Medicine is never an easy field. People accuse doctors of not doing enough, or doing too much.

There are no easy answers. We’re caught between doing what’s best, without putting the patient through too much, and doing what’s needed to protect ourselves from legal action.

Let’s take Mrs. Summer. She’s a nice 78 year-old lady I saw in the office last week.

Earlier this month she hurt her back. So she saw her internist, who correctly diagnosed her with a muscle strain. He gave her a muscle relaxant and Tylenol #3.

A few hours after she took the medications she became confused and sleepy. Her family called Dr. Internist, who said to stop them immediately.

She was absolutely fine the next morning, but her daughter is a nurse at the hospital, and wanted me to have a look at her for the episode. So she called Mary, and they came in last week.

The odds are that all she had was confusion due to Tylenol #3. So do nothing. It’s most likely and least expensive.

But maybe she had a TIA. If I don’t correctly diagnose that, and she has a big stroke, than they could sue me. So let’s order a brain MRI, head & neck MRA, and echocardiogram. That’s a few thousand dollars in tests.

Or maybe she had a seizure, and needs to be started on seizure medications. So lets order an EEG, too. Another $500.

Perhaps it was a metabolic event, with her blood sugar getting too low. So I’ll order some labs. That’ll be another $500-$1000 depending on how much I order.

This is the dilemma your doctor faces each day, many times over. None of us come to work saying “Oh boy! I can’t wait to drive up the cost of health care today!” But we’re faced with finding an (at times) impossible balance.

We don’t get a 2nd chance, either. If we guess wrong we run the risk of getting sued. Another doctor is always willing to make a living as an expert witness and testify that we are incompetent.

And yet, with this sword of Damocles hanging over our heads, I and thousands of other doctors do this every day. And try to do the best we can, within the limits of human fallibility.

Doctor Grumpy is a neurologist who blogs at Doctor Grumpy in the House.

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