Why are EM doctors so scared of lawyers

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RustedFox said:
You ... don't... automatically... ? Well... why the hell not, man !?
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Boots (especially with yer scrubs) are, however, quite mandatory...heh
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medicolegal possibilities enter my mind on nearly every patient
1) with someone I believe is high risk or doesn't quite fit into any one diagnostic box -- I never want to be the last one holding the hot potato, which is why i think my admission rate is probably higher than average
2) there is nothing to gain by sending a chest pain patient home, pretty much ever
3) if a case ever goes to trial, it most certainly will not be a jury of our professional peers. i feel obligated to objectively prove with tests, documentation, and normal vitals that i did a full eval on a patient and ruled out badness; laymen won't understand medical impressions based on H&P only
4) when in doubt, i ask myself -- "do you want to bet your livelihood on this person?" answer is always no and i order whatever i need to do to make me feel warm and fuzzy about the ultimate end point of disposition

also....this CT stuff being linked to cancer and coming back to haunt us -- i don't buy it. odds are these people are going to be having lots of CTs for their nebulous complaints, and i think it will be virtually impossible to link causality to the single CT I ordered
 
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Mighty Mouse said:
medicolegal possibilities enter my mind on nearly every patient
1) with someone I believe is high risk or doesn't quite fit into any one diagnostic box -- I never want to be the last one holding the hot potato, which is why i think my admission rate is probably higher than average
2) there is nothing to gain by sending a chest pain patient home, pretty much ever
3) if a case ever goes to trial, it most certainly will not be a jury of our professional peers. i feel obligated to objectively prove with tests, documentation, and normal vitals that i did a full eval on a patient and ruled out badness; laymen won't understand medical impressions based on H&P only
4) when in doubt, i ask myself -- "do you want to bet your livelihood on this person?" answer is always no and i order whatever i need to do to make me feel warm and fuzzy about the ultimate end point of disposition

also....this CT stuff being linked to cancer and coming back to haunt us -- i don't buy it. odds are these people are going to be having lots of CTs for their nebulous complaints, and i think it will be virtually impossible to link causality to the single CT I ordered
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Interesting take I'd never thought of before.

We do see a certain group of incredibly unsophisticated people who don't seem to be able to comprehend that a runny nose is not a harbinger of impending ebola-death. I think those people tend to wildly overstate their symptoms and as such get larger workups.

This is one of the reasons why I think it's bull**** that hospitals advertise their ER as essentially a walk-in family practice clinic. ER docs are not experts at family practice, we're experts at finding badness.
 
pratik7 said:
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
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So what are you relying on?

Rendar5 said:
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
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I can certainly appreciate this. We get to sit on our patients overnight (or for a week) and see how things go.
 
Perrotfish said:
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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So in Real EM life these are my two choices.

1. Do what I think is medically justified and likely have 1-2 lawsuits a year for missed appy, missed MI, missed dissection, missed PE. So in essence, I will have a lawsuit over my head in perpetuity with letters telling me to be in deposition on X days just to be told a few days before that the dates are changed. Thus I have to be constantly changing my schedules and life to accommodate these lawsuits b/c I was "practicing correct medicine"?

vs

2. Over ordering CT chests for PE (yes I have found a few in my years where my pretest risks was very low), admitting 50YR old Chest pain with non cardiac stories, over ordering CT heads to rule out bleeds = low risk of lawsuits.

Easy decision for me. Do I increase risk of radiation? Do I increase costs of medicine b/c I over admit? ABSOLUTELY. But I would pick #2 yesterday, today, and tomorrow. Anyone who thinks i am wrong will change their tune when they get their first bogus lawuit.
 
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I hear lawyers can turn you to stone with their venous bite, and can only be defended against using the smell of a weasel.

Though to be fair, my legal basilisk is awesome.
 
I think non docs or maybe even residents miss the point. The fear isnt about being sued and losing or settling. it is really just about being sued. Look at the research into this. Once someone gets sued. The rates of depression skyrocket.

For me I find that being nice to people (even the terrible humans we deal with daily) helps a lot. In the end I get to go home to a great family, in a nice house in my reliable and safe car and have the lights on and food in the fridge.

For this I am thankful. I dont need to "prove" anything to the patients.
 
Couldn't agree more with ectopic--I'm afraid of forever having to question my practice, being deposed, having to report that to potential employers, ect.

As mentioned, being nice is incredibly important:
1) It's well proven that people are less likely to sue doctors they like--it's the reason why PMDs rarely get sued and
2) I know that there's things I'll miss or disease processes I'll see that are very early in their natural progression. By being nice, patient's are less likely to be angry for these unforseen misses

Additionally, it's key not to pick a battle or prove a point in the chart. If you're wrong, it looks terrible. Even if you're right, it doesn't really fix anything. The residents always give me a hard time, but I always start with "patient is a very pleasant ...." simply because it looks thoughtful and caring in chart review
 
Tiger26 said:
The residents always give me a hard time, but I always start with "patient is a very pleasant ...." simply because it looks thoughtful and caring in chart review
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I start every note with "patient has a history of confabulation and abuse of the legal system..."
 
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I know it's a pipe dream, but I really wish that the physician lobbying groups would go to war with the medical malpractice lawyers lobbying groups as well as the people pushing Press Ganey scores as a "standard" but I also realize that unicorns don't don't fart rainbow glitter either so I doubt it will ever happen.
 
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Doctors are poor at the legistlative game. We take it over and over and over. Historically all we cared about was money. Even that we have failed to fix the SGR for as long as I can remember. We have to see patients while lawyers are billing their clients like crazy and hanging with their law school buddies who sit in the state and federal legislatures.
 
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QuackaDO said:
I know it's a pipe dream, but I really wish that the physician lobbying groups would go to war with the medical malpractice lawyers lobbying groups as well as the people pushing Press Ganey scores as a "standard" but I also realize that unicorns don't don't fart rainbow glitter either so I doubt it will ever happen.
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After reading your post, my first impression was it was totally off base. So I read your post to my five year old daughter, and she confirms that a unicorn absolutely did fart rainbow glitter in season 2 of "My Little Pony-Friendship Is Magic". So I'm calling BS on your post. Stop spreading this crap to impressionable pre-meds.
 
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Birdstrike said:
After reading your post, my first impression was it was totally off base. So I read your post to my five year old daughter, and she confirms that a unicorn absolutely did fart rainbow glitter in season 2 of My Little Pony. So I'm calling BS on your post. Stop spreading this crap to impressionable pre-meds.
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Yeah, well... ya see, there's a catch to that. My Little Pony is/was a TV show and in NO way is it true to reality at all. Everyone know that in reality unicorns fart gold glitter, not rainbow. I swear... between TV shows and the internet there is no end to the fountain of misinformation.
 
emergentmd said:
So in Real EM life these are my two choices.

1. Do what I think is medically justified and likely have 1-2 lawsuits a year for missed appy, missed MI, missed dissection, missed PE. So in essence, I will have a lawsuit over my head in perpetuity with letters telling me to be in deposition on X days just to be told a few days before that the dates are changed. Thus I have to be constantly changing my schedules and life to accommodate these lawsuits b/c I was "practicing correct medicine"?

vs

2. Over ordering CT chests for PE (yes I have found a few in my years where my pretest risks was very low), admitting 50YR old Chest pain with non cardiac stories, over ordering CT heads to rule out bleeds = low risk of lawsuits.

Easy decision for me. Do I increase risk of radiation? Do I increase costs of medicine b/c I over admit? ABSOLUTELY. But I would pick #2 yesterday, today, and tomorrow. Anyone who thinks i am wrong will change their tune when they get their first bogus lawuit.
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Great point.

I think other specialties don't understand the pressure on an EM doc to make decisions in seconds with little information, frame of reference or history and in a variety of areas (all of medicine). It's very difficult and with 5 million dollar lawsuits being slapped on physician for missing Dx that specialists often misdiagnose in a nice focused one on one clinic visit - I can't udnerstand how they expect EM physicians to NOT practice CYA medicine.

If they don't want physicians doing this then change malpractice. Have the juries a random selection of physicians that are impartial and go over medical facts and standards of care. Having lay people laying down million dollar judgements after being persuaded by a smooth talking rich lawyer who is paid millions to persuade susceptible people is a recipe for disaster.

The United States malpractice environment is costing America billions. If people could get over their need to be able to sue the bad doctors and make millions, they could cut our health care costs substantially.

There's no reason for an EM physician to compromise his decade of training and 200k + in debt and 500K in lost income just to practice by the book medicine. Ask other people if they would risk $1,000,000 in old income, $1,000,000 in future income and peace of mind to save a few dollars for a corrupt system.
 
QuackaDO said:
I know it's a pipe dream, but I really wish that the physician lobbying groups would go to war with the medical malpractice lawyers lobbying groups as well as the people pushing Press Ganey scores as a "standard" but I also realize that unicorns don't don't fart rainbow glitter either so I doubt it will ever happen.
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The war is also with the American public. They are easily persuaded into thinking they are losing their freedom if they can't sue someone - and that this would be socialism. Someone greed corporations are smiling because of this. Rich people are capitalizing on the gullibility of the masses.
 
Is my computer broken.

There are a whole bunch of "Me think" in these posts.

It's like some hacker got into the system and replaced all the I's with me's.

EctopicFetus said:
Doctors are poor at the legistlative game. We take it over and over and over. Historically all we cared about was money. Even that we have failed to fix the SGR for as long as me can remember. We have to see pateints while lawyers are billing their cleints like crazy and hanging with their law school buddeis who sit in the state and federal legislatures.
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Birdstrike said:
After reading your post, my first impression was it was totally off base. So me read your post to my five year old daughter, and she confirms that a unicorn [me]absolutely did[/me] fart rainbow glitter in season 2 of "My Little Pony-Freindship Is Magic". So me are calling BS on your post. Stop spreading this crap to impressionable pre-meds.
Click to expand...

QuackaDO said:
Yeah, well... ya see, there's a catch to that. My Little Pony is/was a TV show and in NO way is it true to reality at all. Everyone know that in reality unicorns fart gold glitter, not rainbow. me swear... between TV shows and the internet there is no end to the fountain of misinformation.
Click to expand...
 
Will there ever be a day when malpractice doesn't have the power that they do now? Why do we have lay people in the jury? Why can't we have non-biased doctors (as mentioned above) to handle all of the cases? I don't get it! Some entity is handing lots of money somewhere for bad reasons, corrupting healthcare in this country, destroying the doctor/patient relationship, and this entity is paying off another entity to make sure malpractice always has power. Doesn't it piss you off? I'm sure the public's view of "greedy, rich doctors" overclouds its judgement about "greedy, rich, slimy special interest lobbying groups."
 
I'm less scared of lawyers than I am of missing something and hurting someone because I wasn't smart enough or didn't take enough time with them. Defensive medicine isn't just about lawsuits. It's also about squirrely people you don't trust, people who can't give a decent history, people who don't or can't follow-up etc.
 
@JackShephard said:
The war is also with the American public. They are easily persuaded into thinking they are losing their freedom if they can't sue someone - and that this would be socialism. Someone greed corporations are smiling because of this. Rich people are capitalizing on the gullibility of the masses.
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Um... hate to burst your bubble, but the American Trial Lawyers Association ( which includes many self-avowed socialists) is one of the MOST liberal groups in the nation.
 
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wjs010 said:
Will there ever be a day when malpractice doesn't have the power that they do now? Why do we have lay people in the jury? Why can't we have non-biased doctors (as mentioned above) to handle all of the cases? I don't get it! Some entity is handing lots of money somewhere for bad reasons, corrupting healthcare in this country, destroying the doctor/patient relationship, and this entity is paying off another entity to make sure malpractice always has power. Doesn't it piss you off? I'm sure the public's view of "greedy, rich doctors" overclouds its judgement about "greedy, rich, slimy special interest lobbying groups."
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Short answer, no.
 
Perrotfish said:
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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I am not scared of them. I just feel they are bottom feeding, life sucking worthless pieces of trash. Its not fear... no its hate.
 
Telesphorous said:
Um... hate to burst your bubble, but the American Trial Lawyers Association ( which includes many self-avowed socialists) is one of the MOST liberal groups in the nation.
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While I agree fully that the trial lawyers association is a very liberal leaning association (their official lobbying stances and their campaign investments agree), I think starting that many are self avowed socialists is an assumption, and almost certainly a specious or extremely overstated one.

I've interacted with them, they're really closest to old school Rockefeller Republicans, but since that political stance (social liberal with strong protection of individual rights but only for mid size government and staunchly for economics that protect the rich) no longer exists, and the republican party is a *with us or against us* mode right now, going democrat is there next closest thing.

Obviously I soak for the majority/plurality and not each individual member.
 
Jamers said:
I am not scared of them. I just feel they are bottom feeding, life sucking worthless pieces of trash. Its not fear... no its hate.
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Do you feel the same about the lawyers that defend you and I when we're falsely accused of malpractice?
 
Birdstrike said:
Do you feel the same about the lawyers that defend you and I when we're falsely accused of malpractice?
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We had a malpractice lawyer come talk to our medical school class at the behest of a faculty member friend. He basically told us that doctors to the law field were sources of income. He explained that he saw us all as dollar symbols only, even if we hadn't did anything wrong. Both the prosecuting and defending lawyers in malpractice use us to make themselves rich. It was our jobs as physicians to decrease our susceptibility to being sued by them, but in the end there wasn't anything we could do about it. They control the system of laws and profit off of it. All we as physicians can do is reduce our risk. So basically defenders or prosecutors are they same, they suck money out of the medical system. They are leeches.
 
LifetimeDoc said:
We had a malpractice lawyer come talk to our medical school class at the behest of a faculty member friend. He basically told us that doctors to the law field were sources of income. He explained that he saw us all as dollar symbols only, even if we hadn't did anything wrong. Both the prosecuting and defending lawyers in malpractice use us to make themselves rich. It was our jobs as physicians to decrease our susceptibility to being sued by them, but in the end there wasn't anything we could do about it. They control the system of laws and profit off of it. All we as physicians can do is reduce our risk. So basically defenders or prosecutors are they same, they suck money out of the medical system. They are leeches.
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Yeah, they are just playing a game and profiting off of it. Unfortunately, it can ruin people's careers and cause years of unnecessary torment.

Many people earn money off of others suffering. Financial companies have done it, real estate, law, even physicians that over treat (fee for service unnecessarily).
 
They way I look at it, a lawyer is just like a gun: Powerless until someone else pulls it's trigger.

Both can be used for good or evil.

Both can be used to free an innocent man, or to put an innocent man in jail.

Both can also be used to put a murdering man behind bars, or to release one onto the streets.

It all depends on who's holding the gun, or who's retaining the lawyer.
 
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Birdstrike said:
They way I look at it, a lawyer is just like a gun: Powerless until someone else pulls it's trigger.

Both can be used for good or evil.

Both can be used to free an innocent man, or to put an innocent man in jail.

Both can also be used to put a murdering man behind bars, or to release one onto the streets.

It all depends on who's holding the gun, or who's retaining the lawyer.
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The only difference is that guns don't have self interest like lawyers do.
 
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Telesphorous said:
Rockerfeller Republican = RINO
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I agree that a Rockefeller Republican would be called a RINO 1) Rockefeller Republicans basically dont exist anymore and 2) prior to 1992, that political belief was also known as "the republican party platform". So its still a bit soon to disavow it. The platform moved and left them homeless. In the case of trial attorney association, their money went to the democrats as a result fo that.
 
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Birdstrike said:
They way I look at it, a lawyer is just like a gun: Powerless until someone else pulls it's trigger.

Both can be used for good or evil.

Both can be used to free an innocent man, or to put an innocent man in jail.

Both can also be used to put a murdering man behind bars, or to release one onto the streets.

It all depends on who's holding the gun, or who's retaining the lawyer.
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Yeah...lawyers are guns that operate themselves...they are like a-hole terminators. I hate them all, equally.
 
gutonc said:
I like how you've managed to misspell Rockefeller multiple different ways in your post. That's impressive.
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I think its that i misspelled it one way and when I saw it spelled a different way by the other poster I went "oh crap thats embarassing" and switched to his (also incorrect) spelling.

Edit: fixed my spelling in honor of appropriateness.
 
LifetimeDoc said:
We had a malpractice lawyer come talk to our medical school class at the behest of a faculty member friend. He basically told us that doctors to the law field were sources of income. He explained that he saw us all as dollar symbols only, even if we hadn't did anything wrong. Both the prosecuting and defending lawyers in malpractice use us to make themselves rich. It was our jobs as physicians to decrease our susceptibility to being sued by them, but in the end there wasn't anything we could do about it. They control the system of laws and profit off of it. All we as physicians can do is reduce our risk. So basically defenders or prosecutors are they same, they suck money out of the medical system. They are leeches.
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Not just malpractice lawyers. Same thing could be said of divorce lawyers.
 
Birdstrike said:
They way I look at it, a lawyer is just like a gun: Powerless until someone else pulls it's trigger.

Both can be used for good or evil.

Both can be used to free an innocent man, or to put an innocent man in jail.

Both can also be used to put a murdering man behind bars, or to release one onto the streets.

It all depends on who's holding the gun, or who's retaining the lawyer.
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Bird - the difference between a lawyer and a gun is this: A gun doesn't "benefit" from pulling the trigger, where a lawyer will ALWAYS benefit from a lawsuit.
 
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Boatswain2PA said:
Bird - the difference between a lawyer and a gun is this: A gun doesn't "benefit" from pulling the trigger, where a lawyer will ALWAYS benefit from a lawsuit.
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The same could be said for us when people get sick...and the sicker our patients are the more we usually get paid (or at least bill). Obviously that's an oversimplification and not fair, but so is trying to infer that all lawyers are filth
 
namethatsmell said:
The same could be said for us when people get sick...and the sicker our patients are the more we usually get paid (or at least bill). Obviously that's an oversimplification and not fair, but so is trying to infer that all lawyers are filth
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Malprac lawyers are opportunistic... People don't WANT to be sick
 
namethatsmell said:
Not a fan of that breed, and the post I was referencing doesn't seem to limit itself to them.




And people don't want to be sued, but it happens.
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But don't most docs dislike the idea of malpractice lawyers and how they suck money out of the healthcare system?
 
Boatswain2PA said:
Not just malpractice lawyers. Same thing could be said of divorce lawyers.
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I'm in the mood of a good lawyer joke:
"What' s the difference between a lawyer and a catfish?"
(Answer below)










One's an ugly, bottom dwelling, mud sucking, gunk eater and the other is just a fish.
 
Boatswain2PA said:
Not just malpractice lawyers. Same thing could be said of divorce lawyers.
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southerndoc said:
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.
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GeneralVeers said:
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.
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Sure it is. All you do is double malpractice premiums and take it out of physician salaries. In a system where legislators and judges are lawyers, malpractice will never go away. Look what the Georgia Supreme Court did with regards to the definition of gross negligence to allow doctors to be sued.

Sent from my Z10 using Tapatalk
 
Can I just say thanks to all the practicing docs who contributed to this thread. I'm starting intern year in a few months at a residency program where one site we rotate at has attendings that, from the view of the inpatient services, practices very defensive medicine. Having been on those inpatient services as a medical student, part of me was a little ashamed that those attendings practiced that way. Constantly heard the monday morning quarterbacking. But now I'm glad to get exposed to that style at one site, if anything to learn from ED docs that have been burned.
 
Phew, I read all that..
 
I'm happy to practice in a state with good standards, and strive to teach my residents appropriate medicine. We can't justify 1000 workups to find 1 atypical patient. Look at the nonsense that d-dimers, blood cultures for all pneumonia, and now the new high sensitivity troponin will cause. Of note, they should change the name to the low specificity troponin, since that's all they're gaining.
 
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