In my group which has a large database, a physician will get sued on average about every 5000 patient encounters, or once every 2.2 years. Most case I know have very little liability. The percentage I don’t know….no one does. My guess is 90% of cases on aregular basis pose little liability. That leaves about 1/500 of high risk cases will result in a suit. A middleaged person with chest pain is one of those high risk cases.

We do know more about our job than you think we do.

No wonder Frist was so confident in his diagnosis – he actually saw the patient.

“Because of the 1% uncertainty and liability concerns the whole system is clogged up looking for that elusive MI, PE, aortic dissection, etc…..”

Tell me chucky, what are the actual liability risks to the physician in this situation?

“…and it’s better to get 1000 complaints about the big bill or long wait to get a room or inconsiderate staff than one letter from an attorney saying “you have been sued.” “

What’s funny is that you’ve got it exactly opposite here scalpel. Study after study by physicians has shown that if you’ll just talk to your patients, and improve the level of customer service, they are much less likely to consult an attorney regardless of outcome.

I realize this goes against the physicians’ belief that more tests equals less liability risk, but that was always an anecdotal assumption not grounded in any hard facts anyway.

It’s amazing that as scared as all of you seem to be that you haven’t taken more time to learn exactly what you’re so scared of or how to reduce your exposure.

SOC was met. Sounds like she got the PE work up too. In a rational country you can practice medicine using some clinical judgement. You do the appropriate complaint related H&P and determine that she is low risk. EKG is normal, even lower risk. Depending on index of suspicion may or may not do markers. But not in this lawyer crawling, blame crazy country. Here you admit them all, rule them out with enzymes, rule out PE and every other zebra along the way wasting resources, clogging ED’s and hospitals.

If this is correct, as long as the gave her aspirin and the protein markers did not indicate MI, it would seem as if the standard of care was met.

Thanks for the helpful paranoid reminders and why defensive medicine is the name of the game. Hell, if you are reading this right now and feeling fine you ought to go down to the local ER and get ruled out anyway.

*2-8% of pts presenting to the ED with CP are sent home with AMI.

*H&P and EKG miss 1-4% of all AMIs

*Serial EKG has a sensitivity and specificity (Sn/Sp) of 21-25%/92-99% for Acute coronary ischemia (ACI) and 39%/88% for AMI.

What about enzymes? Here ya go:
*Single Creatine kinase (CK): Sn/Sp of 37%/87% for AMI; Serial values have 66-99%/68-84% Sn/Sp.

*Single CK-MB: Sn/Sp 42%/96% for AMI; serial CK-MB-79%/96% for AMI.

*Myoglobin, single: 49%/91%; serial 89%/87% Sn/Sp for AMI.

*Troponin I single: 39%/93% Sn/Sp; serial 93%/85% Sn/Sp for AMI.

What about Echo? Here ya go:
*Rest Echo Sn/Sp: 70%/87% for ACI, 93/66% for AMI.

*Rest technetium-99 sestamibi: ACI Sn/Sp: 81/73%, 92%/67% for AMI.

*Exercise Stress testing for ACI:
-w/EKG alone: 68%/77% Sn/Sp.
-w/Echo: 85%/77% Sn/Sp
-w/thallium-201 or Technetium-99m sestamibi: 87%/64%.

Ripped from Rosen and Barkin’s 5 minute emergency consult.

It is not as simple as just saying “Your not having a heart attack”

Seems that the assumption is that there is something wrong with the patient wanting to be treated or released, but not left in holding for hours on end. I sure don’t see anything wrong with that.

I am reminded of the only time I have been to an ER (exept that time on LifeFlight) as an adult. Vomiting, lots of diarhea, obviously something wrong. Small community hospital, only three other people waiting. I was left to puke and poop all over myself in a waiting chair to what I am sure was the great horror of my fellow three waiting patients for almost an hour. Then I got triaged and sent BACK to the waiting area to spew more bodily fluids in front of and almost on those poor strangers. Hey, at least I had gained a basin to puke in from triage. Didn’t help with the feces all over me and the chair and the floor.

Another hour later I am taken to a bed. I am one of only four patients in beds. There are TWELVE empty beds in the ER. I counted. There are SEVENTEEN staff members sitting around the nurse’s station. Two of them are ACTUALLY reading novels. Within 30 minutes I had used all the toilet paper in my shared bathroom and had started in on the paper towels. I asked for toilet paper. I asked for toilet paper again. Within another 30 minutes I just gave up and wouldn’t even try to get back to bed because I couldn’t begin to clean myself.

When a tech finally came to get my blood she insisted she couldn’t take it in a bathroom while I was puking and pooping because it wasn’t “sanitary”. And SHE wouldn’t get me any toilet paper, either.

Folks, the problem isn’t always the patient.