A few years ago, I was sued. Yes indeed, I can now shout it from the rooftops. I know what it feels like to sit in the fire and burn into ashes of self-doubt, regret and emptiness; staring into the soulless, Cyclopean eye of a deposition camera, recounting my sins, defending my pride. I know what it’s like to live with fear, up close and personal. And I know what it feels like to lose.
Does this make me a horrible, terrible doctor, fit to be hung, dried and quartered?
Studies show that that number of claims filed per physician in the United States is 8 times greater than in Canada. Lawsuits enter the judicial system in the US 75% more frequently. A Canadian physician is one-fifth as likely to be sued for malpractice as their American counterparts. It’s a phenomenon physician and patients have come to accept and expect based on America’s underlying ideology of individualism. And this was all okay, in fact coveted during the height of healthcare delivery in the latter part of the twentieth century. But today, with exponential demand on healthcare services accompanied by its attendant sky-rocketing cost, this nation is beginning to wonder why.
Being sued comes with a terrible stigma. As soon as you open the envelope, you can feel your heart drop a thousand fathoms as the black oil slick of doubt seeps into fissures of your mind. Your thoughts steep in terror, your mind leaping to possibility; I’m done for, what’s going to happen, this is the end of my career, how will I survive … what if I lose? You don’t want to know that truth. You don’t want to walk there. And so you go through the motions with visceral pain until it’s all over, and then bow your head, your self-worth and will power ripped from your heart.
You walk into your future alone, determined never to let this happen again. Determine never to get sued again, determined to order as many tests as possible, defend your career, life, self-esteem and always to cower from fear. And so, you change.
Instead of being a good doctor, a great doctor, you become that doctor. You become the one who’s afraid to stand up for herself, the one who now practices “defensive medicine” before she can practice “good medicine.”
It’s almost as if you go into this giving profession with bright shiny eyes, but before you can get started, the vultures are waiting on the sidelines, ready to peck them out. With those odds against you, there’s only one way left, and that’s to acquiesce, punching a clock day-in, day-out until it’s all over, and you can be happy once again.
But is there really only one way out?
In October 2011, Jackson Healthcare released a study called “Costly Defense: Physicians Sound Off on the High Price of Defensive Medicine.” The cost was estimated between $650 and $850 billion dollars. What does defensive medicine do, not only to us financially and emotionally as physicians, but to our patients and their health?
According to a study by Patients for Fair Compensation, $31 billion dollars in 2011 were paid out in malpractice claims, but only 20% of that went to the actual patient. Eighty percent (80%) went to lawyer’s fees.
Numerous studies show that physicians behave differently when threatened with civil liability. The Jackson Healthcare survey estimated there was up to a 35% increase in the number of tests ordered, correlated by an earlier study in 1991 in the New England Journal of Medicine. Not all testing ordered by physicians is benign. It comes with increased risk, stress, worry, anger, fear, and blame and then more testing to C.Y.A. rather than reasonable decision making. In the end, physicians end up doing the very thing they swore they would never do; cause harm.
Using litigation of this magnitude as the foundation of a healthcare system comes with another immeasurable cost. It leads to the breakdown of intimate trust between a doctor and his patient. A healing, nurturing experience has been replaced with adversity, fear, blame and accusation. Whether we want to admit it or not, these conscious or subconscious emotions lead to physical changes; the damaging release of stress hormones such as cortisol and adrenalin. These stress-related hormones then lead to chronic inflammation and end-stage diseases such as hypertension, heart attacks, strokes and diabetes. We shouldn’t wonder why we’re experiencing the level of epidemics of preventable illness we are today when it stands to reason that our internal and external environment deeply affects us as integrated beings.
At this juncture, it’s no longer good enough to hide from the truth.
One only has to look to the ideological fabric which connects the entire social structure of America and the attitudes held by many individuals inside. The collective will in every instance determines a collective outcome. Not one person is absolved from this foregone conclusion because they exist inside this context. If the context is a belief that anger and blame is a necessary component of the delivery of healthcare in America, we will become exactly what we believe in.
The new Affordable Care Act (ACA) has carefully avoided a discussion regarding malpractice lawyers and their role in healthcare reform. America looks with jealous eyes at other developed countries that have healthcare expenditures as a percent of their gross domestic product (GDP) all at 10% or less. America’s healthcare expenditure as a percent of GDP is currently at 18%, scheduled to reach almost 20% by 2021.
Is there a way out?
The answer lies in the aftermath of confronting fear inside that cold, sterile conference room. Who am I? What do I stand for? What am I willing to do for a greater good? Sound too cliché?
America is being brought to its knees and healthcare is its conqueror, at 17% of our gross domestic product and climbing. What responsibility do we each have as citizens of this country, not just as doctors and patients, in making sure that what we end up with is not only just and fair, but that which resonates with unbreakable truths of our existence as human beings?
This is not a crisis of healthcare, but of conscience and faith. America, you have been tried and you have been found wanting. As individuals, we have to now face this singular truth.
I have burned inside the fires of fear. I have confronted my own worst nightmares, and I have lived to tell the tale. My will is now strong. I know who and what I am, and what I stand for.
The real question is, do you?