I was listening to the news on my way to work recently, and heard a story about the review conducted after the well-publicized security breach at the White House. Like many people, I was shocked when the story of the fence-jumper first broke. How was it possible that some guy with a knife managed to get over the fence, cross the lawn, enter the White House and get deep into the ...

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shutterstock_96224099 Part 3 of a series.  Read part 1 and part 2. The aspect of malpractice suits that lawyers seem congenitally unable to understand is how devastating it is. "Ho hum," says a lawyer who read my first two posts in this series. "Get out the violins." It's as if, because I make my living operating on ...

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In my administrative role, I have the great pleasure of signing thank you letters to patients and family members who have acknowledged the great care they have received by one of our physicians or other caregivers. It is a nice way to tell the patient “we got your note” and to simultaneously recognize the provider by copying her or him. The best part is that I get to read the ...

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Is it about physician drug testing?  Is it about allaying the pain and suffering of families of patients whose outcomes have been devastating and tragic?  Is it about the compensation of the legal counsel who represent those families and patients? Truthfully, I don't want to talk about 46.  I think the issue is very much deeper and the process that underlies medical malpractice litigation has consequences for individuals and society that ...

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The New York Times has reported on a woman who wanted to deliver vaginally and claims she was forced to have a repeat C-section (her third C-section) against her will. I can’t comment on the veracity of her claims, however a forced C-section is never, ever acceptable. It doesn’t mater if the fetus has an agonal rhythm (is visibly dying on the monitor), as an OB your role is to ...

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Part 2 of a series. Read part 1. I realized I was entering into a process the rules of which were entirely separate from normal human interaction when it hit me that news of the lawsuit was in the newspaper before anyone had had the decency to contact me. What kind of people act like that? Civilized behavior, respectfulness -- in short, all the ways in which you'd think nice ...

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If you are a physician like me who performs procedures, then rarely you will cause a medical complication. This is a reality of medical life. If perforation of the colon with colonoscopy occurs at a rate of 1 in 1,500, and you do 3,000 colonoscopies each year, then you can do the math. Remember that a complication is a blameless event, in contrast to a negligent act when the physician is ...

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shutterstock_116541757 Part 1 of a series. In all my years of practice, my dad called me at the office only twice. The second was to inform me of a horrible family tragedy. The first -- well, I guess in a small way you could say it was the same. "I hear you joined the club," he said. "What?" I had no idea what he was talking about. I'd ...

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California is contemplating requiring physicians to submit to alcohol and drug testing.   Citizens there will be voting on this proposal this November. I do think that the public is entitled to be treated by physicians who are unimpaired.  Physicians, as members of the human species, have the same vices and frailties as the rest of us. I have no objection to this new requirement, if it passes. This will not be ...

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November, 1999 was a watershed for physicians. It is then that the infamous "To Err is Human" report was issued by the Institute of Medicine claiming that close to 100,000 patients were needlessly dying due to preventable medical errors. The report was a bombshell, having a significant impact on how medicine was practiced. 15 years later we are still evaluating that impact. To anyone who took the time to read the ...

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When things go wrong in medicine, as they invariably do, we try to figure out what went wrong, and why.  We try to learn if there’s anything we could have done better and what we should do next time. It used to be, in the days of the giants, that the physician responsible for the patient with the bad outcome presented the case during a morbidity and mortality (M&M) conference.  It was ...

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Nobody likes waking up in the middle of the night gasping for air. When you make a mistake in the emergency department, that’s exactly what happens. They come in all sorts of shapes and colors:

  • The sixty-year-old man diagnosed with a strained lower back muscle who comes back with a ruptured abdominal aortic aneurysm.
  • The fifty-four-year-old Hispanic female with generalized malaise who goes into cardiac arrest from a missed myocardial infarction.
  • The two-year-old with ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. Physicians in California are mobilizing to oppose an initiative on the November ballot that will raise the cap on non-economic damages in medical malpractice cases. The current cap of $250,000 is part of California’s Medical Injury Compensation Reform Act, or MICRA. Adopted in ...

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I saw the caller-ID and immediately picked up the phone; it was an old friend from college. “I want to sue a doctor and I want to sue the hospital,” said Karen. Sadly, I hear those words all too often.  I’m a newly-minted lawyer -- after a 35-year career as a publisher -- working at one of New York’s top medical malpractice plaintiff’s firms.  What made this particular call so unusual, was ...

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Emergency physician Brian Goldman, host of CBC's White Coat, Black Art, wants to lift the cloud of shame when medical mistakes are made, so they can be openly discussed and not be repeated by other physicians.  In this masterful TEDx Toronto talk, Dr. Goldman shares compelling stories of his own errors and reveals the 3 words that every emergency physician fears. When it comes to mistakes in medicine, the ...

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The U.S. medical malpractice system is broken. It frequently does not punish doctors who need punishing, while levying fines against doctors who did nothing wrong. And this dreadfully inaccurate system still manages to take almost five years, on average, to settle claims. Experts have been promoting a type of reform known as safe harbor rules, which would shield physicians from lawsuits in cases where they were known to be following accepted ...

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Earlier, I wrote about the tragic case of a young girl in California who was declared brain dead after what most media sources called a tonsillectomy. In fact, the patient had a much more extensive procedure for treatment of obstructive sleep apnea. In addition to having her tonsils removed, she underwent an uvulopalatopharyngoplasty (UPPP) and resection (removal) of her inferior nasal turbinate bones. As I stated before, I will not ...

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Every time you turn around, it seems there’s another CEO apologizing. But, when do apologies work? When does an apology help everyone learn, improve, and move on? What distinguished sincere apologies from the rest? I think it takes three ingredients:

  • Compassion: The words and the tone convey sincere empathy.
  • Coherence: The parts of the apology add up to a meaningful, informative statement and are not internally contradictory or self-cancelling.
  • Credibility: The apology is ...

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cost of medical school Whenever new physician salary data is released, reporters and policy experts often compare doctor salaries in the United States to those of other countries: most notably, France. And on cue, Vox's Sarah Kliff -- normally an excellent health care writer, by the way -- is uncharacteristically lazy in framing physician salaries through a biased lens. After presenting the data, ...

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Remember personal responsibility? There actually was an era of responsibility when folks admitted when they screwed up and didn’t blame others for their own mistakes. I know this may seem incredible to the younger generation who simply assume that when something goes wrong today, it must be someone else’s fault. In today’s culture, this is not scapegoating, but the pursuit of justice. Welcome to the era of big victim. In the ...

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