The threat of malpractice means doctors cannot acknowledge their fallibility

An excerpt from The Color of Atmosphere: One Doctor’s Journey In and Out of Medicine (Chelsea Green Publishing, 2011).

We all make mistakes. To err is human—unless you are a doctor. This is a lesson that began in med school. If something went wrong, some­one else was to blame. Attending physicians blamed the residents, who blamed the interns, who blamed whomever else was within range—med student, nurse, patient. We gave lip service to learning from our mistakes, but in morning report or on rounds, those left standing were the ones who most effectively pointed the finger at someone else. There is no greater pain a doctor can experience than that which comes from making a mistake that causes harm, so we try anything to convince ourselves we did nothing wrong, to protect our sanity. Once we are out in practice, this unhealthy denial goes beyond the personal. The threat of a malpractice suit means we must never, ever acknowledge our fallibility. The wolves are at the door.

I made a terrible mistake when I was an intern in internal medi­cine at Bethesda Naval Hospital. I was on call in the coronary care unit—the CCU—supervised by two residents. B. C. was the junior resident, two years out of medical school. The senior resident, Roy, was responsible for B. C. Roy reported to the chief resident, who took call from home. Roy and B. C. must have been very busy that night with other patients in other parts of the hospital, as I was left alone with the CCU nurses minding a very busy store.  There were six patients in the unit, each of them lying almost motionless on a mechanized bed behind glass walls. A web of lines connected their arteries and veins and chest walls to banks of screens and monitors that flashed around their rooms and across the nurses’ desk in a constant illuminated display. Large flow sheets the size of opened newspapers sat at the foot of each bed, document­ing pulse and oxygen levels, IV fluid rates, and medication orders. The constant electronic beeping was reduced to a background noise in my brain. The scene took on a certain eeriness at night, with over­head lights dimmed to help the patients rest, and the staff talking in hushed voices. The beeps and monitor lights rose to fill the void in an uneasy standoff between vigilance and catastrophe.

I moved quietly from patient to patient that night, watching the watchers—the blood pressure monitors, the EKG tracings. I scanned the elaborate flow sheets to assess vital signs and urine output. Looking at the patient was almost superfluous.

One of the patients, Mr. P, began showing signs of decreased cardiac output a little after midnight. He had been admitted earlier that day after suffering a heart attack. Now the catheters that threaded far into his arteries and veins were transmitting signals that his heart was not pumping blood as effectively as it had been. I paged B. C., but he must have been tied up because he didn’t answer right away. So with Mr. P’s nurse hovering anxiously over my shoulder, I called Roy. We agreed on a medication, Nipride, that would help Mr. P’s heart pump better. I calculated the dose by hand and wrote the order. His nurse efficiently sent the order down to the pharmacy “stat,” meaning we needed it urgently, and in a short while a small plastic bag containing the Nipride arrived in the unit and was connected up to Mr. P’s IV. In all those transactions, no one noticed that I had written for ten times the recommended dose.

I watched that patient closely for the next several hours. Mr. P showed signs of improvement, and I let Roy know that when he called to check in. By 3 am, all the beeping and buzzing and trac­ings had settled into a constant reassuring rhythm, and I crawled into an empty bed so I could catch a nap. I dozed uneasily over the next two hours, so when the nurse jostled me awake just before  dawn, I wasn’t sure if I was dreaming. She looked worried and told me the chief resident wanted to talk to me; there was a problem with Mr. P.

I hopped off the bed and into defensive mode. The chief resi­dent, Carl, was a brilliant superhuman who rolled his filing cabinet around the hospital with him so that he would have instant access to all his cutting-edge journal articles in this pre-cyber world. I imag­ined that with black-rimmed glasses he would even look like Clark Kent. He didn’t usually waste a lot of effort on facial expressions, but as I hurried toward him across the CCU I could read fury and contempt in his face.

“Nice dose of cyanide you gave Mr. P,” he said as soon as I was within civilized earshot.

I was still trying to shake the half sleep from my brain; I couldn’t make sense out of what he was saying. One of the dangers of using Nipride is that it is metabolized to cyanide in the body. Even appro­priate doses of Nipride need to be monitored with blood testing for cyanide. An overdose could be lethal.

“You wrote for ten times the correct dose.”

“No way,” I protested as my shaking finger ran down the order sheet. I blinked at my handwriting—the neat feminine cursive so appreciated by the nursing staff—and began to recalculate the dose, but Carl had already done that and shoved his scratch sheet in front of my face. My stomach contracted, and my own pulse roared through my head as I took in the enormity of my mistake. I stood defenseless as he drove his message home:

“You could have killed him, you know. Didn’t you wonder why his oxygen requirements were increasing?”

“I didn’t know he was having a problem,” I answered weakly. I glanced over at the nurse—I would have expected her to let me know if the patient’s oxygen levels were dropping—but she just stood there, tense. There would be no help from her corner.

B. C., my phantom resident, had been hovering off to the side with the medical students but now chimed in. “Why didn’t you notice? What were you doing?” Of course, he knew perfectly well what I had been doing, so this was a safe avenue to chase me down.  “I was asleep,” I mumbled, as if I was admitting to getting high off the anesthesia machine while my patients screamed for help. “No one notified me . . .” I trailed off. The nurse waited silently at the bedside now, watching closely to see which way this ill wind would blow.

“But you’re the doctor,” B. C. hammered at me. I wanted to smack him.

“You know, we generally don’t try to kill our patients here,” added Carl in disgust.

I was utterly defeated, just a white coat and scrubs draped over the shell of a lousy doctor. “I’ll change the order right away.” My voice sounded as if it were coming from far away.

“Never mind,” spat Carl. “I thought I’d stop the drip myself before he started turning blue.”

I turned without another word and walked into the break room, shutting the door behind me, and began to sob as quietly as I could. I had the sudden feeling that over the past four months I had been fooling everyone into thinking I was a good doctor. In fact, I had even fooled Georgetown into thinking I should have been admitted to medical school. What would that admission committee think now if they could see what a danger they had unleashed upon the world?

A few minutes passed, and then B. C. walked in, closing the door behind him and settling into the opposite chair. “Shouldn’t you get out there and see to your patient?” he asked gravely, a caricature of a wise old TV doctor—though only a year older than me.

Screw you! I thought. I was in no mood for melodrama.

“You know,” he restarted, “I almost wrote a wrong antibiotic order once.” There was a hesitation as he chose his words. “But then I caught it before I sent it off. But still, it could have been serious, I suppose.”

My breath caught, and I stopped crying. A slow burn worked its way up my chest and into my face. “Are you consoling me by telling me that once you almost made a minor mistake, but then you were smart enough to catch yourself?”

“Well . . . yeah.” He shrugged. I could tell he had no idea how furious I was—or that I had just found him out. B. C. had made a mistake last night, too—maybe even bigger than mine, because he should have known better. He should never have left an inexperi­enced intern in charge of six critically ill patients. He should have been checking on us all night or called for help if he was too busy. It turned out he had been too involved in an “interesting case” from the ER; he would make a big splash at morning report.

“Leave me alone, B. C.” My voice had gone flat and cold. “Mr. P is fine now. Carl took care of him. I’ll be out in a minute.” He tried to offer another pearl of wisdom, but I cut him off. He had already helped me more than he realized.

What an asshole! I thought as I washed my face and blew my nose. These guys weren’t any smarter than I was (except maybe for Carl), but now I suspected that B. C. had made plenty of mistakes, and I was pretty sure that everyone else had, too. But nobody was talk­ing. Blame was deflected, rationalized, minimized, swept under the rug—anything to avoid the horrible epiphany I had just endured: We were all capable of royally screwing up, and that was as good as we were ever going to get.

Mr. P did miraculously well—so well, in fact, that he was trans­ferred out of the unit to a “step-down” bed the following afternoon. His cyanide levels had risen briefly but then cleared. My troubles lingered. On attending rounds later that day, shaken and exhausted, I had to relive the experience with the cardiology attending. Later that evening, I asked the senior resident if the cardiologist had said anything to him about me. Roy was a kind soul and took no pleasure in squashing an errant intern. He hesitated but then opted for the truth. “He said, ‘If I ever collapse from a heart attack, don’t bring me here.’” I swallowed hard, and moved on to finish my tasks so I could go home. It had been a long thirty-six hours.

I trudged home alone that night, slowly making my way across the large expanse of lawn that rimmed the navy base as the sun set behind the high-rise buildings across the way. I was parched, and my head throbbed as I walked in slow motion toward the traffic lights of Wisconsin Avenue. I kept playing the course of events over in my mind, trying to find a way to let myself off the hook. The resi­dents had left me alone with desperately ill patients. Why hadn’t one  of them stopped by the unit to check my orders, see for themselves how this critical patient was doing? And that nurse must have tran­scribed hundreds of orders for Nipride in her career. Did she think we were treating a gorilla this time? What about the pharmacy? If they didn’t know drug dosages, who the hell did? This reasoning might have held up in a court of law, but none of it relieved the sick­ness in my stomach, the ache in my chest.

Blame was a tricky thing. It didn’t get rid of guilt. It just wrapped it up in a package, stored it safe from the light. There was so much I had to learn; finger pointing and making excuses wasted precious time. As much as I hated to admit it, B. C. had been right about one thing. I was the doctor now. The fear of making a mistake would follow me the rest of my career. It would be the caution that made me double-check orders, the defensiveness I would have to keep under control when patients questioned me, the meticulous docu­mentation that would follow every clinical encounter. I had discov­ered the greatest and loneliest burden a doctor carries.

Fortunately, in all my years as a pediatrician, I was never sued. Pediatricians have some of the lowest rates of malpractice suits in the profession and therefore pay the lowest premiums. By the time I left practice, I was paying about $13,000 a year for malpractice insur­ance—a drop in the bucket for obstetricians or neurosurgeons, who pay that much in a month. There are a number of theories for why pediatricians are the specialists least likely to be sued. One is that we are more likely to have connected with the family on a personal level. But meticulous charting helps, too, even before an issue has the chance to land on a lawyer’s lap.

“Dr. Kozel,” accused Mrs. C in an imperious voice through the phone line, “we told you months ago that Jamie was having head­aches, and you told us it was nothing. Now the neurologist is sending us for a CT scan. Why didn’t you do something back then?” I could tell over the phone that this mother was loaded for bear.

“How did she end up seeing a neurologist?” I asked.

“Well, I had to do something. The poor child was suffering.”

“Mrs. C,” I began, already fighting the anxious defensiveness that  flared up reflexively, “I am looking at her chart right now. Jamie had a very normal neurological exam at that visit. If you remem­ber, I went over her from head to toe. You have a family history of migraines. We talked about that and the likelihood of this being childhood migraine, especially since they seemed to be triggered by sleepovers. I asked you to have her avoid sleepovers, use ibuprofen as needed, and call me in two weeks if things were not improving. It doesn’t look like you called back. But I agree with the neurologist. If she’s continuing to have problems, she should have an imaging study.”

Mrs. C mumbled her way out of the conversation, my record keep­ing having removed most of the wind from her sails. Even if the CT scan, God forbid, showed an abnormality, my records would support my stepwise evaluation—although I would still almost certainly get sued. But I hardly felt vindicated for doing a good job, just adequately armored. I sat staring into space for several minutes, feeling defeated by something unseen, knowing I had to switch gears, see the next patient, try to connect. Two weeks later, I got a letter from the neurologist stating that the CT scan was normal and he had diagnosed childhood migraine. Brilliant. Mrs. C started taking her daughter to another doctor in the practice.

For surgeons and obstetricians, lawsuits are a way of life, like broken noses to boxers. But all kinds of doctors can get sued, and when they do, it can suck the lifeblood out of them. One highly regarded colleague, a close friend of mine, was asked to consult on a patient of his who had been hospitalized with an infectious disease. The consult was for a minor intestinal problem the patient had had for years, unrelated to the mysterious fever for which she was admitted. Her current doctors were checking to make sure they didn’t need to address that intestinal condition while she was being treated for this infection. The family later sued about some controversy around the diagnosis of her infection; the gastroenter­ology consultant was named in the suit. He was sure there was some mistake. When he asked his lawyer why he was included, the answer was quite simple: “Because your name was on the chart.” It cost that doctor over a thousand dollars in legal fees to get his name dropped from the suit. The greater, hidden cost was the bitterness and frus­tration that settled into his gut. “I gotta get out of this goddamn business,” he said.

So when I sat down at the end of the day to fill out my charts, it was with more than healing in mind. I had come a long way from my teenage image of a doctor, from that naive image of a gifted healer, reaping the gratitude of patients. Much of what I put down on paper was written because I might need protection from the very patients I was trying to treat.

The relationship between healer and patient, which relies so heav­ily on trust, has become too often, in a very fundamental way, adver­sarial. The cloud of mistrust is such a constant in daily practice that its wisps and curls go almost unnoticed in the day-to-day business of treating patients and documenting events. The defensiveness I felt as I constructed my chart entries—and for that matter in all my professional encounters—was not enough to suck the lifeblood out of me. It was more like a slow, barely noticeable trickle.

We have to deal with the reality of medical malpractice, but the process needs to focus on caring for the injured party and improving quality of health care. The current process is driven by how much the malpractice lawyer stands to gain (on average, over half the award), with secondary emphasis on the patient’s well-being and none on improving medical care. Cases should be arbitrated by an indepen­dent panel of health experts, lawyers, and patient advocates who can assess the circumstances in the context of acceptable standards of practice. Disciplinary or remedial action should be directed toward doctors who have practiced negligently, and victims should receive capped compensation from a general fund that doctors pay into. Medical schools could teach, right from the beginning, constructive ways to critique ourselves and our colleagues; once we are no longer target practice for lawyers, trends in poor outcomes could be made transparent, and they could be studied so that we could find more effective ways to deliver care.

It is a sad paradox that the politicians who are most willing to tackle health care reform also tend to be the least likely to take on medical malpractice. They will say it is because malpractice suits do not have a significant impact on health expenditures, but such argu­ments are just grasping at statistical straws. Doctors spend billions in tests every year for no other purpose than to protect themselves from lawyers. It is why so many of us still order MRIs for uncompli­cated back pain. It is why the C-section rate in this country has been on a steady rise. A recent study in the Archives of Internal Medicine reported that 91 percent of physicians admit to ordering more tests and specialist referrals than they think are necessary because they are practicing defensively. A 2008 Pricewaterhouse report estimated the cost of such defensive medicine to be $210 billion annually.

Politicians are, for the most part, lawyers, and they rely on the support of their fellow lawyers. By their very nature, most cannot imagine a bad situation that would not improve with a lawsuit. Tort reform gives them acid indigestion. I say to these political leaders, grab yourself some of those expensive reflux medications that your excellent insurance plan pays for, roll up your sleeves, and do the tough work that needs to be done. Provide this country with a ratio­nal, responsible approach to medical malpracticeone that will protect the health of both patients and medical practice.

Maggie Kozel is the author of The Color of Atmosphere: One Doctor’s Journey In and Out of Medicine, from Chelsea Green Publishing, and blogs at Barkingdoc’s Blog.

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  • Diane D’Angelo

    I agree with you and also suggest that doctors meet with the patient and his/her family to explain what happened and apologise for the mistake. Why? This reduces the tendency for people to put doctors on pedestals (and to also take more responsibility for their own health) as well as providing a way for the doctor to retain his/her humanity.

  • Brian

    I’m not entirely sold. I think doctors play the blame game because they’re human. That people tend to assign blame to other people to avoid consequences (be it the threat of a malpractice lawsuit, or even just abject humiliation at the hands of a junior resident) is not a particularly surprising revelation to me. Hell, there don’t even necessarily have to be particularly severe consequences to observe blame-shifting behavior.

    The idea that tort reform would somehow change this is a bit naive, in my opinion. It may help, but it certainly won’t eliminate it.

  • http://www.taskforce.org/our-work/projects/justins-hope Dale Ann Micalizzi

    “We have to deal with the reality of medical malpractice, but the process needs to focus on caring for the injured party and improving quality of health care. The current process is driven by how much the malpractice lawyer stands to gain (on average, over half the award), with secondary emphasis on the patient’s well-being and none on improving medical care. Cases should be arbitrated by an indepen­dent panel of health experts, lawyers, and patient advocates who can assess the circumstances in the context of acceptable standards of practice. Disciplinary or remedial action should be directed toward doctors who have practiced negligently, and victims should receive capped compensation from a general fund that doctors pay into. Medical schools could teach, right from the beginning, constructive ways to critique ourselves and our colleagues; once we are no longer target practice for lawyers, trends in poor outcomes could be made transparent, and they could be studied so that we could find more effective ways to deliver care.” Great thoughts for change!

    Thank you for writing this, Maggie. It may sound odd, but your feelings of remorse and honesty following an error are necessary to hear and often craved by those of us who never received any acknowledgment that the mistake (and our child) really mattered. You cared…and are an excellent pediatrician.

    ~Dale

  • Matt

    This post is naive in some parts, and simply wrong in others.

    ” The threat of a malpractice suit means we must never, ever acknowledge our fallibility. The wolves are at the door.”

    This is simply ridiculous. The vast, vast majority of malpractice never sees a claim file. And why should the threat of a malpractice suit prevent you from admitting you were wrong? Particularly if there were no damages. And if there were damages, why wouldn’t you want to pay what you’re responsible for? If you don’t, that’s not the fault of the plaintiff who has to file in order to get you to pay for the damage you caused. It’s your own.

    “By the time I left practice, I was paying about $13,000 a year for malpractice insur­ance—a drop in the bucket for obstetricians or neurosurgeons, who pay that much in a month.”

    In what state is the average malpractice premium $156,000 a year for OBs and Neuros?

    “We have to deal with the reality of medical malpractice, but the process needs to focus on caring for the injured party and improving quality of health care.”

    This is an empty sentiment. Caring for the injured party costs money. So if you want to focus on it, admit when you make a mistake and pay for it. That’s what needs to be done. If you want to improve healthcare delivery, well do so. You don’t need to change the law to do that.

    “The current process is driven by how much the malpractice lawyer stands to gain (on average, over half the award)”

    This is incorrect. The lawyer does not get over half the award on average. And the current process is driven by the cost of future healthcare for the injured party and the fact that insurers typically aren’t itching to pay it.

    ” Doctors spend billions in tests every year for no other purpose than to protect themselves from lawyers.”

    Does it work? You’d rather us rely on anecdotes than statistics. We’ve tried your reform, and it never results in any fewer tests.

    “Politicians are, for the most part, lawyers, and they rely on the support of their fellow lawyers.”

    This is nonsense as well. It assumes some sort of uniformity of thought with everyone that has a law degree that simply doesn’t exist. There are more physicians in the US Congress than lawyers who have represented plaintiffs in personal injury suits. Because you have a law degree and worked for some big firm or as a prosecuting attorney tells us nothing about your politics on this issue. And given that business contributes FAR more than lawyers (even including the defense ones) toward politicians, it isn’t even a true statement.

    “victims should receive capped compensation from a general fund that doctors pay into. ”

    Why should victims’ compensation be arbitrarily capped? Because you don’t want to pay the full measure of the damage you cause? Even though you’ve never been sued yourself?

    The author makes a whole bunch of false assumptions, and then offers us the same old tired solutions that haven’t solved the problems before. Because one time she screwed up and it scared her. It should scare her. She had a duty of care and her actions fell below it. She just got lucky there were no damages, and thus no claim to be had. She doesn’t tell us what she would have done to rectify the harm if the patient had been permanently disabled or killed, though. But she knows she wouldn’t want him to get the full measure of his damages. Seems pretty self-serving.

    • Dr. Dredd

      “In what state is the average malpractice premium $156,000 a year for OBs and Neuros?”

      Let’s see:
      Florida OB: $98K-191K
      New York OB: $50K-$170K
      Nevada OB: $67K-$165K

      (Source: 2009 MEDICAL LIABILITY MONITOR SURVEY)

      On average, the attorney gets between 33-40% of the judgement if he/she works on contingency. You’re right in that caring for the injured party requires money, but it seems like the lawyers are eating up a huge chunk of that money.

      • Matt

        You just gave me the highs and lows. Those aren’t averages. What’s more, on the highs, you don’t tell me anything about claims history. Why should I feel bad because a physician with multiple judgments has to pay a lot in insurance. Do we feel bad because people with multiple DWI convictions pay more in insurance?

        What do you think is a fair rate for the work, given your experience funding and trying cases? What would you charge to take on a risk of up to $100,000 with no guarantee of recovery?

    • Marc Gorayeb, MD

      The problem with your attitude is rooted in a misperception that most medical malpractice is as straightforward as the case highlighted above. Do you really think that almost 50% of obstetricians in this country are incompetent at least some of the time? The truth is that practicing medicine is a continuous series of frequently tough judgment calls. And we live in paralyzing fear of having those judgments called into question by persons with financial biases and motives.

      The author of this post has it exactly right. We all make mistakes in training, the acknowledgement of which allows those experiences to remain in our consciousness for the rest of our lives. That no longer operates In private practice, because quality assurance within our profession is constricted by fears of legal liability. You are indeed a wolf at the door.

  • Jerry

    Matt,
    2009 Florida OB/GYN $191,422 practice insurance.
    That is just the money needed to send to the insurance company. The income taxes needed to provide this much will mean that nearly $300,000 has to be earned with about $100,000 going to taxes and $200,000 going to insurance. That is before the first dollar can be paid to the front desk receptionist, his/her backoffice nurse, or for his/her lunch. By the way with a federal tax bracket at 34%, that doesn’t take into consideration any taxes that might be put upon the business. They can be as high as California’s 9% income tax and 9% sales tax on anything you bring home. So, consider that $300,000 a conservative estimate.
    If you can find KevinMD.com, you can find this information easily enough throughout the internet. There are more erroneous assumptions in your reply, but lets not be picky.

    • Matt

      Jerry,

      Do you have a link? I can’t find anywhere where it shows Florida having a nearly $200K average for an OBGYN.

      What I notice is physicians are quick to share their expenses, but loath to share their income. How much do you think the premiums SHOULD be?

      Your math doesn’t make sense, by the way. Insurance isn’t paid with after-tax income in that situation.

      Also, if your net income is $200,000

  • Robert Unseld

    I believe that if a patient doesn’t want treatment, than they should sign out of treatment against medical advice.

    It’s important for the patient to be advised of risks for medical examinations, etc. and sign a statement to such effect and avoid malepractice suits.

    • pj

      I’m not an attorney, but i don’t believe any signing of a waiver by a patient absolves (prevents) a Doc from being sued in any state.

      • http://www.ServantLawyership.com Kathleen Clark

        pj: When you refer to a “waiver”, do you mean an informed consent, informed patient choice?

        • pj

          I was referencing Robert’s comment. It sounds like he has some mistaken beliefs. It would be really nice if maplractice suits could be avoided so simply, but it doesn’t work that way in the USA.

  • just a patient

    Dr. Maggie, your heartfelt revelation of your error and the resulting treatment you received from your colleagues made me appreciate the great weight of responsibility on the shoulders of young doctors. But I’m curious about something. Even though the outcome was positive, was the patient ever informed that he was overdosed? Is there any obligation to do so? If not, does it at least have to be entered in his medical records to be part of his treatment history?

  • http://bit.ly/9wmOLT Dyck Dewid

    Maggie, your story is strong and your a talented writer. And I sense your openness and honesty… You remind me of the excellent book Kitchen Table Wisdom, by Rachel Naomi Remen, also a pediatrician.

    Another book that should be required reading is How
    Doctors Think by Jerome Groopman. Both authors expose what few MDs would, and as you have.

    The monster you expose high Insurance premiums starts to make sense. As you alluded to, it seems a natural reaction to resent, and thus sue someone who has imposed higher rank, self-cherished wisdom, undeserved & forced authority & control over my health & human dignity.

    On the other hand a doc who cares would not have any of these attributes and would put my interests and dignity first, not w lip service, but with their time and behaviors.

    In my business (remodeling) over the years, my lawyer got me started in how to stay out of court. I learned the hard way, if I put (genuine) relationships first everything else takes care of itself. I have no blow-ups, cooperation on inevitable problems, trust, understanding, no collection problems, lasting relationships.

  • http://www.ServantLawyership.com Kathleen Clark

    Thanks so much for your honesty and courage, Dr. Kozel. You tell us that you went into “defensive mode”, when called on to explain how you prescribed ten times the normal dose of medication. You didn’t associate that experience, that “defensive mode”, with malpractice. It seemed more about being human, as well as having feelings of fear and regret, injuring a patient, and making a mistake. You also talked about finding someone else to blame, such as the nurse, the residents on duty, and/or the pharmacist. That situation sounds like a perfect illustration of James Reason’s swiss cheese model, which illustrates healthcare delivery and attribution issues involving medical error. If individual slices of swiss cheese are dropped, one at a time, in a stack, the holes are in dfferent places and do not line up. Sometimes, they all line up, resulting in error that would have been caught before getting to the patient if not lined up. In your story, the residents were busy, the nurse didn’t catch the prescription error, and the pharmacist didn’t either. Had one of them intervened, caught the error, the incorrect dosage would not have reached the patient. The holes in the several slices of swiss cheese would not have lined up.
    Your story is one of shortcomings in the system, not in one person. If your story was addressed as a systemic difficulty, rather than an individual difficulty for which one person could be blamed (or more than one person), prompt improvements would be much more likely. As you write so clearly and beautifully, “finger pointing and making excuses wasted precious time.”
    You make another point so well: pediatricians have some of the lowest rates of malpractice suits in medicine, perhaps because pediatricians “are more likely to have connected with the family on a person level…” Open communication with patients, particularly after medical error, prevents lawsuits.
    You also state that “the current process is driven by how much the malpractice lawyer stands to gain…with secondary emphasis on the patient’s well-being…” Isn’t failure to disclose to a patient, such that they feel they have no choice but to go to a lawyer, ALSO placing “secondary emphasis on the patient’s well-being?”
    Finally, I’m interested in any citation you can offer regarding lawyers, on average, getting more than half of each award.
    Thanks again.

  • http://bit.ly/9wmOLT Dyck Dewid

    Humor in medicine, like in everyday relations, has positive affects on health, and also on relationships. Not relevant to the article but relevant to the subject of insurance claims humor seems obviously related. If is helps reduce barriers between people it can foster respect, authenticity, trust, and affection. It’s harder to be revengeful and easier to forgive, when some of these attributes exist.

    Perhaps some stiff collar docs might be afraid of authenticity and affection. But, transparency versus image building is palpable, and in my world, passe. Those with character learn to take responsibility for their acts and not use insurance to diminish or cover it.

    In an otherwise good article ‘Humor in Medicine’, a recent study is referenced that examined patient-physician communication as it relates to malpractice risks.

    http://journals.lww.com/smajournalonline/Fulltext/2003/12000/Humor_in_Medicine_.17.aspx#P78

    • http://www.ServantLawyership.com Kathleen Clark

      Yes, it seems obvious that more communication, more time between patient and physician means more trust and less need to be adversaries.

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