An ethical dilemma

[Planktonmd]

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You are the anesthesiologist on call in a small community hospital.
You have no backup other than a CRNA.
At 2 am you get called for a patient who has an acute abdomen.
On arrival to the holding area you see a patient who appears to be in acute distress, febrile, and somewhat hypotensive.
He is alert and oriented and says that his abdominal pain is "excruciating".
You suddenly recognize that the patient was the plaintiff's attorney in a malpractice case that was settled against you a few years ago.
You actually hated this guy at that time.
What's your next step?

 

[Coastie]

You are the anesthesiologist on call in a small community hospital.
You have no backup other than a CRNA.
At 2 am you get called for a patient who has an acute abdomen.
On arrival to the holding area you see a patient who appears to be in acute distress, febrile, and somewhat hypotensive.
He is alert and oriented and says that his abdominal pain is "excruciating".
You suddenly recognize that the patient was the plaintiff's attorney in a malpractice case that was settled against you a few years ago.
You actually hated this guy at that time.
What's your next step?

What's the ethical dilemma?

 

[Planktonmd]

What's the ethical dilemma?

Do you do the case?
If you do the case and there is a bad outcome are you going to be OK?

 

[BLADEMDA]

Do you do the case?
If you do the case and there is a bad outcome are you going to be OK?

I bet you he is way more terrified than you are.😉

 

[ProRealDoc]

Push sux, intubate.

 

[Planktonmd]

I bet you he is way more terrified than you are.😉

🙂
True, but if something goes wrong you know that one of his buddies is going to accuse you of killing him.

 

[Bertelman]

Update the consent form to preclude you from any personal or professional liability on the outcome of this case.

Tell him it's an informed contract. He will understand all contracts are just negotiations.

 

[Bertelman]

j/k

Just do the f'ing case and go to bed.

 

[Planktonmd]

In a medical malpractice case usually the plaintiff's attorney accuses you of gross negligence, incompetence and many other things.
Is it possible for you to provide unbiased care to such person?
And in the event a complication occurs how do you prove you were unbiased?

 

[tkim]

In a medical malpractice case usually the plaintiff's attorney accuses you gross negligence, incompetence and many other things.
Is it possible for you to provide unbiased care to such a person?
And in the event a complication occurs how do you prove you were unbiased?

Not an anesthesiologist. But if the guy called into question your competence in a suit, you should disclose this to him and give him the option of letting you care for him or go with the CRNA.

Either way you're screwed. If he declines you and opts for the CRNA, and there's a bad outcome, he'll come back at you saying that you denied him your superior skillset out of spite which could have avoided the bad outcome.

If he opts to use you, and there's a bad outcome, he'll claim revenge.

If you offer to call in another anesthesiologist, and there's a delay, and there's a bad outcome, you're screwed again.

Just walk right up to him, put a bullet in his head, and then yours. Quicker.

 

[Planktonmd]

I like the bullet solution!
One thing to add though: He can not choose the CRNA because at the place in question CRNA's work always under the supervision of anesthesiologists according to the hospital bylaws.

Not an anesthesiologist. But if the guy called into question your competence in a suit, you should disclose this to him and give him the option of letting you care for him or go with the CRNA.

Either way you're screwed. If he declines you and opts for the CRNA, and there's a bad outcome, he'll come back at you saying that you denied him your superior skillset out of spite which could have avoided the bad outcome.

If he opts to use you, and there's a bad outcome, he'll claim revenge.

If you offer to call in another anesthesiologist, and there's a delay, and there's a bad outcome, you're screwed again.

Just walk right up to him, put a bullet in his head, and then yours. Quicker.

 

[pgg]

Is it possible for you to provide unbiased care to such person?

Sure.

And in the event a complication occurs how do you prove you were unbiased?

You don't have to prove you were unbiased.

They have to prove that they were harmed as a direct result of your actions that did not meet the standard of care. The burden of proof is on them.

Duty, standard of care, proximate cause, and injury ... they need all four, and all four need to be related in order to bring a suit. For example, if you stick an introducer in his carotid while bragging to the surgeon that you're not really left-handed, but he dies of sepsis from his acute abdomen, it ain't on you.

 

[Noyac]

Sure.



You don't have to prove you were unbiased.

They have to prove that they were harmed as a direct result of your actions that did not meet the standard of care. The burden of proof is on them.

Duty, standard of care, proximate cause, and injury ... they need all four, and all four need to be related in order to bring a suit. For example, if you stick an introducer in his carotid while bragging to the surgeon that you're not really left-handed, but he dies of sepsis from his acute abdomen, it ain't on you.

Stupid thread!

But it took 12 posts to get to the right answer.

Thanks pgg for ending this thread.

 

[Planktonmd]

I have to disagree with you:
What you are saying is what happens in a perfect world.
But, we don't live in a perfect world.
If you really think that you don't get sued and you don't lose a litigation unless you really did something wrong or were found beyond the reasonable doubt that you did, then I have to tell you you are wrong.
All the lawyer needs to do is show the jury (12 people who usually think doctors are evil rich bastards) that you are a mean person who intended to injure his client because you had other motives.
Actually all he needs to do is wave that idea in front of your malpractice carrier for them to throw you under the bus and settle the case despite your objection.
I know it is difficult for many young guys to believe that unless they have been through a litigation but ask those who did and they will tell you.

Sure.



You don't have to prove you were unbiased.

They have to prove that they were harmed as a direct result of your actions that did not meet the standard of care. The burden of proof is on them.

Duty, standard of care, proximate cause, and injury ... they need all four, and all four need to be related in order to bring a suit. For example, if you stick an introducer in his carotid while bragging to the surgeon that you're not really left-handed, but he dies of sepsis from his acute abdomen, it ain't on you.

 

[Planktonmd]

Why is it stupid?

Stupid thread!

But it took 12 posts to get to the right answer.

Thanks pgg for ending this thread.

 

[asmallchild]

Not an anesthesiologist. But if the guy called into question your competence in a suit, you should disclose this to him and give him the option of letting you care for him or go with the CRNA.

Either way you're screwed. If he declines you and opts for the CRNA, and there's a bad outcome, he'll come back at you saying that you denied him your superior skillset out of spite which could have avoided the bad outcome.

If he opts to use you, and there's a bad outcome, he'll claim revenge.

If you offer to call in another anesthesiologist, and there's a delay, and there's a bad outcome, you're screwed again.

Just walk right up to him, put a bullet in his head, and then yours. Quicker.

 

[bigdan]

Do the case.

As you talk to him in preop, tell him he reminds you a lot of the guy that sued you. As you pound him with kindness, drop a couple of lines about how much fighting the suit stressed you and your family out, and let him know that you come in to work to be sure that guys with abdominal pain at 2am can get the best care. Let him squirm, then do your job.

dc

 

[Narcotized]

You are the anesthesiologist on call in a small community hospital.
You have no backup other than a CRNA.
At 2 am you get called for a patient who has an acute abdomen.
On arrival to the holding area you see a patient who appears to be in acute distress, febrile, and somewhat hypotensive.
He is alert and oriented and says that his abdominal pain is "excruciating".
You suddenly recognize that the patient was the plaintiff's attorney in a malpractice case that was settled against you a few years ago.
You actually hated this guy at that time.
What's your next step?

Let him die.

 

[rmbsstock]

out

 

[fakin' the funk]

IT is so sad that you did this..I bet you are still very young and unexperienced in life 😉. because although, I applause you for not encouraging her to put down herself cause she is fat, you did not try to put effort to understand her. If you took the time to think before passing her to another doctor, you would have understood that she was probably ashamed of her weight and she was using a self defense mechanism to deflect her embarrassment. If I were you, I would have smiled at her jokes and encouraged her that if her weight is causing her health problems, maybe she is in the right place where you can direct her to a dietitian to get some help.
I bet you know how much women are self conscious about their looks and specially their weight. Therefore, can you imagine when they are surrounded by all these healthy conscious people (nurses + doctors) that they think they are going to be judging them!! The hospital can be a very terrifying experience for them!
I would say, you can be a great positive influence in their lives if you give these patients positive attention in the correct direction. However, when you abandon them, as if you are telling them "you are a worthless ugly piece a meat, I do not want to deal with you". How healthy is that!!!

Dude...you're joking...right?

BTW Dream that post was f*cking HILARIOUS. Between this and the "perspective" post in the other thread you're on quite a little off-color-posting winning streak right now.

 

[jwk]

Roughly 25 years ago (don't know all the details, sorry) there was a relatively large OB malpractice case in Brunswick, GA. Brunswick is halfway between Jacksonville, FL, and Savannah, GA. After that case, none of the OB docs in Brunswick or the surrounding area would take ANY attorneys, their office staff, or their families as patients. That means they had to drive to either Jacksonville or Savannah for any and all pre-natal care and deliveries (unless they showed up emergently for delivery in Brunswick).

I don't know how long this went on, but I'll bet they made their point.

 

[Eta Carinae]

Actually, you totally got me. I AM completely insensitive to fat people.

👍👍
ditto, no pity here

 

[Eta Carinae]

IT is so sad that you did this..I bet you are still very young and unexperienced in life 😉. because although, I applause you for not encouraging her to put down herself cause she is fat, you did not try to put effort to understand her. If you took the time to think before passing her to another doctor, you would have understood that she was probably ashamed of her weight and she was using a self defense mechanism to deflect her embarrassment. If I were you, I would have smiled at her jokes and encouraged her that if her weight is causing her health problems, maybe she is in the right place where you can direct her to a dietitian to get some help.
I bet you know how much women are self conscious about their looks and specially their weight. Therefore, can you imagine when they are surrounded by all these healthy conscious people (nurses + doctors) that they think they are going to be judging them!! The hospital can be a very terrifying experience for them!
I would say, you can be a great positive influence in their lives if you give these patients positive attention in the correct direction. However, when you abandon them, as if you are telling them "you are a worthless ugly piece a meat, I do not want to deal with you". How healthy is that!!!

all I ever wanted to be was a doc...people just assume that means angel/saint. I never made that claim.

Love the grammar

 

[rmbsstock]

out

 

[pgg]

All the lawyer needs to do is show the jury (12 people who usually think doctors are evil rich bastards) that you are a mean person who intended to injure his client because you had other motives.

Maybe I'm misreading you here, but you seem to be under the mistaken impression that anybody can file a malpractice suit and PRESTO automatically have the opportunity to con some gullible group of 12 people too stupid to get out of jury duty.

Again: duty, standard of care, proximate cause, and injury.

This is America, so anybody can sue anybody for anything, yes. But not doing an emergency case when you're on duty for fear of getting sued if something goes wrong couldn't be more ******ed if it had a helmet on it.

(Been waiting to use that line and this thread seems the perfect place.)

Actually all he needs to do is wave that idea in front of your malpractice carrier for them to throw you under the bus and settle the case despite your objection.

Well ...

a) Fortunately the malpractice carriers aren't in the habit of settling frivolous suits.

b) My carrier won't settle a case without my consent.

 

[somedumbDO]

Thank you for loving my grammar, I wish you corrected it for me (uh that might make you a saint not a Doc ok I am kidding , don't flip out on me) 😀...I am still working on my English since it is not my first language. But as I said in other posts, this is not an excuse, since I live in this country, served in its military, and now going to school in my new country, I should learn its language properly. However, you should be proud of me since I got my point across to you and you understood it.
As for not liking, or whatever you said about fat people, as a doctor my man, you should be very respectful to everyone. And as a doctor you should know and learn the reasons why people gain weight. Yes, some of them are lazy but these are the minorities, and in this case your behavior towards lazy people is not motivating to them.
As you can see, I look FINE AND DANDY, and lots and lots run after me..(show off 😱) but I was not like this all my life. You can add to my figure 58 pounds that I carried around for a long time. The people who used to pass me by and not even say "Hi", are now running after me just to get a whiff of my scent..But luckily, I found help and I was able to lose the weight and keep it off. Can you imagine how you would feel if you have made someone achieve that healthy dream!! If you do not want to...at least don't cause them to be more hopeless or depressed.

omg dude are you serious

BTW

you smell like curry............

lol

 

[LSU Alex]

But not doing an emergency case when you're on duty for fear of getting sued if something goes wrong couldn't be more ******ed if it had a helmit on it.

(Been waiting to use that line and this thread seems the perfect place.)
.

Well played, mon ami. Salut! 😀

 

[Planktonmd]

Maybe I'm misreading you here, but you seem to be under the mistaken impression that anybody can file a malpractice suit and PRESTO automatically have the opportunity to con some gullible group of 12 people too stupid to get out of jury duty.

Exactly!
Do you know what a lawyer needs to file a lawsuit against you?
He needs an affidavit signed by another physician stating that you have committed malpractice!
Do you know how much this affidavit costs?
About $500 and you will be surprised how many of your colleagues are willing to sign it.
This is not a mistaken impression, this is reality my friend.

Again: duty, standard of care, proximate cause, and injury.
.

I wish it was that simple but it it isn't, all it takes is a jury that hates you and a lawyer who knows how to make you look terrible.

This is America, so anybody can sue anybody for anything, yes. But not doing an emergency case when you're on duty for fear of getting sued if something goes wrong couldn't be more ******ed if it had a helmet on it.
.

I did not even remotely suggest that not doing the case is the best choice but I was trying to present a real life situation where it's not only about you being able to do your duty or practicing your profession.
This is about the issues of providing care to someone you have a conflict with.

a) Fortunately the malpractice carriers aren't in the habit of settling frivolous suits.

I hope you don't really believe that, do you?
The malpractice carrier will settle a case the moment they feel that defending you will cost them more than settling the case, they don't give a rat if you did or didn't do anything wrong.
They know what affects the jury and they know that having a personal conflict with the patient looks really bad no matter how you slice it.

b) My carrier won't settle a case without my consent.

Who told you that?
Do you have some type of special policy?
Unless you have some special type of policy (very uncommon) your carrier can and will settle without your consent anytime they think it will save them money, your consent is not needed.

 

[pgg]

I did not even remotely suggest that not doing the case is the best choice but I was trying to present a real life situation where it's not only about you being able to do your duty or practicing your profession.
This is about the issues of providing care to someone you have a conflict with.

I guess I just don't get your point then.

It's an emergency case.

Of course you do the case.

Where's the ethical conflict? There's no decision to make. You can't refuse to do an emergency case if you're the guy on call and there's no backup!

Yeah, in the event of a bad outcome, you might get sued. This is (a) some of that "liability" we get paid so much to accept, and (b) why we have malpractice insurance in the first place.

Again, what's the ethical conflict?

Do you have some type of special policy?

No. http://www.thedoctors.com/WhyChooseUs/index.htm

 

[DrDre']

When I was a paramedic, I responded to a diabetic call. The pt greeted my crew with a long barreled 357.

We calmly took off and waited for the cops to restrain him.

I had to take care of him. As I went up to him, I told myself to treat him like my grandmother.

He had a sugar of 12.


In your situation, I would consider switching with a partner if it was an elective case during the day and it didnt cause trouble.

I am not worried about myself taking care of him but about what he would do if any little thing went wrong.

You are the anesthesiologist on call in a small community hospital.
You have no backup other than a CRNA.
At 2 am you get called for a patient who has an acute abdomen.
On arrival to the holding area you see a patient who appears to be in acute distress, febrile, and somewhat hypotensive.
He is alert and oriented and says that his abdominal pain is "excruciating".
You suddenly recognize that the patient was the plaintiff's attorney in a malpractice case that was settled against you a few years ago.
You actually hated this guy at that time.
What's your next step?

 

[Arch Guillotti]

. http://www.thedoctors.com/WhyChooseUs/index.htm

The site provided states that "we will never settle a case without approval*"

*where permitted by law

My guess is that the asterisk could prove significant. I don't know the state laws though.

From a thread in the genres forum:

http://forums.studentdoctor.net/showthread.php?t=685807

In an actual case where I rotated for third year.... a surgeon was sued by a patient and the hospitalist consulted for medical management was sued as well. The hospitalist's insurance providor settled for 50 grand before the depositions were even taken. Two weeks later the case was dropped for lack of evidence. The hospitalist was never given the chance to defend himself, but it is now part of public record that he settled in this case. His malpractice is going up and it's just another strike on his record. Where's the justice in that?

This is not a new concept.

Employees of hospitals or other organizations where malpractice is provided as part of a package, may be required to allow the employer to decide whether or not to settle. So this is not unusual - employer decides to just make everything go away with a relatively smallish amount check to the plaintiff, the accused gets no say in whether or not to settle, and regardless of the reason for settling (ie, to get it over with vs you know you'll lose in court), its reported to the NPDB (and state boards) without those involved being able to addendum WHY it was settled or defend themselves.

There have been cases of hospitals requiring employees who demonstrate themselves to be "suit-worthy" to pay back the settlements, or a portion thereof.

Usually the way it works is that an attorney will draft a settlement request, sort of feeling the waters out, especially if they aren't sure they have an "open-shut" case. These letters can be done with no discovery process, no depositions other than what the plaintiff claims. They ask for a large sum of money (more than they know they are going to get) and see what rolls in. For a couple of hours of work and a percentage of the "take", it can be very profitable. Some will actually do the legwork before sending the letters out, but I am told many do not, simply feeling like they will get a settlement a good percentage of the time just for scaring people with all their fancy talk.

If a settlement is refused, then the attorney goes back to the plaintiff and sees if they want to pursue (remember, that will incur more charges, going to court etc.) and they will start doing some actual research, expert testimony, etc. if the plaintiff does want to sue. Most malpractice companies will not provide you an attorney until you have been sued. Thus, in the case above, if the hospitalist was only served with a settlement request, he may have never been offered counsel (because they are not required to), may not have sought it out himself (these guys are expensive), and the hospital decided to settle without much input from him/her. 😡

One advantage in private practice: I decide whether or not to settle. My malpractice company cannot settle without written consent from me.

Moral of the story: if an employee check your liability contract and see if they are allowed to settle without your consent. Do not sign if they do.

IIRC Only 2 per cent of persons injured by medical neglience sue and well less than half of them get any recovery. So, the lawsuit system is compensating less than one per cent of the victims. Unforunately, people also get compensated for dumb lawsuits.

The system does not work on multiple levels and needs fixing.

 

[Planktonmd]

The ethical problem is the following:
I agree, You have to do the case unless the patient decides not to be under your care.
How do you approach this patient?
Is there anything you do or say now that will minimize your exposure in the case of a complication?
Also would your insurance cover you if you were accused of criminal negligence (not just negligence) if they brought up the fact that you had personal motives to harm the patient?

Thank you for the link to the Doctor's company site and I actually did not know they offered a guarantee that they would not settle without your consent but honestly I find it difficult to believe and would look into the fine print of the policy to find what exactly they mean by that.

I guess I just don't get your point then.

It's an emergency case.

Of course you do the case.

Where's the ethical conflict? There's no decision to make. You can't refuse to do an emergency case if you're the guy on call and there's no backup!

Yeah, in the event of a bad outcome, you might get sued. This is (a) some of that "liability" we get paid so much to accept, and (b) why we have malpractice insurance in the first place.

Again, what's the ethical conflict?



No. http://www.thedoctors.com/WhyChooseUs/index.htm

 

[pgg]

How do you approach this patient?
Is there anything you do or say now that will minimize your exposure in the case of a complication?

OK, specifically, I'd

• be extra thorough with the consent, actually saying the words death dying organ damage heart attack prolonged intubation ventilation ICU stay mental or physical disability etc etc
• make sure a trustworthy person actually WITNESSED the consent and if I'm at a hospital that doesn't do anesthesia consent forms separate from the surgical consent, that my discussion is well documented either on the anesthesia record or as a progress note
• not take this opportunity to try out any new technique I just read about on SDN 🙂

Honestly, the same thing I do for ALL emergency and higher-than-normal risk cases, regardless of whether the patient is some oily scumbag lawyer or not. There's not much more you can do.

I'm not a fatalist by any stretch, but the risk of being sued after a bad outcome is ALWAYS present in our line of work, and we get paid for accepting that liability.

You do the case, you keep him alive, you dump him off in the ICU, and maybe just maybe you secretly hope he throws a saddle embolus as he happily walks out of the hospital a month later.

Also would your insurance cover you if you were accused of criminal negligence (not just negligence) if they brought up the fact that you had personal motives to harm the patient?

I'm not a lawyer, thank god, but I thought criminal charges could only be brought by prosecutors, DAs, etc. They're not likely to have any kind of vendetta in this case.

Maybe you're referring to punitive damages, which require the (high) burden of proving actual malice?

Thank you for the link to the Doctor's company site and I actually did not know they offered a guarantee that they would not settle without your consent but honestly I find it difficult to believe and would look into the fine print of the policy to find what exactly they mean by that.

I scoured the fine print and my reading (again as a non-lawyer) was that if you really want to fight, they'll fight ... but they reserve the right to drop your ass as a policyholder the instant that case is done. The reputation they have amongst the (few) other policyholders I've talked to is that they really are pretty aggressive about fighting frivolous cases.

But yeah, I know that when $millions are at stake, just about any contract has loopholes and exceptions to exploit.

 

[Eta Carinae]

Thank you for loving my grammar, I wish you corrected it for me (uh that might make you a saint not a Doc ok I am kidding , don't flip out on me) 😀...I am still working on my English since it is not my first language. But as I said in other posts, this is not an excuse, since I live in this country, served in its military, and now going to school in my new country, I should learn its language properly. However, you should be proud of me since I got my point across to you and you understood it.
As for not liking, or whatever you said about fat people, as a doctor my man, you should be very respectful to everyone. And as a doctor you should know and learn the reasons why people gain weight. Yes, some of them are lazy but these are the minorities, and As you can see, I look FINE AND DANDY, and lots and lots run after me..(show off 😱) but I was not like this all my life. You can add to my figure 58 pounds that I carried around for a long time. The people who used to pass me by and not even say "Hi", are now running after me just to get a whiff of my scent..But luckily, I found help and I was able to lose the weight and keep it off. Can you imagine how you would feel if you have made someone achieve that healthy dream!! If you do not want to...at least don't cause them to be more hopeless or depressed.

Thanks for giving me the opportunity to vent my frustrations with fat people- and yes, we need to go back to using fat and not some stupid PC term like "overweight".

I'm glad you're learning English well. and honestly, your grammar isn't that bad, it just belies the fact that you're foreign- regardless of what your "citizenship status" claim is. I wish more FMG's would be committed to making the rest of our lives easier by learning the language well.

in this case your behavior towards lazy people is not motivating to them.

If you do not want to...at least don't cause them to be more hopeless or depressed.

Umm, since I didn't strap them down and stuff the 10,000 calories/day down their throats, the onus is not on me to motivate anyone.

And I DO think being more "hopeless and depressed" will serve as an effective wake up call. That way maybe the rest of us won't have to pay for their diabetes and HTN drugs or their statins or their ambulance ride to the ER when they have their MI.

OR

The bigger hospital equipment we have to buy

OR

the larger CT scan that can house them while we try to find the frigging Embolus that's lodged in their lungs

OR

the X-Ray Vision we have to invent to frigging place an epidural

I could go on

Obesity is an infection in society that other people get and the rest of us have to suffer through

As they glibly make their way down from the cath lab to stand in line at the hospital McDonald's

 

[Eta Carinae]

I wish you corrected it for me

I'm still trying to find a copy of my JOB DESCRIPTION! Doggonnit, where did I leave it?

not my first language. But, this is not an excuse

If you say it's not an excuse, well, who am I to argue?

you should be proud of me

as a doctor my man, you should be very respectful to everyone

Except when your circumstances are a consequence of your personal actions! and lack of restraint or self-discipline.


I'd still love to chat with you, though, nothing personal. 😀

 

[Planktonmd]

I am actually referring to criminal negligence as a criminal not a civil charge.
They can actually bring criminal charges against you if they thought that you injured the patient by intentionally disregarding the standard of care for your personal motives.
This will not be covered by your malpractice insurance.
When it comes to criminal charges they of course need to prove it beyond the reasonable doubt (unlike civil cases), but it has happened before that criminal charges were brought against physicians in similar situations

I'm not a lawyer, thank god, but I thought criminal charges could only be brought by prosecutors, DAs, etc. They're not likely to have any kind of vendetta in this case.

Maybe you're referring to punitive damages, which require the (high) burden of proving actual malice?

 

[pgg]

I am actually referring to criminal negligence as a criminal not a civil charge.
They can actually bring criminal charges against you if they thought that you injured the patient by intentionally disregarding the standard of care for your personal motives.
This will not be covered by your malpractice insurance.

Look, you're moving the goalposts here, or you're getting confused. I'm not sure which it is, or if it's intentional.

When it comes to criminal charges, they are not the plaintiff's attorneys.

They would be the district attorney or one of the DA's assistants, and they presumably don't have any ax to grind with you. They have better things to do than waste time manufacturing and trumping up criminal charges against some random doctor.

You started this this thread asking about a patient you don't have the option of not treating, who might be more likely to sue, if there is a bad outcome. Now you're going off into the weeds babbling about criminal charges and claiming that this lawsuit-happy patient can somehow influence that.

The closest the plaintiff can get in such a malpractice suit are punitive damages, which require proof of deliberate malice, and have nothing to do with criminal charges.

Your latest proposition, that law enforcement and a district attorney might get involved and pursue meritless criminal charges based on the patient's bad attitude is an absolutely preposterous (mind-numbingly so!) thing to worry about or even discuss.

Honestly, WTF are you talking about?

 

[2win]

Seriously, who the f*ck are you to be lecturing about what a doctor should be? Moreover, who the f*ck are you to be lecturing what I should and should not know? Have you written any textbooks lately? You remind me of every pain in the ass attending I had. Now I recall why medical school and residency was so miserable. You have a mighty big ego to be making these statements. Furthermore, you are exponentially annoying. Are you an anesthesiologist? Do you have any interest in anesthesiology?
If not, STFU.

Hey dream - maybe he's a bariatric surgeon - he has to kiss the ***** of fatties to make his dough.
On a curry diet I noticed at Olympics that they are a kind of skinny...
And not to many too...

 

[Planktonmd]

If you are accused of intentionally harming a patient (by the patient, the media or whomever) it will become a criminal case!
It happened before and it is not as unusual as you might imagine!
It appears to me that you are more interested in proving me wrong than in actually discussing anything here.
And I also see that you are using a little bit too aggressive of a language although I have not attempted to insult you here.
You could express your disagreement with me without all these powerful words that you seem to enjoy.
You just finished residency, you don't know much about the real world except your little imaginary view and on top of that you practice "I think" in the navy or the army, so you are actually not even exposed to the real world.
So, is it possible that I might have a point that you don't understand?
Or if I don't do you really need to be obnoxious?

Look, you're moving the goalposts here, or you're getting confused. I'm not sure which it is, or if it's intentional.

When it comes to criminal charges, they are not the plaintiff's attorneys.

They would be the district attorney or one of the DA's assistants, and they presumably don't have any ax to grind with you. They have better things to do than waste time manufacturing and trumping up criminal charges against some random doctor.

You started this this thread asking about a patient you don't have the option of not treating, who might be more likely to sue, if there is a bad outcome. Now you're going off into the weeds babbling about criminal charges and claiming that this lawsuit-happy patient can somehow influence that.

The closest the plaintiff can get in such a malpractice suit are punitive damages, which require proof of deliberate malice, and have nothing to do with criminal charges.

Your latest proposition, that law enforcement and a district attorney might get involved and pursue meritless criminal charges based on the patient's bad attitude is an absolutely preposterous (mind-numbingly so!) thing to worry about or even discuss.

Honestly, WTF are you talking about?

 

[pgg]

If you are accused of intentionally harming a patient (by the patient, the media or whomever) it will become a criminal case!

No, the authorities are obligated to investigate the allegations. This is a long, long way from actually filing criminal charges and putting you in front of a jury.

Your scenario in this thread hinges on the risk of a meritless malpractice lawsuit from an unethical patient. Television notwithstanding, most DAs are honorable and intelligent people who are pretty good at seeing through unscrupulous people who make baseless accusations.

You've said nothing to support this silly, paranoid, CSI-watching, needs-a-helmet idea that baseless accusations from a patient are enough to land you in front of a jury, desperately fighting to avoid a criminal conviction! What you're saying is nuts!

Sure, if the system is corrupt and the DA and your lawyer patient are golf buddies, you're screwed. But this is the stuff of bad made-for-TV movies. It's ridiculous to actually worry about such a scenario. You might as well worry about the DA planting a row of poppies in your back yard while you're at work and charging you with last weekend's unsolved meth-lab murders.

It's ... absurd. And yet, you speak of by-definition baseless criminal charges as if it's something a reasonable person should think about.

You just finished residency, you don't know much about the real world except your little imaginary view and on top of that you practice "I think" in the navy or the army, so you are actually not even exposed to the real world.

Ah, a patronizing pat on the head and dismissal of the my wet-behind-the-ears argument. Took longer than I expected, actually. Yes, I'm ~6 whole months out of residency, but
a) medicine isn't my first stab at life
b) aside from the Navy, I work quite a bit for private groups on a 1099 basis

What does it say about you, an allegedly experienced guy, that you're so afraid of this scenario's absurdly inconsequentially small risk, that you feel the need to start a thread about it?

What's next? A thread about whether we should cancel all elective cases after the Yellowstone supervolcano erupts and covers the western United States in 50 feet of molten rock?

So, is it possible that I might have a point that you don't understand?

Of course it's possible, as a general theoretical possibility. In this case, you don't.

Or if I don't do you really need to be obnoxious?

My sarcasm and incredulity are a result of your bizarre flight-of-ideas and silly misconceptions, as well as my own personal drive to entertain myself. But we might as well end it here. No one else seems to be interested in seriously discussing this issue with you.

I tried. Besides, there's really not much left to say. To recap:

• The scenario is not an ethical dilemma at all, despite the thread title.
• A successful malpractice suit requires (1) a duty to the patient, (2) a breach in the standard of care, (3) proximate cause, and (4) actual damages
  Yes, juries can be suckered into believing lies about 2. They still need 1, 3, and 4.
• Punitive damages require proof of injury due to deliberate malice
• Anybody can sue anybody for everything. Life isn't fair. The world isn't just. Oh well.
• The plaintiff can't file criminal charges.
• Worrying about this stuff is an exercise in paranoid neurosis.

I think that about covers it.

 

[Arch Guillotti]

You are the anesthesiologist on call in a small community hospital.
You have no backup other than a CRNA.
At 2 am you get called for a patient who has an acute abdomen.
On arrival to the holding area you see a patient who appears to be in acute distress, febrile, and somewhat hypotensive.
He is alert and oriented and says that his abdominal pain is "excruciating".
You suddenly recognize that the patient was the plaintiff's attorney in a malpractice case that was settled against you a few years ago.
You actually hated this guy at that time.
What's your next step?

Whats the big deal?

Pretend like you don't know him. Go over the consent line by line up to and including death. Document everything meticulously. Do the case.

 

[Planktonmd]

Pgg,
I am glad that you already know everything on how a malpractice litigation actually proceeds and that you already know all the answers.
And I do apologize for wasting your time with all that pointless stuff.
I did not know all about litigation when I finished residency and I had to learn the hard way.
So, obviously you don't think it will ever happen to you and I hope it doesn't.
👍

 

[Planktonmd]

Can you pretend that you don't know him or is it better to tell him that you know him and have a frank discussion?
I chose the second option.

Whats the big deal?

Pretend like you don't know him. Go over the consent line by line up to and including death. Document everything meticulously. Do the case.

 

[pgg]

Tell you what, if it happens to me and if there's wifi in PMITA prison, I'll be sure to bump this thread with the story. 🙂

The fact that this particular patient is a scumbag is a red herring. It's much ado about nothing. Lots of people we don't like - gangbangers, criminals, pedophiles, neocons, hippies, failed-suicide-bomber-wannabe terrorists, etc - roll into hospitals, and we all take good care of them.

If anyone here can't offer professional, competent care to everybody who shows up sick or injured, the problem is them, not an imperfect malpractice system.

Can you pretend that you don't know him or is it better to tell him that you know him and have a frank discussion?

I agree with you - a frank, complete, witnessed, documented discussion is best. Of course, we should do this for every case.

 

[deleted126335]

You are the anesthesiologist on call in a small community hospital.
You have no backup other than a CRNA.
At 2 am you get called for a patient who has an acute abdomen.
On arrival to the holding area you see a patient who appears to be in acute distress, febrile, and somewhat hypotensive.
He is alert and oriented and says that his abdominal pain is "excruciating".
You suddenly recognize that the patient was the plaintiff's attorney in a malpractice case that was settled against you a few years ago.
You actually hated this guy at that time.
What's your next step?

Tell him that you can't represent his health because you are conflicted out...because you hope that he dies.

 

[rmbsstock]

out

 

[rmbsstock]

out

 

[Narcotized]

2) the picture by my name is my personal picture
I have to go now and teach my Belly Dance class.

.

 

[militarymd]

You are underway on a hospital ship in a war zone in the Gulf.

You are one of 3 intensivists working round the clock on 40+ some odd number of intubated...seriously traumatized patients from US firepower....

And some of these patients are Dirtbags....with a capital D....meaning there are FBI agents stationed on board waiting to take them away.

One of them tries to attack a nurse.....what should you do?

Be nice ...and restrain them according to JCAHO standards...because Red Cross representatives and CNN are watching you....

OR...do the right thing.

 

[Eta Carinae]

I have to go now and teach my Belly Dance class, I hope by then you would have calmed down.

I've been looking for a good belly dance class to take. PM me your phone number.

rmbsstock,
RUNNNNNN!!! Honey, that dude's married; I know his wife!
btw, I'm a gal, too. Just looking out for you 😉. 😍