly explain the 78th most common side effect for a given med. Never mind the fact that this side effect only presents in 1 out of 5 million patients, docs are expected to cover every conceivable side effect scenario.

  • Gasman

    Bad documentation is a problem for litigation; fraudulent entries, backdating and other obvious missteps should be avoided.
    But let’s be serious, no one pays us to document sufficiently to keep the legal system at bay. The insurers squeeze us with documentation demands, refusing to pay if we don’t jump through all the hoops, but that’s not the same as paying us to perform non-productive work. Charting for lawyers is non-productive 99.9% of the time. No matter how meticulous one is, when the suit hits the fan, there will almost certainly some hole in the charting that a lawyer with medical consultants spending hundreds of hours on can find in a chart we spent 5 minutes on. It is impossible to outmaneuvre the legal system on documentation because of the nature of the asymmetrical warfare.

  • Anonymous

    Somewhat related to the documentation subject… I recently read a letter to the editor by a health care consumer advocate who recommended that patients obtain and review copies of their medical records to make sure they’re accurate.

    I’ve also read numerous articles over the past few years, both by consumer groups and medical professionals, calling for patients to take a greater role in their health care by coming to consults prepared with questions, asking more questions of providers, etc.

    Particularly in regards to the records, I wonder if this doesn’t just set patients (like myself) up to become unnecessarily alarmed. We are not doctors, don’t understand medical technology or jargon, what’s acceptable or unacceptable. Even while these groups are telling us to get involved, they’re not educating us about you, the doctor, and the environment in which you work.

    Seems to me that this creates a “bull in the china shop” situation which does neither the patient nor the doctor much good.

    Does the medical community have any feelings about this? How does a patient become educated enough about the medical environment to participate without becoming a hindrance or nuisance?

  • Anonymous

    Very good question, anon 8:34. I guess I would approach it as if I were hiring a contractor to build my home. I would check his/her credentials at the appropriate professional societies and most importantly, I would go by local community recommendations. And then when the contractor I have chosen recommends a certain way to build the house, I would ask appropriate questions and render appropriate opinions. However, if it comes down to leaving it in the hands of the contractor because he/she knows better, then I have chosen this person to do what’s right. Medicine, like accounting/contracting/law/etc., is a specialized field. One cannot expect laymen to understand all the nuances in that field, otherwise, why not build the house yourself? It will come to a point where one will have to rely on the professional judgement of another.

  • DNR Bflo

    I call bullshit on a lot of his suggestions! “Make referrals happen.” Apparently he doesn’t live in an area with a shortage of high-risk specialists. Try to find a pain management doc who takes medicaid here! “Close the loop on test results.” Good luck with that in a poorly staffed group primary care practice. Part of the reason I left was because I knew things were falling through the cracks. I can find the breast mass and order the mammo/ultrasound and refer to the specialist for biopsy…but is it my job to call the specialist’s office to make sure they showed for the appt? In one month I had two women with likely breast CA who, despite a long chat about the seriousness of the situation, failed to show for the biopsy and went to a naturopath instead. The no show letters? Took a month. Who’s getting sued down the line when there is a bad outcome? Bet it isn’t the naturopath.
    This guy needs to come to grips with the reality of primary care today.

  • diora

    One cannot expect laymen to understand all the nuances in that field, otherwise, why not build the house yourself?
    I think a patient doesn’t need to understand all the nuances of the whole field – only the very small subset that concerns him/her. I think it is possible to learn about one very narrow problem more than a professional that has to know about a lot of things about many different conditions. Especially if a problem is relatively rare.
    But one needs to know where to look e.g. NIH, papers in medical journals, etc. and be very thorough since often something reported yesterday is shown to be wrong today and sometimes there are disagreements between experts. BMJ articles often have “rapid responses” which I find fun to read because they show how often something there are flaws in studies media is very quick to report on and how often there are really disagrements between experts. As far as being a nuisance – I often find an answer to my question by just looking, so I rarely need to bother a doctor with it.
    If I have a concern, I bring it up, but I usually try to sumarize it in one or two sentences. But most of the time I just find the information I was looking for. I think my regular doctor doesn’t even know how much I read. I only asked him once “I read on the NIH website that people with X are at higher risk of Y, shall I be concerned about it?”. He explained to me why I shouldn’t worry about Y — the whole conversation took about 30 seconds.

    When it comes to medications, I don’t expect the doctor to explain every side effect to me. I do, however, make a habit of reading the drug package inserts. If a drug is prescribed for a short period of time for a real problem, I don’t worry too much – I simply pay attention to how I feel. But if I am concerned about a side effect for a long-term medicine, I try to research on the internet how often a particular side effect happens. There are real studies on the web and there are tables with percentages comparing drugs with placebo. I also check out if there are alternatives to the drug and the differences between them. For preventive meds designed to reduce risk, I find out what the absolute risk reduction is for me personally not some meaningless relative numbers doctors love so much. If I don’t feel that for me personally benefits outweight the risks, I just say to the doctor “I don’t want it”. My choice, my responsibility. So I don’t think I am a nuisance.

    It will come to a point where one will have to rely on the professional judgement of another.
    If I were to have a serious illness and it was a question on treatment, then absolutely. I would probably still try to find out everything about it, but mostly I’d use the internet only to find information about doctors, maybe a particular clinic, etc.

    But for preventive and minor things — forget it. With all the defensive testing you guys do, we can no longer blindly trust you. In order for us to be able to say “no, thanks” we need to have at least some idea of what is really necessary. Also, often you guys deliberately mislead us by using meaningless statistics (e.g. relative risk reduction numbers, cumulative life-time risk, etc.) instead of NNT or better yet absolute risk reduction based on our personal 10-year risk. So, it is a little different from a contractor.

    If I am interested in a specific condition or if a specific test/medicine concerns me, I read everything I can about it. I don’t bother with vitamin-selling sites, but go directly to places like NIH or/and abstracts of articles in medical journals. I have a bit of advantage because I have a math background and papers describing studies is more about math than medicine.
    I don’t usually bring it up to doctor’s attention unless I have concern in which case I try to summarize it in one or two sentences.

    For example when it comes to medications I make a point of reading all of the side effects listed in the insert that comes with the medicine. Since most of the listed side effects are usually very rare, I

  • Anonymous

    I get copies of all my records, procedures and surgeries. I don’r care if I can’t understand all of it. I have a pc. If there is something I don’t understand I can sure find in laymens terms fast enough. They are my records I surely have a right to know everything about my own medical conditions.

    Also, if a contractor is building or working on my house, I certainly will expect all reports from him, including a copy of the blueprint that I couldn’t begin to understand. If I’m paying 300,000.00 to have a house built you bet your a** I want paper documentation and whoever gave that hideous explanation also wants his documentation.

  • Anonymous

    If patients are going to be advised to check out their records, they probably should be informed about what to expect from them. Medical records aren’t tidy narratives, and they have their own methodology.

    The first time I saw mine, I got a little upset that all my responses to the typical questions (such as, “Are you feeling any pain?”) were recorded as “Pt. denies.” That sounded to me like “patient may well be having pain but the b**tard is probably lying about it.” But medical practioners have been using that phrasing since dinosaurs walked, and getting upset about unintended connotations seems like a waste of everyone’s time.

  • Anonymous

    I’m wondering how realistic it is to expect documentation that (1) is useful to the practicioner; (2) can be understood by the layman; and (3) is sufficiently ironclad to satisfy any attorneys involved on both sides.

    If as a patient I have a choice between getting more face time with my doctors OR putting them and their staff through that kind of bureaucracy, I think I’d rather have the face time…

  • Anonymous

    “is sufficiently ironclad to satisfy any attorneys involved on both sides.”

    The documentation is NEVER sufficent to satisfy the attorney’s. Why? Beacuse it is a big game of “monday morning quarterback” to these jokers. Any doc who has ever been named in a claim knows exactly what I am talking about.

  • Anonymous

    “Lawyers love this fact, its a big lawsuit winner for them. They can argue that its the docs responsibility to thoroughly explain the 78th most common side effect for a given med.”

    Can you give us an example of a case where any of the above is true?