Medical malpractice deposition survival tips for doctors

An excerpt from How to Survive a Medical Malpractice Lawsuit: The Physician’s Roadmap for Success.

by Ilene R. Brenner, MD

The most important part of your case is upon you: the pretrial deposition. If you do a poor job, you can ruin your case and make a defensible lawsuit become indefensible.

So what is a deposition? It is the sworn testimony of a witness taken before trial, in a location that is out of a court setting, without a judge present. Still, the witness is placed under oath, a court stenographer records the testimony, and if necessary, translators will be present.

It is the practice in most states that the plaintiff and all defendants have depositions taken prior to trial. In addition, there may be a deposition of the plaintiff’s spouse. Some states permit the deposition of experts and some states do not.

The deposition process consists of meeting with plaintiff’s attorney face to face while they question you for as long as it takes in an attempt to lock in your testimony and to try to prove their case. The plaintiff’s attorney can then use what you say to frame questions at trial. Contrary to what you may think, the deposition is rarely for your own benefit. It is not there to clear up the facts so that the plaintiff’s attorney can realize just how wrong they were for suing you.

There is a common misconception amongst physicians that if they explain things well, their intelligent responses will prove to the plaintiff’s attorney that the whole thing is a mistake. They may also think that they need to explain their defense clearly and completely to the plaintiff’s attorney. However, as will be detailed later on in the chapter, a general rule is, “the less you say the better.” Since there is the potential to do significant damage to your case, it is critically important that you perform well; otherwise you may be forced to settle an otherwise winnable case.

Preparing for the Deposition

Your first step in your preparation is to meet with your attorney to explain the process.

Some attorneys hire trial/jury specialists to help you. Frequently, attorneys supplement their own preparation with these experts who get you ready for your deposition and trial. If you are given the opportunity, use it. If not offered, ask if this is possible.

Few attorneys spend the time and effort required to make sure you are “ship-shape.” If your attorney doesn’t prepare you adequately for your deposition, you will likely perform poorly (especially if this is your first time). A preparation expert can fill in the gaps and give you the extra confidence you need to do a great job at the deposition and trial. I have found that even if it is only one or two things they tell you that helps you, it is worth it.

Know your strategy for dealing with co-defendants.

At the time of the deposition, all co-defendants should be cooperating with each other. Even if you think one of your co-defendants committed malpractice, this is not the time to mention that fact. Keep that information to yourself until backed into a corner where you have no choice but to reveal that. Why? You don’t want to help the plaintiff’s case at all.

You might think that revealing this information might get you out of the case leaving only the “true guilty party.” Wrong. Turning on your co-defendant won’t help you get out of the case. In fact, it will likely ensure your staying in the case because your co-defendants’ finger will now be pointing directly at you. Thus, you will fall into the trap set by the plaintiff’s attorney; sue everybody in sight and have them turn against each other so as to get money from at least one of you. Work with your co-defendant(s) and provide a united front. Do your best not to say anything that could make the other look bad; though of course make sure that whatever you say is within the confines of truthful testimony.

If you have a corporate entity, such as your boss’s company, as a co-defendant, it is to your advantage to do and say anything your attorney recommends to help get them dismissed from your case. For instance, if you have independent contractor status, there are legal tactics that can show that your boss is in no way tied to any possible medical malpractice on your part. While this may seem like you are getting the shaft in favor of your company, it is to your benefit to separate yourself from them. This is an important part of your case, as jurors like to award money to plaintiffs when a corporation is involved. The last thing you want is to have jurors in a mood to award money.

Make sure you understand well the basic medicine components to your case.

If you are wrong on the medicine, it will not matter what your defense is. All may be lost and you have not even started the trial. Now that you’ve met with your attorney (as opposed to before), go ahead and do your research and make sure you’ve got the medicine correct. Your research is protected by attorney-client privilege, and thus, is not discoverable by the plaintiff’s attorney.

Be aware of subsequent treating physician testimony/documents, but DO NOT read those documents yourself.

I know on the surface this doesn’t make much sense. However, think about what I just said about less is more. The more you have read prior to the deposition, the more you can be asked about.

There are many circumstances where knowing information about subsequent treating physician testimony/documents can be helpful to you. For instance, in the instance of a heart murmur, you might not have documentation that specifies heart sounds. It is likely you don’t remember if you heard one or not. However, if asked if you heard a heart murmur, you might be inclined to say “no,” since it was not specifically charted. If you were to then find out that the cardiologists who saw the patient subsequent to you all heard murmurs, you might want to finesse your answer so as not to look incompetent. In this case it would be better to simply say, “I might have, but it is not explicitly documented.” Sure, this shows you didn’t document your exam perfectly, but it prevents you from saying something that is clearly opposite to subsequent expert physicians.

So how do you know what is in documents you never read? That is where your attorney comes into play. Your attorney will read those documents. And they can inform you of any information they deem important. That way if asked if you have any knowledge of subsequent treating physician testimony or documents, you can say, “only what my attorney told me.” Boom! Attorney-client privilege is now brought to light. The question is objected to, and you cannot be asked about anything that your attorney told you.

Choose an appropriate location.

Your attorney’s office is the best place to have the deposition. But it really can be at the courthouse, plaintiff’s attorney’s office or in any conference room. Do not host the deposition in your office or hospital as anything in there, such as diplomas, books or journal articles could become fodder for questions by the attorney.

What should you wear to your deposition?

You want to look clean, neat and professional. Nothing flashy. You want to look “put together,” like someone who will make a good impression with a jury. You’d be surprised how many physicians disregard this basic rule. In fact, I have heard of many instances where the physician puts up a big fight to try to get out of dressing nicely to the deposition. Yes, it is stupid. Yes, it is superficial. Are you going to lose your case because you decided to wear jeans and a t-shirt to the deposition? Not necessarily.

However, you might end up going to trial on a case where you might previously have been dropped. This is because some plaintiff’s attorneys sue everyone in sight and use the deposition as a fishing expedition. If the plaintiff’s attorney thinks you will come off poorly on the stand, they may keep you in the case hoping your poor performance will make them money.

Thus, the need to dress nicely is not to be underestimated. At a deposition, you are being judged by your words and by your appearance. The plaintiff’s attorney is watching you closely; don’t give them anything with which to find fault. Though you don’t have to wear a suit, you do want to look sharp. If that means buying a new outfit for the occasion, then do it. That extra expense pales in comparison with the consequences of a lost medical malpractice lawsuit.

Ilene Brenner is an emergency physician who blogs at Dr. Brenner’s Thoughts on Healthcare, and is the author of How to Survive a Medical Malpractice Lawsuit: The Physician’s Roadmap for Success.

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  • TrenchDoc

    Very good advice and unfortunately from my experience it is dead on. The discovery deposition will be used at trial to impeach your credibility. It is not about the truth coming out but the side that convinces the jury that their story is more believable will win. That is why anyone who goes into medicine now in this current malpractice environment is nuts. There are more rewarding carriers for your talents and intelllect.

  • http://www.CareerMedicine.com CareerMedicine

    It does show the corrupt system of medical malpractice which is nothing but a God Rush for many attorneys- unfortunately! And then there is no mention of Tort Reform in the current Healthcare bill. I have seen physician colleagues of mine spend hours in answering these deposition questions rather than patient care. One of my friends had decided he would change professions if he ever got sued. He did get sued and he did change professions even though the suit was later dropped before trial.

  • http://supremacyclaus.blogspot.com Supremacy Claus

    This is the best article ever written on the defense deposition.

    http://forthedefense.org/CD/Public/FTD/2006/July/2006%20July%20FTD%20-%20Simply%20Positive%20-%20Preparing%20Witnesses%20for%20Deposition.pdf

    I suggest every doctor read it 6 times, and take it along to the preparation for the deposition with the defense attorney. No doctor should be deposed without undergoing a rough rehearsal with his own attorney, asking the likely plaintiff questions. Although the lawyer cannot propose any answer, the lawyer can give the likely consequence of each sort of answer, based on case law, statute, and personal court experience.

    Two take home messages, among many:

    1) You are not in a conversation in the deposition, however friendly the opposing lawyer comes across (far deadlier than the hostile, frustrated lawyer). You are dictating answers into an eternal, permanent record, to be used against you until you are dead. Therefore long pauses and consideration of alternative answer in one’s mind is completely warranted. The plaintiff attorney will never demand faster answers. Unless being videotaped slowness of responses will not be reflected in the transcript.

    2) If the plaintiff attorney starts to get inappropriately nasty, think of a recalcitrant child, and manage that behavior accordingly, with patience but firmness.

  • MillCreek

    Speaking as a healthcare risk manager who has helped prepare hundreds of clinicians for depositions, and been deposed several times myself, this was a pretty good article on dep prep.

    Over the years, I have become a fan of having the jury/witness prep experts have a session with the main defendants. In most cases, they videotape the prep sessions, and that can be a real eye-opening exercise for a clinician to see how they come across.

  • Matt

    “Even if you think one of your co-defendants committed malpractice, this is not the time to mention that fact. Keep that information to yourself until backed into a corner where you have no choice but to reveal that. Why? You don’t want to help the plaintiff’s case at all.”

    Well, at least we know longer have to hear physicians yammer on about how they’re all about “truth”, and how they wish people with meritorious claims could get their claims resolved sooner.

    • Bob

      Truth has nothing to do with a malpractice lawsuit.

      Physicians lose cases without any medical malpractice having occurred, and thus, even if they’re completely innocent, have to do EVERYTHING in their power to avoid a career ruining award or settlement. I would love to have a system where there can be compensation for true malpractice without the current system’s goldrush and smear campaign. That system currently doesn’t exist, and unless you want your premiums to rise even faster than they already are (guess who ends up paying for higher malpractice costs? The patients), then you should support physicians doing whatever necessary to win frivolous malpractice cases.

      • Matt

        And physicians win cases when they have committed malpractice. No system involving humans is infallible, you know that.

        My healthcare premiums don’t change that much based on your malpractice premiums. CMS barely puts any weight at all on your malpractice costs as it has noted that it represents on average less than 5% of your overhead. You don’t really have the ability to pass that cost on. Hell, the physician class actions against the health insurers where they’ve collected tens of millions have probably had more effect on my health premiums. You want to abandon those?

        And while I do support physicians doing whatever necessary to win FRIVOLOUS cases, you didn’t read the quote very well. The quote is to shut your mouth even if you KNOW another defendant committed malpractice.

        Which is fine, I guess, but let’s not hear anymore sanctimonious speeches about how everyone else is out for money while physicians are interested in truth.

        You’re wrong about one point – the truth is what the whole point of a trial is about. Determining what happened and if it’s actionable, and what the actual value of the loss is. Now, you may not always agree with the outcome, and you may think there is a better process for discovering it, but that’s the point of the trial.

  • http://www.notebookingdiscovery.org/wordpress Alice Robertson

    quote: There is a common misconception amongst physicians that if they explain things well, their intelligent responses will prove to the plaintiff’s attorney that the whole thing is a mistake. [end quote]

    Isn’t that why a lawsuit is filled? An unresolved mistake was made, although, I realize what you are saying, I just found that line of interest. This is excellent advice to defend yourself, but the part about co-defendents being on the same page seemed only advantageous if something really did go wrong…..maybe a bit disingenuous? I am for torte reform and will state upfront that frivilous lawsuits are a huge problem, and should possibly even be penalized in some fashion……but……..that’s for another day.

    From a patient’s perspective this is perplexing because doctor’s do make mistakes, and if they would just fess up and apologize to the blatant ones the public perception of them would improve. I don’t know……it’s just discouraging to know that when you enter an office you are seen as a potential lawsuit (which should cut down on mistakes, but it certainly doesn’t help the patient trust the doctor they are going to depend on for often life-threatening treatment. You long to trust the doctor, and like them, but sometimes you sit there and feel an invisible blanket separating the two of you. You are terrified because you need them, and they are often standoffish because of lack of trust and probably their own sanity……but the really dismaying part is the doctor’s fear of their employer).

    What I am trying to say is that as a patient reading this it would seem between-the-lines the doctor’s ideal is not to fess up if he made a mistake. Form teams, get your act together, make sure your stories match, but what if…….really what if…. the patient really was harmed? It is said doctors will rarely rat on each other because then their own reputation goes down the tubes. If that is true, or if it’s true that contractual issues keep them from being blatantly honest this article just gives patients more fuel to add to their fire that doctors are a band of men hell bent on covering their mistakes.

    I am sincere when I ask (alert…….Alice is seeking a blatantly honest physician to help her crack the code……doctors seem to have their own Rosetta Stone type of language that only they understand and they often want to keep it that way) why won’t doctors just admit their true errors…..the blatant ones (I know…….I know…..it opens up a lawsuit possibility……but what if in their humanness, forgiveness and public perception is changed by their own humility)? One wonders what is more important……the truth…..or a doctor’s insurance rates….career……etc. All these are important issues, but nothing trumps the truth.

    Instead of a good defense it just seems in the simplest of terms an apology would be worth the risk, and help heal a hurting heart…….because everyone reading this knows the bottomline is in their humanness doctors do err. Surely, there is a better way to deal with this than covering up, because if we tell the truth we really don’t need articles like this.

    If the public perception of doctors is ever going to change it’s going to take doctors being a bit less defensive and not using a gang-type of mentality of covering each other’s mistakes. The patients suffer from stigmas, and they know it, and we don’t like falsified lawsuits whether it be lying patients or doctors. I am flustered that both sides are worried about money, while the patients seem to take on the stereotype as the wrongdoers. Both sides have issues and only blatant honesty will cure this ill.

    Why is the truth such a novel idea in this debate? Considering the subject at hand is healing.

    • Bob

      “I am sincere when I ask (alert…….Alice is seeking a blatantly honest physician to help her crack the code……doctors seem to have their own Rosetta Stone type of language that only they understand and they often want to keep it that way) why won’t doctors just admit their true errors…..the blatant ones (I know…….I know…..it opens up a lawsuit possibility……but what if in their humanness, forgiveness and public perception is changed by their own humility)? One wonders what is more important……the truth…..or a doctor’s insurance rates….career……etc. All these are important issues, but nothing trumps the truth.”

      You’re right, that in an ideal world physicians, who do make mistakes like any other human, would be able to admit their fault, apologize, and offer some form of recompense to those they have wronged. Currently, this is a fantasy, however, nothing more.

      The vast majority of malpractice lawsuits have no malpractice. The vast majority of malpractice never gets sued over. The largest factor in determining whether a malpractice case is won or lost is not whether or not malpractice was committed, it is the amount of “damage” sustained by the defendant, regardless of physician fault.

      In this current system, to admit fault is to invite a lawsuit. To invite a lawsuit is to irreversibly damage your career, for which you have sacrificed a minimum of 11 years of post-high school education (leaving you hundreds of thousands of dollars in debt with no other significant employment prospects outside medicine). That means that for any doctor to survive, they have to cover their ass through defensive medicine, endless documentation, and hiding mistakes.

      Nothing would make me happier than to restore the doctor-patient mutual trust, which I feel is extremely important to quality health care. This can be done in a variety of ways, whether it is through special health-care courts or “no fault” admissions of malpractice. The fact of the matter is, however, that under current conditions, any physician must view every patient as a potential lawsuit. Wishing it weren’t so doesn’t change anything, only lobbying and legislation will (and it’ll take a lot, because congress is largely made up of lawyers, who don’t want to piss off their trial lawyer colleagues or lobbyists.)

      • Matt

        “The vast majority of malpractice lawsuits have no malpractice. ”

        Studies have shown that this statement is incorrect.

        “In this current system, to admit fault is to invite a lawsuit. To invite a lawsuit is to irreversibly damage your career, for which you have sacrificed a minimum of 11 years of post-high school education (leaving you hundreds of thousands of dollars in debt with no other significant employment prospects outside medicine). That means that for any doctor to survive, they have to cover their ass through defensive medicine, endless documentation, and hiding mistakes.”

        Likewise, this paragraph is incorrect. No one knows if apologizing and admitting error reduces or increases your change of getting sued, because it’s rarely if ever done by physicians. Nor is one’s career “irreversibly damaged” are there are physicians with multiple PAID claims, drug convictions, etc. still practicing and making a good living. Finally, hiding your mistakes is the most foolish thing you can do. If you think the damages are high when you screw up and admit it, what do you think they are when it’s discovered you’re lying about it?

        “The fact of the matter is, however, that under current conditions, any physician must view every patient as a potential lawsuit. Wishing it weren’t so doesn’t change anything, only lobbying and legislation will (and it’ll take a lot, because congress is largely made up of lawyers, who don’t want to piss off their trial lawyer colleagues or lobbyists.)”

        More nonsense. That’s no more true than you have to treat every person you sign a contract with as a potential litigant, or every person you see on the highway. And what’s more, because Congress has people with law degrees in it doesn’t mean they have any particularly love of those who have represented plaintiffs in civil actions. There are more physicians in Congress than attorneys who have represented individuals like you and I in civil lawsuits. If they have actual litigation experience (and many just have the degree, it’s usually on the defense bar or as a prosecutor)

        • http://www.kevinmd.com Kevin

          “The vast majority of malpractice lawsuits have no malpractice. ”

          “Studies have shown that this statement is incorrect.”

          ***

          The initial statement needs to be revised to: “The vast majority of malpractice lawsuits cannot be attributed to the negligence of physicians.”

          According to a NEJM piece written by Hillary Clinton and Barack Obama: “We all know the statistic from the landmark 1999 Institute of Medicine (IOM) report that as many as 98,000 deaths in the United States each year result from medical errors. But the IOM also found that more than 90 percent of these deaths are the result of failed systems and procedures, not the negligence of physicians. Given this finding, we need to shift our response from placing blame on individual providers or health care organizations to developing systems for improving the quality of our patient-safety practices.”
          http://content.nejm.org/cgi/content/full/354/21/2205

          The current malpractice system fails to incentivize improving the failed systems and procedures, which account for the majority of medical liability.

          As the Clinton/Obama piece states, individual physician negligence accounts for only a minority of malpractice.

          Kevin

          • Matt

            ” “The vast majority of malpractice lawsuits cannot be attributed to the negligence of physicians.””

            You didn’t make your case. I think you meant to say “The vast majority of malpractice cannot be attributed to the negligence of individual physicians.” Your quote says nothing about lawsuits, or even claims. Of course, physicians are usually quick to criticize the methodology of that IOM study, so I’m surprised to see you seize on it, much less seize on a politician’s interpretation of it.

            “The current malpractice system fails to incentivize improving the failed systems and procedures.”

            An odd criticism, considering that is not the goal of a civil lawsuit that doesn’t involve punitive damages. It’s like criticizing medical providers for not developing safer cars.

            Although, it seems strange to suggest, as you often have, that physicians do all kinds of defensive medicine to avoid lawsuits.. Yet then you turn around and state that there are systemic errors whose repairs are not incentivized. Why does the apparent incentive of avoiding malpractice claims only cause you to act in a way that you’re not sure helps, if you KNOW where the errors are? Wouldn’t it make more sense to spend your time that you currently spend doing “defensive medicine” on fixing those systemic errors?

          • Matt

            One other interesting note, Kevin, the study you linked very clearly contradicts Bob’s “clam up” and “patients are hostile” advice to resolving potential claims.

          • http://www.kevinmd.com Kevin

            Agreed.

            Kevin

          • Matt

            I too agree we need more fairness. Please let me know how we can make it more fair for those injured by malpractice to have their damages paid faster and with less cost to them.

          • http://www.kevinmd.com Kevin

            No-fault.

            Kevin

          • Matt

            Great, where do I find this legislation? AMA backing it? Any other physicians groups backing it?

            Also, when you say “no-fault”, so do you mean any adverse event that occurs under a physicians’ care gets compensated? All one has to prove is where the injury occurred?

          • http://www.kevinmd.com Kevin

            You asked, “please let me know how we can make it more fair for those injured by malpractice to have their damages paid faster and with less cost to them.”

            I simply answered your question. No fault medical malpractice satisfies both those criteria. Why don’t you join me in convincing other physician groups to back it?

            Kevin

          • Matt

            You didn’t really answer the question, because the term “no-fault” isn’t really defined in terms of how you would enact it and how it would apply, so it’s impossible to say how much more “fair” it would be. How can I get behind something so vague?

            Perhaps if you can point me to the legislation that you’re supporting. Then we can see the details and see if this is truly the same old-same old “reform” or something new.

          • http://www.kevinmd.com Kevin

            For the sake of argument, let’s say I agreed to a no-fault malpractice plan based completely on how you define it. I’ll agree to all your conditions.

            Would you then support a no-fault approach and help me convince the AMA and other physician entities?

            Kevin

          • http://supremacyclaus.blogspot.com Supremacy Claus

            No fault, workmen’s comp style medmal system would be catastrophic, and explode legal costs. People with moderate, temporary injuries would start filing claims. Today, only people with extreme injuries are entering the medmal system. Most are from bad outcomes not from physician negligence.

          • Matt

            I would want to know the cost first. If it made fiscal sense I’m with you.

            The only hesitation I have would be that it might open the door even further for single payer. I guess one could argue though that the door is already wide open so what’s another inch.

          • MillCreek

            For those advocating the no-fault approach, the experience of Sweden, Denmark, Finland and New Zealand should be studied first. They have some appealing features, but note what happens when the number of claims required additional assessments on healthcare providers to fund the no-fault compensation scheme.

            Studdert and Brennan are fans of the Swedish approach but admit that the bar on filing lawsuits makes acceptance problematic in the US.

    • http://drbrenner.blogspot.com @irb123

      Alice:

      I wish you could read my whole book. If you did, you would see the “true” definition of malpractice (that is, how the law defines it). And mistake is not one of them. Humans make errors. Most bad outcomes that lead to a lawsuit are statistically expected realities and not even errors. Malpractice is much bigger than that. Malpractice means that you deviated from the standard of care, and that care was the exact reason for the patient’s damages. (lawyers don’t get on me about the lack of legalese, i’m explaining the essense, not the intricacies)

      Lawsuits tend to be filed because a patient did not have a good outcome, and because they were angry. Sometimes there is malpractice as a cause. Oftentimes, there is not.

      I am not espousing that doctors cover each other’s mistakes. Co-defendants need to be on the same page at a deposition because plaintiff’s attorneys often have sue everybody in sight, and sort it all out later. They hope that doctors will turn against each other and say things that will sound great to a jury, and hurt one of the docs involved. Scared doctors might say things about a colleague that are not based on a complete handle of the facts in order to “save themselves.” I am simply saying that Physicians need to stick to the facts about themselves, don’t point the finger at others, and wait until trial to share what you felt was the cause of the patient’s malpractice, if any. A deposition is often a way to trap a doctor into giving testimony that can be used against them or others in court.

      Most of the time, no one committed malpractice even though something went wrong. Being on the same page means that nobody will say something to deliberately harm the other person’s case. In other words, no one should become the jury before the jury has a chance to hear the case. And if someone did commit malpractice, the other codefendants are not the ones who can make that call. That is why we have the legal process where a Jury makes that decision.

      I completely agree that the system would be improved if docs would fess up about their mistakes. But again, mistakes don’t = malpractice necessarily, so doctors are hesitant to be open. I also agree that the loss of trust between a patient and physican is tragic. But the current system does, unfortunately pit patients against doctors. My book (and this excerpt) was not designed to “game” the system, simply to show scared doctors, who know nothing about the legal system, how to get through the most gut-wrenching even of their life – getting sued for medical malpractice.

      And while I agree with you philosophically, my book is about dealing with the current system, not an idealized one. I do address apologies in my book, and frankly more states are giving protections to doctors that allow them to do this more freely. However, if you were a doctor and you knew that apologizing could be used as an admission of malpractice (and they are not the same) would you do it?

  • radiculous

    Lastly, be prepared for one of the final questions which sums up the whole situation: “What is your net worth?”

    How germane!

  • http://rebeldoctor.blogspot.com/ Michael Rack, MD

    “Hell, the physician class actions against the health insurers where they’ve collected tens of millions have probably had more effect on my health premiums. You want to abandon those?”

    yes. I want to abandon those. In most cases, the only people who make money off class action law suits are the lawyers involved.

    • Matt

      You realize that your claim that the only people who make money off class actions are the lawyers is false of course. I wonder how many of your brethren will turn down what they believe is justly theirs?

  • TrenchDoc

    The legal system is adversarial by design. Until that actually changes when I am sued I going to do everything in my power to win. Doctors have the advantage because we are well educated, deal with stress well and generally have the financial resources to withstand a protracted lawsuit. So you gotta ask why wouldn’t plantiff attorneys want to change the system to balance out the equation? In my state 80% of cases are won by doctors. Again, why not change the current system to make it more fair? It must be the lottery mentality of trial lawyers and the fact that they are getting 30%. Until the current malpractice system changes,I am going for all out war when I am sued because I have no other option. Matt is going to say there is mediation. I have been there and what I experienced was not mediation but extortion and blackmail. My advice to younger doctors facing their first suit is NEVER NEVER quit or give in and DEMAND a vigorous defense

    • Matt

      “octors have the advantage because we are well educated, deal with stress well and generally have the financial resources to withstand a protracted lawsuit.”

      If that’s true why do you whine so much about it?

      ” So you gotta ask why wouldn’t plantiff attorneys want to change the system to balance out the equation? ”

      What makes you think they don’t? Because they reject your proposed reform that only tilts the scales in favor of your insurer? The truth is the real impediment to paying more injured people faster is you and your agent, the insurer. That’s the last thing they want, and they work for you. You want to blame plaintiff’s attorneys, but the real impediment to meritorious cases getting heard and paid is YOUR insurer. If you want to change the system, why not start there. Rather than amending the Constitution. You do remember the Constitution, right? You should check it out sometime if you haven’t lately.

      “Again, why not change the current system to make it more fair.”

      Why not indeed? Show me the legislation backed by physicians to make it more “fair” and perhaps we can talk. Right now all your legislation makes it less fair.

      Of course, you’ve yet to define what you think is “fair”. You’re throwing the term around but haven’t really told us what is “unfair” about the current system of having 12 disinterested people decide the case nor have you said how you would make it more “fair”. You and Kevin both agree, but it’s not really clear what you’re agreeing on besides vague phrases.

      “Matt is going to say there is mediation. I have been there and what I experienced was not mediation but extortion and blackmail. ”

      I believe in the jury system. Mediation is up to you (although some judges make you go, but even then it’s not binding). And it’s a lot of things, but extortion and blackmail it’s not. You’re a fool if you think the mediator only comes in and works over one side about their case. They do that to both sides.

      But I fully support your right to mount a vigorous defense. By both sides putting on their best case, I think we get as close to the truth as possible.

      • platon20

        “But I fully support your right to mount a vigorous defense. By both sides putting on their best case, I think we get as close to the truth as possible”.

        You’re mistaken if you think a layperson jury is able to understand the difference or “truth” between dueling experts who are arguing over whether a complete Fontan or a bidirectional Glenn procedure is more appopriate for an 8 m/o with TAPVR.

        Lawyers love to argue that you have to prove a “standard of care” was broken to win a lawsuit, but thats total BS. The court pays no attention to “standards” it only pays attention to dueling experts. One “expert” witness getting paid thousands of dollars on either side of a case does not make a “standard”

        • Matt

          “You’re mistaken if you think a layperson jury is able to understand the difference or “truth” ”

          Why? Because you assume everyone else is so much dumber than you? Should we just let physicians judge themselves?

          ” One “expert” witness getting paid thousands of dollars on either side of a case does not make a “standard””

          True. Perhaps physicians need to make it clearer what the standards of care are. But of course, when you do that, and they don’t meet them, they’ll argue that their particular case is different.

  • TrenchDoc

    “If that’s true why do you whine so much about it”
    Show me where I am whining. If someone doesn’t agree with you you call them whiner.
    “You’re a fool if you think the mediator only comes in and works over one side about their case. They do that to both sides. ”
    Again you are not reading and understanding what I wrote. I said nothing about the mediator. I also don’t appreciate you calling me a fool. Since I didn’t see you at the mediation session, IN MY CASE you don’t know what you are talking about. Please don’t try to insult or bully me or the other people on this blog by such statements. Most of us can have a “fair” discussion on these topics but apparently not by your definition of “fair”.

    • Matt

      “Show me where I am whining. If someone doesn’t agree with you you call them whiner.”

      I don’t mean you personally, I mean physicians in general. They’re always whining about it.

      ” Since I didn’t see you at the mediation session, IN MY CASE you don’t know what you are talking about. Please don’t try to insult or bully me or the other people on this blog by such statements. ”

      You know what? You’re right. That was rude. I apologize. However, in mediation in general it’s rare that any one side is bullied. I have been in hundreds of mediations, and the reason I know it’s rare that either side is “bullied” any more than any other is because in almost every case both sides have to agree on the mediator. And no good attorney agrees on a mediator that’s just going to pick on his client. Now, I’ve had clients who THINK they were bullied, because they were told some hard truths about how their case looks.

      But I should leave open the possibility that your experience was the exception to the rule, and I apologize. I will tell you though that you don’t have to take bullying from a mediator. It’s a nonbinding proceeding, so there’s no reason to feel bullied or extorted.

  • http://drbrenner.blogspot.com @irb123

    Matt:

    Regarding my excerpt:“Even if you think one of your co-defendants committed malpractice, this is not the time to mention that fact. Keep that information to yourself until backed into a corner where you have no choice but to reveal that. Why? You don’t want to help the plaintiff’s case at all.”

    and your response to it:

    Well, at least we know longer have to hear physicians yammer on about how they’re all about “truth”, and how they wish people with meritorious claims could get their claims resolved sooner.

    –I can see why you might be upset with this quote taken out of context, but the intent of this book is to help physicians once they’ve been sued. In this scenario, physician A and B have been sued. The law allows both of them a fair jury trial. It would be unfair for physician A to deprive physician B of their trial when physician A might be clouding their judgment based on the anger they feel about being sued. Physician A is not the jury and should not pass judgment on physician B. The advice for the “innocent” physician A to get out of the case is to not call out their colleague because it could and probably will harm their own case.

    Even though it seems that doing so might have the plaintiff’s attorney drop them from the case, the reality is the opposite will happen – the plaintiff will keep you in to damage the other guy, and hope that you get caught in the melee and have to pay some damages too.

    I am giving a strategy to help physician’s thrust into a legal system they don’t understand. I do want a system where patients get their money faster and where physicians get evaluated by their true peers, and if you read my blog http://drbrenner.blogspot.com/2009/08/medical-malpractice-reform-debate-part.html – you will see i’ve proposed a system to accomplish just that. However, i am working in our current system, for better or for worse, and the book is to help physicians win their case.

    • Matt

      “I can see why you might be upset with this quote taken out of context, but the intent of this book is to help physicians once they’ve been sued.”

      Don’t misunderstand. I’m not upset at all. I fully support a defendant using whatever legal trial strategy they want. I was simply noting that the holier than thou “we’re searching for the truth” nonsense we hear from physicians in criticizing the legal system and lawyers isn’t true and never has been. As your post illustrates.

      I don’t know that it’s “unfair” or that you’re depriving them other party of a jury trial by being honest, though.

      I also disagree with you on what the plaintiff’s attorney will do. Now, if you both turn on each other, then yeah, you’ll both get left in, as you should be.

      I actually do like parts of your proposal. I think the thing physicians forget when they look at these other proposals, and wax poetic about helping the victims of malpractice, is that the people paying the bills, the insurers, do NOT want a different system. And they work for you. They might want a system that lowers THEIR costs, but they don’t want one that makes it easier for smaller claims to be pursued, or to make claims easier for plaintiffs to pursue.

  • http://www.notebookingdiscovery.org/wordpress Alice Robertson

    I am really grateful that a couple of doctors answered honestly (whether it’s what we want to hear, it was raw honesty). This is one of the most interesting conversations I have read in awhile. Of course, most patients are going to see Matt as the protagonist in this conversation. Doctors face a terrible PR battle, but I think maybe the problem is in your own backyard…….not really the patients (who are usually tamable, though I realize sick people are often petulant).

    I should, also, be honest and share that I have a daughter with cancer (she was misdiagnosed), so this topic flutters through my mind at times. Her illness has rocked my world (actually, she is my second child with cancer. Both unrelated and not genetic). CS Lewis summed up my mental condition when he said it’s like a “monotonous treadmill march of the mind.”

    I share this because I have longed for an apology from the doctor who didn’t read the lab notes. My longing, ultimately, means nothing……my daughter is still sick so circumstances will not change if he apologizes (but maybe my heart will). It’s just very hard when you perceive someone has injured your child. I realize his error wasn’t intentional……it was simply carelessness, but it hurts nonetheless.

    We have a surgeon, who I guess in all honesty, we sorta adore! He is kindhearted and patient and answers e-mails thoughtfully. So, I am not anti-doctor……….if anyone can change the face of medicine he will. But I, also, believe he likes his job very much, and as it was shared here, you invest so much of your life in becoming a doctor, then so much afterwards, you make decisions that some would view as a bit self-serving (I completely understand student debt, but it’s a bit shallow to justify any reason for fudging on the truth. Surely, these risks were weighed before you entered this field? I understand the real debate here is if the end justifies the means).

    And you are right, the reality is a “fantasy”, but a girl can dream ya’ know! The reality is sick people face what patients view as a sick system. That’s the harsh reality of treating sick people. Mistakes will be made, and they will be covered. What an irony! Those dedicated to healing, may very well be part of the problem……..whether consequentially or inconsequentially (doctors are smart…….so I tend to think it’s intentional when they compromise).

    Anyhoo………..thanks for your blatant honesty in your answers, and taking the time to answer. I think most patients feel unheard, and I think it’s great you defended your position, and that you are willing to dialogue. This is a strength of the internet………..and doctors willing to share this openly do take risks, but I tend to think it’s overall worth is of great gain to the medical profession when you are open, honest, and real.

  • http://supremacyclaus.blogspot.com Supremacy Claus

    Matt is a bit misleading. He is not telling non-lawyers a few things.

    About 80% of med mal claims are weak, and fail at every stage of litigation, especially with juries. The filing of a weak claim is lawyer malpractice. As an injured party, the doctor should be able to get compensated for damage from lawyer malpractice. However, the lawyer has dealt itself near absolute immunity from any accountability for carelessness. The adverse third party cannot sue the lawyer despite the enumeration of dozens of duties to the other side in statutes and case law. No one else gets to be protected by a privity obstacle, as has been true for 100 years.

    The defense lawyer always makes money. He will absolutely will refuse to counterattack the plaintiff lawyer, the source of his job. His loyalty is to the other lawyer, not to the doctor. They are probably friends after the case.

    These weak claims need only work 1 in 10 times to score big in this legal lottery for the plaintiff lawyer. Meanwhile, it prevents the investigation and causes a cover up of medical error. If you are injured by a medical error, thank the lawyer. It is responsible for every single medical error, not to mention the inflated costs of medical care.

    • platon20

      “However, the lawyer has dealt itself near absolute immunity from any accountability for carelessness.”

      This is true. Lawyers like Matt argue that if a lawyer files a frivolous suit that its “easy” to countersue him in court and win. But judges set the standards so high for proving a “frivolous” suit that its virtually impossible to enforce. Most of the time the judge will only find the lawyer guilty if there’s some kind of smoking gun memo or email in which the lawyer directly states “yeah this suit is frivolous BS but I’m going to do it anyways” kinda stuff. Anything short of that, and you arent going to win a case against the lawyer. Funny how the standard for proving suits against lawyers is infinitely higher than what it is for doctors.

      • Matt

        “Lawyers like Matt argue that if a lawyer files a frivolous suit that its “easy” to countersue him in court and win. ”

        I’ve made no such argument. You can get sanctions, but I would never tell you that it’s easy to sue them and win. However, your definition of “frivolous” may not be universally accepted.

        ” Funny how the standard for proving suits against lawyers is infinitely higher than what it is for doctors.”

        This is incorrect as well. There are actually more procedural hurdles for suing physicians.

  • ninguem

    Some northern European and Scandinavian countries have no-fault med-mal. The doctors encourage patients to make claims. Since it goes to government, they do place limits on noneconomic damages. When there is really poor physician performance, the matter goes to their medical board.

  • http://www.notebookingdiscovery.org/wordpress Alice Robertson

    While visiting our son in Chicago for Thanksgiving the dinner guest sitting across from me announced she will soon be an unemployed attorney. I struck up a conversation with the soon-to-be laid-off lawyer. She was a malpractice attorney and shared that settlements aren’t what they used to be. Patients need to repay the insurance company whatever the insurer paid for their treatment, then the lawyers take their cut, and patients are often left with nothing (and that’s in the small percentages of people who even get a settlement).

    Her reason for being laid-off is it’s not a great field to go into and with the economic downturn insurers aren’t paying out settlements like they used to. She had nothing good to say about risk management, and even when they would gain a settlement sometimes the insurer won’t pay. She said lawyers don’t take cases like they used to because they can’t put the work into a case that in all likelihood isn’t going to be profitable to them.

    It would seem doctors are winning the malpractice battle as we enter more-and-more into corporate medicine. It’s one of the few professions that wants a type of carte blanche protection, and they are getting it because most humans have a strong will to live! It’s dismaying to read about doctors who only take healthy patients in an effort to raise their rankings, so even choosing a good doctor means the stats we use may be “doctored”. And why does that word have such a negative connotation?

  • http://www.notebookingdiscovery.org/wordpress Alice Robertson

    Ilene wrote: However, if you were a doctor and you knew that apologizing could be used as an admission of malpractice (and they are not the same) would you do it? [end quote]

    Thanks so much for patiently explaining this plight of medicine from a doctor’s vantage point (which, in truth, is often about money from both sides of the aisle). You are right I am idealistic, but as I shared earlier today as a patient’s mom who was dealt a raw deal by a doctor I feel the need to be vocal that not all injured patients are out for the blood of a doctor, or to ruin them on a personal or professional level……..some patients have legitimate mistakes that cost them on a personal level (undiagnosed cancer does spread, so sure some patients are focused on a type of outcome-based prognosis……..isn’t that what they go to a doctor for? To get a better outcome for their disease?) So I will subjectively (and truthfully) say, I hope I wouldn’t lie to prevent a lawsuit (some patients actually deserve their rewards. Just as we beat down those who abuse doctors and insurers with their false litigation, surely we can beat down on doctors who lie to cover their mistakes? Some beat downs are well-deserved on both sides of the medicine aisle).

    I am a bit of a Dr. Jerome Groopman groupie! He wrote How Doctors Think. It’s a great read (obviously, because he allows us into the doctor’s only cafeteria mindset). He admits his mistakes, says he remembers everyone of them, shares openly about the flaws in the system and how doctors are trained to think (i.e. trained to view the patient with a raised eyebrow, read their body language, even their handshake). Shares his own misdiagnosis and the fear that completely enveloped him and how he forgot all his doctoring. How refreshing to be so completely understood on a human level. All of what he shares is understandable, and I think the stereotypes on both sides are just too broad a brush.

    Getting back to the matter at hand. To the average reader it’s going to look like doctors are suggesting that a doctor should lie to cover a mistake rather than uphold the truth and just admit he messed up (there is research online that showed that half the doctors who said they apologized avoided a lawsuit……..appealing to the human heart and dignity is quite often the best road. It shows integrity and aids in healing, and thus it makes the “anger” that was mentioned as a basis for a lawsuit diminish. It’s why judges and lawyers look for remorse and apologies…….it’s because it helps a family heal. I sorta thought that was the whole goal of medicine). Patients often feel on trial…..even when they have did nothing wrong? It starts to look like a legal lynch-mob (Achen-type) of mentality, and some of it is justified and some of it isn’t.

    To be consistent if we follow this line of thinking then we can justify insurers lying not to cover claims, guilty parties in accidents claiming they can’t belly-up and admit their guilt because they will be placed in a high-risk category……I can irresponsibly drive or not upkeep my property and lie about the whole event just because I don’t want sued and lose my home. That’s where this line of thinking that the end justifies an anything-goes to defend my error mentality goes. I don’t think doctors would put up with this stuff from others who a doctor felt had injured them or a family member. I believe it’s right to rally about untruths and injuries, because in the grand scheme of things I find it fascinating that people in a profession about healing mankind won’t publicly recognize it when they injure someone. It’s just an odd line of thinking I can’t wrap myself around……….I guess I prefer idealism.

    Thanks again! I appreciated your feedback, and still find this thread fascinating on a level for the sheer reason that doctors are giving their perspective. It’s refreshing to see both sides able to share their rants openly and not be ignored.
    God bless, Alice

    • http://drbrenner.blogspot.com ilene brenner

      Alice:

      You are completely accurate in your assessment of the studies about apologizing. It does diminish the likelihood of being sued. Unfortunately, in many states that is considered an admission of guilt and is a slam dunk loss for the doctor. Again, I would like to make it clear that systemic errors, statistical expectations, and medical judgment (even if wrong) are not necessarily malpractice. So you might apologize for something that isn’t malpractice. My father, a med mal attorney, advises his clients not to apologize because of the legal and career implications. However, if the state “I’m Sorry laws” protect the physician from an admission of guilt, they will be more likely to do what I agree should be done more often.

      Missing a diagnosis of cancer is horrible, and common. There are many reasons why this could occur, and yes, malpractice is one of them. I completely agree that patients deserve more than the current health care system can provide. And they should have recourse if malpractice occurred.

      I’ve written about this on my blog: http://drbrenner.blogspot.com/2009/08/medical-malpractice-reform-debate-part.html – but in brief, what are patients looking for when they sue: 1) Stop bad doctors from practicing? 2) Have doctor who committed malpractice learn from their mistakes? 3) Prevent this occurrence in other patients? 4) Money to cover expenses due to malpractice?

      The current system does very little for #1,2 and 3 – yes you get money, but it is years later and the attorney gets a huge cut. On my blog I propose something else. But again, this book is not about some hypothetical system. It is about the current one. And most doctors are devastated by a lawsuit. Even if they eventually “win” they’ve lost by being sued. I’m trying to help my colleagues through the worst experience in their life.

      I am not advising that they cover anything up. Or lie. My statement simply says that no doctor should, in a deposition, point the finger at another doctor because it is bad strategy at this juncture. Any beliefs you have that other doctors committed malpractice should only be shared at trial. Partly because of the emotional strain on an MD who is sued–judgment is often hypercritical and skewed. And even if accurate, the trial is the time and the place for details like that to come out.

      Physicians often criticize another’s care in peer review. This is where mistakes are pointed out, and remedies assessed. It is the best that the current system has to weed out bad doctors (docs with multiple infractions will lose hospital privileges) and teach doctors who made an error. If the error is common amongst docs, a whole hospital teaching event can occur. These episodes are not reported to patients. If they were, no doctor would submit to voluntary peer review. There is no easy answer to your question. But if patients can sue more freely, doctors will be too emotionally scarred to practice good medicine (if at all). If patients can’t sue, they lose legitimate rights. I proposed a solution on my blog.

      Doctors are pulled in 10 different directions-see more people in less time and spend less money doing it. But make sure you are perfect or else you will be sued. The health care system is set up for the doctor to fail. And it isn’t all that friendly to the patient either.

      All I can say, is in regards to my book, you are taking a legal concept and legal strategy out of context to imply “hiding mistakes of other doctors” which I can assure you is not what I advise at all. Patients who sue have plaintiff’s attorneys who will do whatever they can-including suing docs they know didn’t commit malpractice but might cough up some dough to make it all go away-so physicians deserve an equal chance to maximize a winning strategy once pulled into a case.

  • http://www.notebookingdiscovery.org/wordpress Alice Robertson

    Ilene that was excellent and honest! Thank you! I did want to add that I went through a peer review process (the doctor was supposedly cited, but I have no proof of that and have no idea what that actually means…..still no apology! Sigh! The doctor has a local reputation of being arrogant, but I found that out too late). The process nearly ruined a relationship with a doctor I love (you are quoted what the other doctors said and even the person on the phone was exasperated by the comments). It’s this process that made me so vocal, because afterwards I didn’t sleep for a few nights and at the appointment for my daughter tried to ask the doctor why he said what he said. I couldn’t look him in the eyes and fell apart because my emotions were convoluted. I felt that someone I trusted had chosen their job over the truth (in fairness, he would disagree). He was very open to discussion and we have such a good relationship my daughter actually looks forward to her visits with him (he is humble, and not defensive).

    I guess from where I am sitting it seemed the doctors got on with their lives, while the process added to my internal misery. I take responsibility for my own overreactions to my own pain. But the process was so sadly enlightening it seemed almost as painful as the diagnosis……..and my story was believed (it’s an obvious error). I found myself wondering about it all………and this is why I posted here as a firsthand eye witness to the pain of what happens on a personal level when the foundation of that pain is an error, then a cover up. I wanted doctors to know that in their quest to exonerate themselves, they more misery to the patient/mom emotional pain rector scale. I sorta consider this an appeal to the heart of doctors. Whether it works or not is up to them.

    I really enjoyed your writings and will visit your blog to try to understand the “other side” more. A skewed view is never good, nor is a completely emotional view w/o logic.

    And, lastly, who is Matt? Others identify themselves via links or signatures. He definitely added a lot to the conversation with his challenging debate. Without him the thread would not have been so interesting. And thank you to the doctors who helped me/us to understand what some of us believe is the dark side of medicine……it’s intriguing. I wrote to my doctor yesterday and shared with them that to the average patient we view doctors as a type of Knights of the Roundtable Club! An exclusive, noble club with rights and privileges that we don’t understand. Of course, the search for the Holy Grail and what that means is debatable, but I do believe the public views themselves as a type of Robin Hood! Unfair stereotypes abound, but gosh…..it makes for such good reading!
    God bless, Alice

  • Moedocl

    As one of the traitors that helps lawyers win lawsuits against docs, I will say a few things:
    first, every lawsuit that my client has won, with average awards of $1.2 million dollars, began with a PATTERN of mistakes where each one went unchecked until there was a catastropic event, rather than one event. Second, pretty much all of the good doctors had horrible documentation of their reasoning, forgetting both the “A” and the “P” in their SOAP notes. Third, nearly all the doctors took the deposition lightly, obviously not reading the chart. One doc proclaimed the patient’s vitals were normal when he saw her, despite the nurse’s documented tachypnea, tachycardia, and low bp just fifteen minutes prior to his visit.
    Before we reform tort law, Physician heal thyself…

  • http://www.notebookingdiscovery.org/wordpress Alice Robertson

    I know this is a dead thread, but while out-of-town today at a volleyball tournament I found time to read the book I purchased titled, “blink” by Malcolm Gladwell. The book has some sections addressed to doctors because it’s about intuition, and teaches you how to see the most important details to make intellectual snap judgements within the first two seconds of encountering a new situation. I need a lot of training because my first inclination was to ditch the book, but it was just too highly recommended to do that. I stumbled upon something so basic, and useful, I wanted to add it to this thread for future readers.

    Anyhoo…. in the first part of the book he discusses malpractice suits and how to avoid them. Bottomline is people don’t sue doctors they like. He shares malpractice suits have little to do with doctor’s mistakes, and everything to do with how the patient feels about the doctor. He highly recommends doctors get to know their patients to show they care, and laugh with them. Patients sue because they say they were ignored, treated shoddy, or were rushed. It’s just basic human nature to forgive easier when it’s a person you like, but want to punish those you don’t.

    Excerpt: “People just don’t sue doctors they like,” is how Alice Burkin, a leading medical malpractice lawyer, puts it. “In all the years I’ve been in this business, I’ve never had a potential client walk in and say, ‘I really like this doctor, and I feel terrible about doing it, but I want to sue him.’ We’ve had people come in saying they want to sue some specialist, and we’ll say, ‘We don’t think that doctor was negligent. We think it’s your primary care doctor who was at fault.’ And the client will say, ‘I don’t care what she did. I love her, and I’m not suing her.”"

    He shares that a medical researcher Wendy Levinson has recorded hundreds of conversations between a group of physicians and patients. Half had never been sued, while half had been sued at least twice. She was able to decipher who had been sued based solely on the recorded conversations, and found that surgeons who spent three minutes more with a patient (15 minutes for the surgeons who were sued, compared to 18.3 minutes for the surgeons who were more personable).

    Just a thought about building trust with patients and giving them a face………one that isn’t easily forgettable (your own…… in their heart! ). If doctors reached out on an emotional level and made the patient feel good about them, then were quick to apologize for their errors, they would gain immeasurably, and so would the patients who would then forgive and heal faster. I would probably add one last tip………..answer your e-mails. Patients need answers and become insecure and feel ignored when you don’t. And those e-mails can bring a lot of comfort to them.

    • http://drbrenner.blogspot.com irb123

      Alice, I got your FB email, thank you, but I don’t respond to people who write me on FB. But bc of your comment, I made a very clear contact page, where you can email me safely – irbrennermd at gmail dot com

      What you say -from Blink- is true. I wrote a whole chapter on it. (re: angry patients) However, as an ER doc, much of that is out of my control. I can’t control the wait. I can’t control the temperature. I can’t control if the TVs work. I can’t control if the nurses do my orders in a timely manner (I try, boy do I try). I can’t help that most patients are there bc they can’t see their doctor but aren’t truly emergent. Therefore, what would have been at least a 15minute visit with your Primary care doctor is 5minutes with me. I would love to sit and get to to know you more, but there are ten other patients in the waiting room who want to see me, plus the ambulances with the sicker patients (usually but not always), rolling in the back door regularly. I can help my attitude, certainly, and compassion, and friendliness. Sure. But ER docs (as a whole) get sued bc something went wrong and there is not a real way to have a relationship with the patient or their family. However the “went wrong” usually means a bad outcome out of the the doctor’s control, or a statistical reality, or just “the patient was emergent and did poorly bc they were very sick”.

      Is there real malpractice? Sure, but that’s usually from underqualified docs, or burnt out docs just trying to do what the administrators tell us to do (move the meat is what they say). Move patients in and out as fast as possible so new patients can be seen. That is what we are told to do, and some docs take this to mean giving less care. Again, these docs are rare.

      BTW the blink instant assessment is how docs do their job in general, but in ER, even more so.

      • Alice Robertson

        Sharing your personal experience is helpful to those who seek a full vision of the problems facing both doctors and patients. I find blogs like this invaluable when both sides can share knowledge and experience from each vantage point. Sometimes it seems management uses doctors as scapegoats, which is why I shared how discouraging it is to understand the fear corporate doctors live with (and where I live private doctors are being run out of town, and some excellent doctors have tried to quit and get sued, and some have to relocate to get out of the contractual range their hospital places upon them. Some real cut-throat policies are running medicine).

        But gosh…………it’s just so hard to realize I don’t have all the answers! Wish our legislators would read this blog!

        Thanks again for sharing your perspective.