Why are EM doctors so scared of lawyers

[Perrotfish]

Alright, so I'm doing yet another EM rotation. It's fun, its interesting, my bosses are great, and the hours aer insanely short. However one thing that's driving me nuts: when I ask why we're managing a patient in a certain way, there is approximately a 50% chance that the answer is going to be 'lawyers'. Why are we giving that virus an antibiotic? "well it looks bad legally if..". Why are we doing cardiac enzymes on a healthy 18 year old with obvious musculoskeletal pain? "Well, in a lawsuit, you need to be able to say...". Its non-stop.

This is a common theme I've seen at the three ERs I've rotated through. There seems to be a persistent fear of litigation that guides management, much more than any other profession in Medicine. This seems strange to me. After all I've rotated with all the professions that work with babies, who are also sued alot, but I barely ever heard Neonatologists or even Obstetricians (the most/worst sued) mention lawyers when explaining their management. I know ER is up there near the top in terms of volume of lawsuits, but they seem to be way over the top in their response.

Thoughts? Do you think this is true, and if so why are ER docs so much more legally minded?

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[Boatswain2PA]

I blame the OB/GYN's.....they are the one's who delivered most of the lawyers.

 

[RustedFox]

Rather than a flippant reply, I'll give you a very real one: because its so easy to make a simple oversight in EM that will get you involved in a lawsuit, and its better to win the war before the battle ever begins. Also, since the vast majority of cases are settled outside of court, its likely that you may never get the chance to tell your side of the tale and "make your case that you are right in your management." When you apply for licensure/accreditation/privileges/whatever, you have to go and list every single one of those cases, the details, the outcome, if settled, for how much, why, etc, etc,.... it may act as a barrier to employment at a job or with a group that "you want".

Waaay easier to avoid it all. If you think that you are immune to the stress and adverse psychiatric effects of a potential lawsuit; you're wrong. Suits result in lots of substance abuse, depression, divorce, etc. etc. - and remember - you were doing what you thought was BEST for the patient... and this is your thanks ?!

 

[Birdstrike]

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[Arcan57]

Alright, so I'm doing yet another EM rotation. It's fun, its interesting, my bosses are great, and the hours aer insanely short. However one thing that's driving me nuts: when I ask why we're managing a patient in a certain way, there is approximately a 50% chance that the answer is going to be 'lawyers'. Why are we giving that virus an antibiotic? "well it looks bad legally if..". Why are we doing cardiac enzymes on a healthy 18 year old with obvious musculoskeletal pain? "Well, in a lawsuit, you need to be able to say...". Its non-stop.

This is a common theme I've seen at the three ERs I've rotated through. There seems to be a persistent fear of litigation that guides management, much more than any other profession in Medicine. This seems strange to me. After all I've rotated with all the professions that work with babies, who are also sued alot, but I barely ever heard Neonatologists or even Obstetricians (the most/worst sued) mention lawyers when explaining their management. I know ER is up there near the top in terms of volume of lawsuits, but they seem to be way over the top in their response.

Thoughts? Do you think this is true, and if so why are ER docs so much more legally minded?

We have no prior connection to the patient, we're seeing the patient exclusively in times of stress and pain, we only have a couple of hours to determine what's wrong, we have big name academic colleagues who will sell us out to supplement their income, and we function in an almost complete void of information. Even highly educated patients often are so interested in making sure we get the minutia of their medical history correct, that they neglect to tell us the important information (I don't care about a dose adjustment on your RA meds made 8 months ago, but it would be nice if when I asked you if you had ever felt like this before you'd have told me about having the exact same symptoms last year and being hospitalized for a month because of it). None of this washes our hands clean of over-testing to make up for deficient patient communication, but it explains it. Also a signficant percentage of EM docs have been sued, and from everyone I've ever talked to or read a description from the process is amazingly aversive. I think the EMRAP quote was "I'd bankrupt the entire medical system to avoid getting sued again."

 

[pratik7]

i would order 1000 ct's to potentially avoid a single lawsuit. Its just that simple When you do this long enough you realize that clinical intuition will misguide you eventually. You never know who it is gonna be

 

[RustedFox]

i would order 1000 ct's to potentially avoid a single lawsuit. Its just that simple when you do this long enough you realize that clinical intuition will misguide you eventually. You never know who it is gonna be

this.

 

[southerndoc]

i would order 1000 ct's to potentially avoid a single lawsuit. Its just that simple When you do this long enough you realize that clinical intuition will misguide you eventually. You never know who it is gonna be

Even practicing in a state with a gross negligence standard, I still order a lot of CT's. I've been surprised at the number of atypical presentations for stuff. I always complained about hospitalists wanting CT's on every syncope until I found a 30 year old syncopal patient with a spontaneous subarachnoid hemorrhage (he denied a headache). 36 year old the other day had burning left upper quadrant abdominal pain, belching, and feeling an acid taste in his mouth. EKG was normal. Troponin was 11. Went to the cath lab to have a circumflex lesion.

There's a reason we order a ton of workups. One could easily argue that 36 year old had acid reflux, write him a script for Protonix and send him out... only to either have severe CHF, die, or come back the next day with worsening condition.

 

[ERDude]

36 year old the other day had burning left upper quadrant abdominal pain, belching, and feeling an acid taste in his mouth. EKG was normal. Troponin was 11. Went to the cath lab to have a circumflex lesion.

There's a reason we order a ton of workups. One could easily argue that 36 year old had acid reflux, write him a script for Protonix and send him out... only to either have severe CHF, die, or come back the next day with worsening condition.

This scares me.

I'm good with getting the EKG on any upper belly pain, belching, reflux, or any other potential GI masquerader of angina (about 1 month ago picked up a young 30s F with a massive anterior STEMI/99% LAD on cath, cc: was burning in her throat and belching after eating cheetos - not making up the cheetos part either) but I rarely order a trop on the young ones. I typically get the EKG to r/o STEMI and that's my cardiac w/u (barring risk factors or otherwise concerning history).

I'm not too far out of residency and thus far any of my "good pick-ups" have just made me more conservative.

 

[GeneralVeers]

The problem with our system is two-fold. On one hand we expect a 0% miss-rate on everything, a virtually impossible task. On the other we are trying to keep costs down so we can afford to provide medical care to everyone, also a virtually impossible task.

Eventually something is going to have to give. I'm not sure what that will be just yet.

 

[EctopicFetus]

Perrot,

Since you mentioned OB Ill just say this. The C section rate has soared. Do you know why? Trying to prevent CP births. Has it worked? No?

IN the ER we are simply the most honest. I agree with what most above have said. See we work in a landmine. We cant miss the MI in a young person with an atypical presentation.

I would also say that while your exam is important it matters little in the court of law. Backup info (Scans labs etc) are what save your butt.

Also, with regard to "obvious" MS chest pain.. please give details. Outside of a very few circumstances there is no such thing. Most people with MS CP dont show up in the ED. Makes you wonder why these people showed up in the ED (leading to more risk).

 

[RustedFox]

Psst: I think you mean to say: "We work in a minefield."

*sly high-five*.

 

[Perrotfish]

I blame the OB/GYN's.....they are the one's who delivered most of the lawyers.

I LOL'd

We have no prior connection to the patient, we're seeing the patient exclusively in times of stress and pain, we only have a couple of hours to determine what's wrong, we have big name academic colleagues who will sell us out to supplement their income, and we function in an almost complete void of information. Even highly educated patients often are so interested in making sure we get the minutia of their medical history correct, that they neglect to tell us the important information (I don't care about a dose adjustment on your RA meds made 8 months ago, but it would be nice if when I asked you if you had ever felt like this before you'd have told me about having the exact same symptoms last year and being hospitalized for a month because of it). None of this washes our hands clean of over-testing to make up for deficient patient communication, but it explains it. Also a signficant percentage of EM docs have been sued, and from everyone I've ever talked to or read a description from the process is amazingly aversive. I think the EMRAP quote was "I'd bankrupt the entire medical system to avoid getting sued again."

I thought this was pretty insightful, particularly the bolded. It sounds like a major driving factor in the fear of litigation in EM is that they feel more out of control of their outcomes than other specialties. Maybe OBs complain about lawyers less because, despite the statistics to the contrary, they feel more in control of their outcomes? Like how a man can get behind the wheel for a cross country drive and never worry about having an accident, but be deathily scared of flying in a statistically much safer flight, because he feels like he's in control when he's in the car.

 

[Rendar5]

a few other points:
1. on chest pains, you really do need trops on certain people to actually reduce that risk of MI under 1%. Keep in mind we see over 200-300 chest pains a year. Even with a risk under 1%, you're talking about at least one or two missed MI every year. The outpatient population is a different population than the ED, and can be sent for testing the ED can't provide in the ED.

2. If you don't look for something, you won't find it. That may mean extra testing on atypical cases

3. Again with chest pain, musculoskeletal is easy to assign to a case, but hard to prove. pain on palpation? 15% of MI's do that. no risk factors? "risk factors" refers to things tha tincrease risk of developing CAD in 10 years. if you look at the lit, they don't change pre-and post-test probability of MI (not CAD). I have had 18 year olds with MI. Do I get trops on all those in my own practice? nah, but still, I call it atypical chest pain unless there's an established pattern with appropriate rule out testing.

4. We don't follow-up on these patients, other docs do. We don't get a second chance to get things right. That gynecologist can see the pateitn again and figure out the next step if the initial plan fails to resovle the issue or establish a diagnosis

 

[diphenyl]

EM physician's get sued on average once every 10 years. Good reason to be scared.

 

[southerndoc]

This scares me.

I'm good with getting the EKG on any upper belly pain, belching, reflux, or any other potential GI masquerader of angina (about 1 month ago picked up a young 30s F with a massive anterior STEMI/99% LAD on cath, cc: was burning in her throat and belching after eating cheetos - not making up the cheetos part either) but I rarely order a trop on the young ones. I typically get the EKG to r/o STEMI and that's my cardiac w/u (barring risk factors or otherwise concerning history).

I'm not too far out of residency and thus far any of my "good pick-ups" have just made me more conservative.

My ordering of troponins has significantly increased since we started doing i-stats. It only takes 10 minutes to get it back. Usually I send the troponin while waiting on the chest x-ray. Anyone 18 or older, even with atypical pain, gets a troponin now. I'm surprised at the number of "atypical" chest pains that have had positive troponins. I'm not talking about the 0.09 troponin. I'm talking about troponins in the 3's and one atypical with a normal EKG in the 70 range (seriously). The guy that came back with a trop of 70 had a stone cold normal EKG, had chest burning and I was in the process of telling him how his pain sounds like it's GERD when the nurse walked in to show me the i-stat result.

Have also picked up a few myocarditis cases with atypical symptoms in the young.

Sorry to go on with the anecdotes, but enough anecdotes in my measly 4 years of practice has made it appear p <0.05 in my experience. So heck yea, I order a lot of tests (mainly lab work, sometimes imaging) on trivial presentations.

 

[Birdstrike]

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[docB]

Have also picked up a few myocarditis cases with atypical symptoms in the young.

Me too. I may be a bit more aware of this because I had myocarditis when I was younger but I still catch one every year or two.

On a related note I do get single troponins. I feel that if you document that you know the diagnostic limitations, i.e. it isn't a "rule out" but it does screen for something from the previous day or so they can be valuable.

When it really comes down to it, it's not really about you or your care, competence or whether you're a good doctor or not.

It's about lawyers suing other lawyers to get money from an insurance company.

They have no intention of bankrupting you. They want you working, billing patients, and paying money into an insurance policy so they can sue that insurance company for the money. Have you ever wondered why they make no effort to get your license pulled after saying in court you are negligent and a a danger to your patients and society?

Its not about you. Think about it.

To lawyers we aren't the enemy. We're just sheep to be fleeced. Lawyers believe that getting sued is just the cost of doing business. It's the attitude that will ruin America.

 

[EctopicFetus]

EM physician's get sued on average once every 10 years. Good reason to be scared.

Obviously tthat number depends on your personal workload but I believe it is one in 21k patients we see.

 

[EctopicFetus]

Me too. I may be a bit more aware of this because I had myocarditis when I was younger but I still catch one every year or two.

On a related note I do get single troponins. I feel that if you document that you know the diagnostic limitations, i.e. it isn't a "rule out" but it does screen for something from the previous day or so they can be valuable.



To lawyers we aren't the enemy. We're just sheep to be fleeced. Lawyers believe that getting sued is just the cost of doing business. It's the attitude that will ruin America.

So I was just talking to a med mal guy in town here. Thats exactly what he said. He also told me in his 20+ years of med mal he has NEVER sued for more than policy limits.

He also told me that they get a thousand or so cases brought to them every year, of those they send about 50 to "experts" of those 6-10 cases get filed and they collect insurance money on 2-3 cases a year.

The most recent case they had they settled for 500k.

 

[Birdstrike]

?

 

[diphenyl]

Obviously tthat number depends on your personal workload but I believe it is one in 21k patients we see.

Yes definitely. I work between 15-20 ten hour shifts a month. Any given night I see around 15 patients. So roughly 21k patients per 10 year period.

 

[EctopicFetus]

Yes definitely. I work between 15-20 ten hour shifts a month. Any given night I see around 15 patients. So roughly 21k patients per 10 year period.

Wow.. 1.5 pph?

BTW I dont think we are "scared" of lawyers. We are afraid of being sued. There is a long list of why..

The lawyers are scared of us. I have lots of lawyers as patients and all of them feel the need to justify their legal standing.

Things like "I only do med mal defense", or "I dont do litigation". Never had a trial attorney ever admit that to me when they were a patient.

I know lots of lawyers since my spouse is one. Their professional mentality is not like ours. A physician is just collateral damage in their pursuit of insurance money.

 

[StevieStud]

A physician is just collateral damage in their pursuit of insurance money.

 

[my doc in a box]

Yes definitely. I work between 15-20 ten hour shifts a month. Any given night I see around 15 patients. So roughly 21k patients per 10 year period.

This. A cardiologist or internist discharges, what, 1-3 patients per day? while an EP discharges 15-25 patients they've never seen before, after those patients waited in the waiting room for hours, didn't get their narcs, whatever. If it's a numbers game you simply have more exposure, and less-friendly conditions. That's my impression as a MS, at least.

 

[AmoryBlaine]

This is actually a great question and a great discussion.

I would turn the question back on the OP a little bit: since we are practicing in essentially a 0% miss rate tolerant environment, why doesn't medical school spend more time teaching young doctors about the reality of medicine?

I agree with the statement that I would order 1000 CTs to avoid a lawsuit.

The other thing that I think about a lot is that I see a ton of patients and there are always more waiting to be seen. One school of thought in EM (that in my experience clusters around older providers in academics) is that the right way to handle this is just work very slowly, spend a great deal of time with a careful H+P, and then base your testing on that.

The other, which I think is basically correct in 2012 given where we are in terms of ED volume and medmal climate, is to just test a lot.

As others have pointed out, I'm going to see at least 200 chest pain patients this year. Do I really trust my H+P to tease out the real pathology from the GERD? If I do I'm deluding myself, as every EM doc who has been out for awhile can tell you the story of the 27 year old with reflux like sx who had that 99% LAD (see other posts on this thread). So in that respect I treat my job a bit like cookbook medicine. When the summons comes, the plaintiff's attorney is not going to ask you about what was going on in the ER that day. To them the only thing that happened on August 12 at 11:23pm at St. Richard's emergency room is that Dr. Blaine missed the MI on John Smith, the loving father of 3 and pillar of his community.

This allows me to dispo people quickly, not miss stuff, and have intellectual energy to spend on cases that really interest me.

 

[EM4life]

I think this is a great discussion also. I think that it's unfortunate that most of the attendings you work with say the only reason they are doing something is fear of litigation though, because it's not just litigation right? It's an unwillingness to miss badness when it presents itself in unusual ways. Not all attendings do it just because they don't want to be sued, it's that if my mother walked into the ED with arm pain, I would expect the doc seeing her to thinking about an anginal equivalent. We gamble everytime we send someone home and it's dependent on how risk adverse you are as a practitioner. The easiest stuff we do as EM docs is pick up the obvious stuff in the most classic presentations, the sickest people and bundling them up for admission, the STEMI for crushing exertional chest pain. What makes our job hard is all the gray crap in between, the atypical presentations of badness. If you don't want to work people up because they don't fit a classic presentation or don't fit what you read in a text book, then EM is going to make you very unhappy doc.

 

[Birdstrike]

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[Perrotfish]

I think this is a great discussion also. I think that it's unfortunate that most of the attendings you work with say the only reason they are doing something is fear of litigation though, because it's not just litigation right? It's an unwillingness to miss badness when it presents itself in unusual ways. Not all attendings do it just because they don't want to be sued, it's that if my mother walked into the ED with arm pain, I would expect the doc seeing her to thinking about an anginal equivalent.

I guess where its the most glaring is when we know that the test ordered has a cost in negative outcomes, rather than just a financial cost. A flat film to r/o pnumonia or a troponin to r/o MI in an otherwise atypical presentation probably aren't great examples, since they don't really cost anything but money. CTs and surgery consults are a bit harder to justify: there's at least some data that those have a number needed to harm as well as number needed to treat.

I will also say, I'm surprised at how many of the legally minded suggestions sound like pure superstition/speculation. My favorite is documentation: when attendings want long notes they tell me you need to write long notes to show you ruled out every possibility, or the lawyers will use your note to show you skimmed over the patient. When attendings want short notes the tell me that you need to write short notes or the lawyers will show that the one in a million possibility that you missed was common enough to be worth documenting. I don't think any of them really knows what the actual effect of all of their premptive legal defenses are. For all the chart reviews we do of our medical treatments, you would think someone would start publishing chart reviews of medical malpractice cases to show what does and does not work.

 

[GeneralVeers]

The system is going to change, and I suspect eventually the lawyers are going to lose out. States are going to have no choice but to pass physician-friendly tort reform laws just to keep doctors from leaving.

There is going to be an estimated shortage of 20,000 doctors by 2020. If the medical climate keeps going the way it is, that number will be much higher as otherwise intelligent people pursue other careers instead of medicine.

Quite simply medical malpractice is not compatible with government-run healthcare and rationing. Since rationing is going to come, no matter what anyone says, then malpractice has to give. Otherwise there will be no doctors to take care of the 30 million more people who will be "covered" with Medicare/Medicaid.

 

[Siggy]

This was the point I was trying to make in this article (Cause of death: Defensive medicine) first posted here on SDN-EM. However, many people choose to ignore these risks and the need for fundamental tort reform (not just awards caps) or just simply don't understand the issues which are complex. Read the comments from attorney's and non-physicians at the end of the post. It is very enlightening.

However how many people get sued for side effects of defensive? Is the physician who prescribed antibiotics that ultimately lead to the ingrown toe nail turning into sepsis going to get sued? Is the EP who got the GERD patient admitted for the cath going to get sued? Is the EP who ordered the CT that eventually turned into the glioma going to get sued?

If the public wants to play silly lawsuit games, then they can win their silly prizes. The unfortunate thing is that none of this, neither defensive medicine or frivolous med-mal suits are silly. However why should we care about NNT and NNH for defensive medicine when the lawyers and the public don't care about the NNT and NNH for their lawsuits?

 

[docB]

The system is going to change, and I suspect eventually the lawyers are going to lose out. States are going to have no choice but to pass physician-friendly tort reform laws just to keep doctors from leaving.

There is going to be an estimated shortage of 20,000 doctors by 2020. If the medical climate keeps going the way it is, that number will be much higher as otherwise intelligent people pursue other careers instead of medicine.

Quite simply medical malpractice is not compatible with government-run healthcare and rationing. Since rationing is going to come, no matter what anyone says, then malpractice has to give. Otherwise there will be no doctors to take care of the 30 million more people who will be "covered" with Medicare/Medicaid.

I agree. I am also in the minority that thinks that once we socialize more completely and the politicians realize how much the system loses in indirect costs due to defensive practices and direct costs with suits they will shut it down. Why lose votes by raising taxes when they can give out goodies by stopping the lawsuits. They won't do it for us. They'll do it for themselves.

However how many people get sued for side effects of defensive? Is the physician who prescribed antibiotics that ultimately lead to the ingrown toe nail turning into sepsis going to get sued? Is the EP who got the GERD patient admitted for the cath going to get sued? Is the EP who ordered the CT that eventually turned into the glioma going to get sued?

If the public wants to play silly lawsuit games, then they can win their silly prizes. The unfortunate thing is that none of this, neither defensive medicine or frivolous med-mal suits are silly. However why should we care about NNT and NNH for defensive medicine when the lawyers and the public don't care about the NNT and NNH for their lawsuits?

It's hard to get sued for defensive medicine. If your dubious antibiotic causes a reaction the plaintiff will have to get a jury of lay people, who all know antibiotics cure colds, to side with them. Not impossible, but hard. Proving causality between the antibiotic for the toenail and the eventual sepsis is very difficult. Proving causality between the unnecessary CT scan and the tumor years down the road is near impossible.

 

[Birdstrike]

?

 

[GeneralVeers]

Rarely, if ever. That's the whole point. It's a lot easier for a lawyer to sue you for not ordering a CT in a kid that comes back with a subdural the next day brain dead, than it is to go back and find which radiation beem mutated the DNA base pair within the white blood cell of the two year-old that 18 years later, turned malignant and caused his leukemia.

Nothing will change unless we start denying treatment to lawyers.

"I'm very sorry Mr. Scumbag Leech attorney, but the direct risk to me of treating you is too high. Please go die in the gutter."

 

[Daiphon]

Rarely, if ever. That's the whole point. It's a lot easier for a lawyer to sue you for not ordering a CT in a kid that comes back with a subdural the next day brain dead, than it is to go back and find which radiation beem mutated the DNA base pair within the white blood cell of the two year-old that 18 years later, turned malignant and caused his leukemia.

Agree, sadly, but agree. Not sad to agree with Birdstrike... but rather that this is where we're at as a profession.

That said, if y'all will allow me a moment of being trite, the EPs job isn't to play the game of what's most likely going on; but rather the game of what's most likely to kill you.

This is why we all work up GERD-associated chest pain (in the appropriate patient population, mostly). In the clinic it's "trial of H2RAs or PPIs, & come back in 2 weeks," but a different bag altogether in the ED.

Oi.
-d

Sent from my DROID BIONIC using Tapatalk

 

[ditch doctor]

Rarely, if ever. That's the whole point. It's a lot easier for a lawyer to sue you for not ordering a CT in a kid that comes back with a subdural the next day brain dead, than it is to go back and find which radiation beem mutated the DNA base pair within the white blood cell of the two year-old that 18 years later, turned malignant and caused his leukemia.

Along a similar note, I think there's another EMRAP quote about never, ever has there been a lawsuit for giving an antibiotic (outside of known allergy given by mistake).

I think this was in the context of strep throat and talking about Rheumatic Heart Disease; something like we are killing 2-3 people a year from allergic reactions to penicillin to save 1 person every 3 or 4 decades from RHD.

 

[RustedFox]

agree, sadly, but agree. Not sad to agree with birdstrike... But rather that this is where we're at as a profession.

That said, if y'all will allow me a moment of being trite, the eps job isn't to play the game of what's most likely going on; but rather the game of what's most likely to kill you.

this is why we all work up gerd-associated chest pain (in the appropriate patient population, mostly). In the clinic it's "trial of h2ras or ppis, & come back in 2 weeks," but a different bag altogether in the ed.

Sent from my droid bionic using tapatalk

this.

 

[Apollyon]

However how many people get sued for side effects of defensive? Is the physician who prescribed antibiotics that ultimately lead to the ingrown toe nail turning into sepsis going to get sued? Is the EP who got the GERD patient admitted for the cath going to get sued? Is the EP who ordered the CT that eventually turned into the glioma going to get sued?

If the public wants to play silly lawsuit games, then they can win their silly prizes. The unfortunate thing is that none of this, neither defensive medicine or frivolous med-mal suits are silly. However why should we care about NNT and NNH for defensive medicine when the lawyers and the public don't care about the NNT and NNH for their lawsuits?

First member of my residency class to get sued (and lose, too!) was one year out - a patient he ADMITTED for pneumonia (note, did NOT discharge), and died (in hospital). This patient that my classmate ADMITTED was sued because the Levaquin for community acquired PNA was not "broad spectrum" enough. One writeup from myriad law firms (these attorneys are like vultures at carrion) said that, during his evaluation, my classmate ordered a CT of the chest, and there was "something" suspicious on the CT, but not specifically PNA. As such, the Levaquin was ordered, and pt admitted. He had been seen at an urgent care 2 days prior, and was prescribed doxy, for possible Lyme (versus the flu). He got 2 liters of fluid in the urgent care, and a liter in the ED 2 days later. Then, overnight, he went downhill, coded twice in the morning and at noon, and, still searching for a source, he went to the OR, where he was opened to look for an abdominal source, where he coded again and expired.

My classmate was sued for "wrongful death". Others, including the urgent care doc, the pt's PMD, and the hospitalist settled out of court prior to trial.

I don't know the details more than, somehow, he lost the case, and was driven out of state by it.

 

[RustedFox]

Thaaaats absurd ! "Not broad spectrum enough" ?! What do they want ? How can you possibly lose this one (proving directionality) ?!

 

[diphenyl]

"If there were no bad people, there would be no good lawyers"

-Charles Dikens

 

[AmoryBlaine]

"An estimated 70 million CT (for computed tomography) scans are performed in the United States every year, up from three million in the early 1980s, and as many as 14,000 people may die every year of radiation-induced cancers as a result, researchers estimate."

Unfortunately, physicians have allowed the profession of medicine to be molded, shaped and cultivated by the actions, policies and laws of lawyers, businessmen, and politicians. This is the reason we are where we are today.

This has strong armed physicians into doing exactly that which you describe: drastically increasing the amounts of tests and treatments to reduce the pervasive legal risks to physicians. All of these tests come with side effects and complications, including sometimes cancers, organ injury and death. The effects often times are very subtle, insidious or occur at a much later date so that the initial cause cannot be easily identified such as with radiation exposure, antibiotic resistance or hospital acquired infections. They don't occur in all patients exposed, but inevitably do if enough patients are exposed.

This was the point I was trying to make in this article (Cause of death: Defensive medicine) first posted here on SDN-EM. However, many people choose to ignore these risks and the need for fundamental tort reform (not just awards caps) or just simply don't understand the issues which are complex. Read the comments from attorney's and non-physicians at the end of the post. It is very enlightening.

I don't need education on risks of radiation.

I need ACEP to say that 1% miss rate is acceptable.

And I need the Senate to pass a tort cap.

And I need patients to stop having the level of expectation they do.

I love love love my job, but med mal is a cancerous festering sore on the arse of medicine. It has fundamentally altered the doctor-patient relationship.

 

[Daiphon]

I love love love my job, but med mal is a cancerous festering sore on the arse of medicine. It has fundamentally altered the doctor-patient relationship.

There's a doctor-patient relationship still? I only know of the "consumer-customer service" relationship...

</ironic cynicism>

Cheers!
-d

Sent from my DROID BIONIC using Tapatalk

 

[deleted109597]

I don't need education on risks of radiation.

I need ACEP to say that 1% miss rate is acceptable.

And I need the Senate to pass a tort cap.

And I need patients to stop having the level of expectation they do.

I love love love my job, but med mal is a cancerous festering sore on the arse of medicine. It has fundamentally altered the doctor-patient relationship.

Vote with your feet, and move to a place with better tort law.
All the neurosurgeons in WV basically went on strike to do it. You have to be willing to sacrifice a little to get what you need.

 

[RustedFox]

Speaking of "places with better tort law"... anyone know how Virginia is ? I kinda have a small fascination with the Norfolk area.

 

[deleted109597]

Speaking of "places with better tort law"... anyone know how Virginia is ? I kinda have a small fascination with the Norfolk area.

The Tidewater is run by basically one group, and they set the pay rates. Unless you work at the VA, which we all know is a cash cow[/irony]

Also, Virginia got a C- on the last ACEP report card for tort.
Also, it's going to get worse caps

 

[AmoryBlaine]

Vote with your feet, and move to a place with better tort law.
All the neurosurgeons in WV basically went on strike to do it. You have to be willing to sacrifice a little to get what you need.

Great idea for those that can, some of us are tied to geographical areas.

And frankly the best med mal states are not everyone's idea of the greatest places to live.

 

[deleted109597]

Great idea for those that can, some of us are tied to geographical areas.

And frankly the best med mal states are not everyone's idea of the greatest places to live.

As I said, you have to be willing to make sacrifices.

EM is one of those fields where you can just up and move with a day (or 2 weeks, or 30 days, or whatever) notice. We don't have to worry about patient abandonment, or keeping records.

Of course, most of the "negative" things people have about states are simply anecdotal or stereotypical views. Texas is home to 3 of the largest 10 cities in America (and 6 of the largest 20), and Houston has an openly lesbian mayor. You don't automatically get a truck with a gun rack when you move.

Best 10 states for malpractice (per ACEP in 2008) are CO, TX, KS, GA, SC, ID, MT, AK, CA, OK.
If you can't find something in any of those 10, you're looking for something very specific, and the sacrifice you're making is lack of tort reform. Sorry. Also you're probably making less, as the NE is the lowest paying area.
Worst 10(11) are DC, NJ, RI, AZ, KY, NC, DE, VT, NY, WY, MI, WA.

 

[RustedFox]

As I said, you have to be willing to make sacrifices.

EM is one of those fields where you can just up and move with a day (or 2 weeks, or 30 days, or whatever) notice. We don't have to worry about patient abandonment, or keeping records.

Of course, most of the "negative" things people have about states are simply anecdotal or stereotypical views. Texas is home to 3 of the largest 10 cities in America (and 6 of the largest 20), and Houston has an openly lesbian mayor. You don't automatically get a truck with a gun rack when you move.

.

You ... don't... automatically... ? Well... why the hell not, man !?

 

[EctopicFetus]

I imagine AZ moved up.. passed some helpful laws..

 

[GeneralVeers]

You ... don't... automatically... ? Well... why the hell not, man !?

I want a handgun to go with my bottle of Jack!