Classic post: The other side

October 2004 – The importance of open communication in cases of medical error:

Mistakes happen in medicine. Lawsuits are bourne out of the public’s expectation and demand for perfection. As advocation for non-economic caps continue, this reader’s letter reminds us that we should continue to be vigilant in maintaining open communication with patients – especially after medical error.

Comments

Anonymous
“Lawsuits are bourne out of the public’s expectation and demand for perfection.”
As long as physicians continue to believe this, they will continue to be frustrated and plagued by what they feel are too many claims.
Anonymous
The public’s expectation and demand for perfection is nothing more than the reflection of the standard put forth by the organized allopathic community when it comes to their members to justify supply side restrictions on the domestic production of providers, which in turn is the sole factor governing the salaries of existing providers and the lack of access to care by the general populace.
Let us not forget the words of the Massachusetts Medical Society:
“[physicians should be] looked upon by the mass of mankind with a veneration almost superstitious.”
If the provider community wishes to maintain the perks of its venerated status incumbent with monopoly control via legislative feat then perhaps it is time that they lived up to the performance aspect of what one would expect from those attempting to pass themselves off as being akin to devinity.
Anonymous
“Lawsuits are bourne out of the public’s expectation and demand for perfection.”
I suppose all generalizations carry a small amount of truth, but I think this one is overwhelmingly inaccurate. Whenever I hear friends and colleagues discuss their medical experiences today, what they EXPECT is long waits, occasional rudeness from overstressed providers, mistakes, and prolonged hassles with billing departments and insurance companies. It’s like a little gift from heaven when things actually go smoothly. Whatever the alleged lawsuits originate from, I seriously doubt it’s an expectation of perfection. We don’t expect that anymore, if we ever did.
Anonymous
I disagree. Perhaps this is not true of the general populace, but there are many patients out there that have unreal expectations. I was counseling a patient for surgery the other day and told her the potential complications, such as an possible disfiguring scar. She was shocked and told me that how is it that I will give her a scar. She honestly believed in the “Star Trek” and “Logan’s Run” type of surgery that does not leave any evidence of an incision whatsoever. There are some patients who are more attuned to their television sets than the real world.
Anonymous
I disagree with the generalization that “lawsuits are bourne out of the public’s expectation and demand for perfection.” I think sometimes it has more to do with the attitude of the physician and the lack of communication.
I’ve written about this before, but what got the physician into trouble in my family’s situation was not the missed fractures on the xray. What got the physician into trouble was his flippant attitude about my grandmother’s pain. She comes into the ER with a history (on record at that hospital) of osteoporosis and broken bones. She is elderly and frail. She c/o excrutiating pain after falling and her leg was starting to swell (that was noted by the nurse in the medical record). The ER physician, doesn’t see the fractures, that the radiologist reading the same xray the next morning sees. The issue with my family is not the missed fractures. The issue is that my grandmother couldn’t walk and was in horrible pain and the doctor told her she was “going to have to call a friend to find a way home.” I could understand if she had a h/o of drug seeking behavior. But, when an elderly person with a h/o broken bones can’t even walk to the bathroom and is in pain, how in the hell do you send her home? An ambulance took her back to her house. She went all night without pain medication and was transported to another hospital the next morning to have surgery for multiple fractures. She’s now recovering in a nursing home. My family didn’t sue, but instead handled it through the medical board. If he missed the fractures, but had taken her pain seriously then it would be much easier for my family to deal with. Knowing that she suffered in so much pain that should have been addressed is hard to stomach. Mistakes happen. But being a horse’s ass when someone is suffering is NOT a mistake.
Samson Isberg
I guess all doctors can tell similar tales; I once tried to tell a woman with a massive hereditary risk of thrombosis (including the Leiden Mutation) and a significant non-hereditary risk (including smoking 15 cigarettes daily) that perhaps elective surgery (in casu sterilization) wasn’t a good idea – only to find her disbelieving me, with the words “It can’t be that dangerous, can it?”.
10 % of humanity – and therefore of patients – are stupid. 10 % of humanity – at least as much of patients – are psychopaths. These make a lot of trouble and are the driving force behind all the lawsuits and the other lawyer’s meat we see around us.
What we as doctors must remember, is that the remaining 80-90 % of humanity actually are decent, reasonable people with legitimate cases and real lives of their own.On this forum (as well as in my own heart from time to time) I see a tendency to extrapolate from the deviant minority to the normal majority. This is doing us all a disservice.
I often have patients from the psychopathic minority, as they tend to seek medical services more often than others – perhaps to alleviate the big hole inside their heads that they must perceive is there – and they used to provoke me in the past. Nowadays (I’m getting old) I can only say to myself: “I’m so happy I’m not married to you, at least I can go home at four o’clock and never see you again; your husband has to take it 24/7 for the rest of his life.”
Anonymous
I see quite a few complaints on this blog when the allopaths find themselves on the defendant side of the legal equation.
I have yet to see any complaint when the same providers are bedding the same attorneys that they cry about when it comes to the personal injury world or the criminal defense world. In regards to the former, we all know the prostitues that the the plaintiff’s attornies can trot out that are willing to opine “to a reasonable degree of medical certainty” that the plaintiff’s TBI, multi-level cervical and lumbar DDD, bilateral posterior horn medial meniscal tears, bilateral supraspinatus tears and CTS were all caused by the 1 oe 2 mile per hour change in speed rear-end impact. All of this comes without any objective evaluation of the underlying history (I have yet to see a provider be able to reconstruct a collision from physical evidence) and is solely based on the “patient said they were asymptomatic prior to the accident” and the ability to diagnose a condition (with no singular unique history). I think we all know that this biased unverifiable post hoc ergo propter hoc illogic is unscientific (in the least). If the word of the “patient” is enough to assess causation in the PI world then the same standard should apply to the med-mal world. Instead, we see a very interesting dichotomy on the reliability of patients and their character as a direct function of the role of the provider as a profiteer/defendant.
In the second instance – the Twinkie Defense, the Prozac Defense, the BS psychiatric excuses for every criminal, thug and child molester in order to avoid responsibility for their actions.
The medical community has a lot of cleaning up to do in their own camp before they can reasonably complain about the legal system.
Anonymous
I agree with the comment above.
The “expert” witness system in our country is a joke.
Doctors make 10 times more money as a lawyer whore “expert” than they make in clinical medicine.
Its a tremendous incentive to lie/mislead juries.
Anonymous
“10 % of humanity – and therefore of patients – are stupid. 10 % of humanity – at least as much of patients – are psychopaths.”
Since all doctor’s are also part of all humanity, should we now consider that atleast 20% of them are either stupid or a psychopath?
That’s 1 of every 5 doctors that is either one or the other. Thats kind of shocking news.
Kathleen
“Lawsuits are bourne out of the public’s expectation and demand for perfection.”
As a nurse of 30 plus years experience, I understand & appreciate the feelings on both sides.
I started out in nursing in the ’70′s. Back then, physicians were still “walking on water”. Our patients were in awe of their vast knowledge & skills – and were dutifully respectful.
That was a time though when physicians communicated more, were more empathetic, held a patient’s hand once in a while, took the time to look into a patient’s eyes & really listen to them.
However, things changed. More & more, we would be at a patient’s bedside and watch as the MD zoomed his way through, barely taking enough time to say hello, much less answer questions.
What the physicians usually didn’t hear though was verbalized feelings of frustration & anger from their patients.
As the next couple decades went by, things get worse. I worked in the home health field then & can’t count the number of times we nurses tried to talk to physicians about their patients, only to be brushed off.
When I finally left the field, it had gotten to the point, they wouldn’t even talk to us. We had to go through the gatekeeper – even when it came to taking orders. It made many of us very uncomfortable & was one of the reasons I finally left.
Between the changes in medicare & the insurance industry, putting severe constraints on everyone, and the hassle with physicians, it just wasn’t worth it anymore.
If it was so hard for us nurses to talk to the physicians, how much more so was it for their patients? How many times did patients feel bushed off? Plenty, I can tell you! We nurses usually got an earful.
Now, things are even worse. Now we all get taped “menues” we have to sit through when we call, and our 15 minute allotment when we visit. Many people feel it’s become assembly line medicine and that makes everyone unhappy – providers & patients alike.
When patients are frustrated, unhappy, and feel like their physician could care less, they are less forgiving of mistakes.
In all my years of nursing, I never sensed that it was perfection patients were looking for. What they are looking for is respect, competency, and caring coming from the people they have to trust their lives to.
Anonymous
“Since all doctor’s are also part of all humanity, should we now consider that atleast 20% of them are either stupid or a psychopath?”
I don’t know if I agree with the stupid part (med school/residency tends to weed out that crew), but 10% psychopath…definitely. I rarely interact with other docs after hours. I tend to gravitate to real people not pompous asses. Lord knows the process tends to interst the pompous and nutty (though smart).
Kathleen:
See my post above. I tend to agree that a subset of docs do brush off RN’s professional opinions. They don’t realize (especially in the inpatient setting) YOU are the primary caregiver not us. The time constraints in medicine are getting worse and worse, exacerbating a bad situation. Medicare is making it harder and harder on docs, patients, and RN’s. The only time I get irritated is when an RN is trying to force my hand by playing “doctor” in a circumstance when I clearly know they are wrong.
Samson Isberg
Sure, at least 10 % of physicians (at least where I work and live) can be classified as psychopaths.
I have long asked for the med schools to find a way to keep them out, but in vain. Instead they are allowed to prey freely on the public.
But the present system doesn’t weed them out either. On the contrary, psychopaths can take any criticism, trial, warning and downright abuse without feeling bad about it, as it is (they feel) always someone else’s fault.
Normal people, on the other hand, are dropping out of medicine, scaling down their practices, being burned-out or changing into what they perceive as low-risk specialities. Some migrate to other countries where they can practice medicine with a measure of fulfilment denied to them in the developed world. And, tragically, as we have seen, some commit suicide.
So the present system is an evolutionary experiment where doctors with normal sensitivities are systematically being weeded out, while the medical psychopaths remain working, happy and carefree. If they are really squeezed, they can relocate to another state and even change their names.
Anonymous
“In all my years of nursing, I never sensed that it was perfection patients were looking for. What they are looking for is respect, competency, and caring coming from the people they have to trust their lives to.”
Let me say as a patient, thank you Kathleen.
My aunt retired early from nursing for the very same reasons you mention. She particularly disliked working with her hospital’s surgeons, whom she felt as a group had serious attitude problems (the “tin god” thing).
Maybe today’s nursing shortage will help turn things around so that nurses get treated better and a little more humanity is brought back into medicine.
Anonymous
http://www.psqh.com/mayjun06/dun.html
Perhaps this link will help. I, also, thank you Kathleen. You are completly accurate in your analysis.
–dag–
Anonymous
Great link. Lots of wisdom there. Thanks.
Anonymous
Kathleen, thank you.

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