malpractice issues

[ac47]

I don't post many threads but I saw an interesting topic on television today and wanted to hear what others have to say. The topic was medical malpractice and the guests on the show were sharing their horror stories about what had happen to them in hospitals. One lady had a double mastectomy and later found out that she didn't have cancer, and another women had to wait 4 days to deliver her twins because her dr. was out of town, which caused serious mental and physical defects to one of her sons.

It really opened my eyes to the increasing concern with medical malpractice across the country. It also made me realize the microscope that is placed on physicians as well. It seems as though physicians are like professional athletes in a way, such that they are admired and respected when things go well, but the few that make crucial mistakes are placed in the media and give viewers a sense of distrust. I am not saying that these critical mistakes don't deserve attention, they do, after all it is a life that is altered forever because of them. However, I feel that dr.s are saving more lives than they are responsible for ending them. Maybe its because I am entering this profession and I am constantly looking for health care related topics, but I seem to come across these malpractice topics and I ask myself if this is something that is happening more often, or is the media attracting more attention, which makes it seem more frequent? I don't claim to know anything that goes on "behind the scenes" because I haven't even begun medical school yet, but it was a topic that caught my attention. Anyways, sorry for the long soap box, but I just wanted to hear thoughts about the topic.

ac

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[Amy B]

I didn't see the show, but I could not imagine what hospital wouldn't have some else deliver those babies. Anyone could have filled in for her doctor. Makes me wonder.... Did she even go in to have them delivered? Sometimes patients don't use their heads in situations for whatever reason. If I was in that situation I would have raised such a fuss....

That said, malpractice does happen and it is awful when it does and it is due to a doctor's error. I realize we all make mistakes, but the profession we are going into leaves no room for error. And that is a scary thought if you think about it.

 

[LetGo of TheEgo]

Institute of Medicine's Report, To Err Is Human, is an extensive study on this issue. You can also read it online.

"To Err Is Human breaks the silence that has surrounded medical errors and their consequence--but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agenda--with state and local implications--for reducing medical errors and improving patient safety through the design of a safer health system."


For a synopsis and links to the book:

http://www.informedpremed.com/books/toerrishuman.php

 

[Shinken]

A few weeks ago I read a book titled "Wall of Silence" which deals with both malpractice issues and the so-called "code of silence" where physicians supposedly cover up for each other. It was too sensationalistic and painted too bleak a picture (it read more like one side of the story instead of an unbiased analysis). If you find the book, don't buy it. It was pretty bad and only took a handful of extreme cases of gross negligence to prove their point.

Anyway, I personally think that the issue is so complex that it's not going to get solved anytime soon. On the one hand, we have human mistakes for which patients should rightfully be compensated fairly (key word is fairly). On the other hand, we have the "malpractice lottery" where the general public has been conditioned to believe that you can strike it rich with the one "key" lawsuit, and lawyers are too happy to help you. It's going to take a change in public attitude, more trust in their physicians, and a change in the way our justice system is set up (good luck with that...most lawmakers are also lawyers).

If you can get your hands on the June 9, 2003 issue of Time magazine, the cover says "The Doctor is Out". The main article deals with malpractice premiums and how some states are losing doctors in droves. The most ironic (and depressing) story was of a physician that actually switched careers to become a lawyer!

 

[DrQuinn]

There will always be the threat of malpractice if you practice medicine. I was a medical malpractice defense paralegal throughout medical school, and saw the other side of medicine that most people (thankfully) will never see.

It is not about preventing lawsuits, it is about being able to defend yourself. If you practice medicine as a "good doctor", i.e., good medicine, NOT defensive medicine, you will be fine.

Those stories you have are obviously horrible... but they are extremely one-sided. Perhaps the woman with the mastectomies' pathology showed a PRE-malignant tumor. Perhaps the mother who delivered did not go to the hospital at all, and didn't call her doctor. Believe me, a woman would not sit in the L&D floor with her water broken for four days without being seen by someone. These news reports are often sensationalized.

I have a VIP in the Tampa area under my care right now, and the press reports are vastly differnet from what is really happening. It just shows that the press has such a strong impact on the way people view topics.

Q, DO

 

[Shinken]

It is not about preventing lawsuits, it is about being able to defend yourself. If you practice medicine as a "good doctor", i.e., good medicine, NOT defensive medicine, you will be fine.

But how do you do that? There are countless examples of "good doctors" who get sued anyway, and the scummy lawyer will always be able to find some specialist that will testify against him. For D.O.'s it can be even worse. All you need is an M.D. specialist who doesn't like D.O.'s to testify that he/she is a quack and didn't follow the appropriate standard of care. A jury will most likely agree with the M.D. because most people in the jury probably won't be familiar with D.O.'s at all! If you want to be scared out of your mind, just remember what happened to Dr. Stan Naramore (The DO Magazine, May 1999. I tried to attach it as a pdf but it's too large)

That article almost made me reconsider applying to medical school, especially because I have a family to take care of and if the same thing happened to me it would basically kill me.

It's a complicated, scary issue, but one that we'll all have to face at some point.

 

[group_theory]

The key phrase is "standard of care"

Since when do DOs not practice according to standard of care? Is there something different that they teach you in the clinical phase that is vastly different from what MDs learn?

Good luck having the attorney paint osteopathic medicine in a negative light. Before the "DO basher" gets on the stand, you can argue before a judge that since MDs and DOs are recognized as legal and professional equivalent through legislation in all 50 states (and licensed by the same board in most states). If the judge allow the "DO basher" to take the stand and say "osteopathic medicine is quackery", just have your own witnesses -

Have someone from the AMA (an MD) state the official position of the AMA - that DOs are the professional and legal equivalent. Then have the AOA come and inform the jury about osteopathic medicine (the plantiff openned the door by bashing osteopathic medicine). Then have a member from the State Board of Medicine testify "to the best of your knowledge, do you think osteopathic medicine is dangerous? Would you consider it quackery? Would a state medical board license someone whom it considers a danger to the community and uses questionable treatments not recognized by the medical community?"

Any good lawyer will go after THE DOCTOR, not the profession. Besides, what argument will the lawyer use? "DOs are inferior and more dangerous because they have lower undergrad GPA and MCAT scores"

Rebuttal - "Did you pass all 3 steps of your medical licensing exams? Did you graduate from medical school? Did you finish your residency? Are you board certified?"

Also, remember who the juries are - they are not a group of "premeds" - they are your average joe. Many of them don't have college education (numbers varies depending on location) and don't give a **** about 0.1-0.5 undergrad GPA variation. Many of them seek alternative treatment because they are dissatisfy with the medical establishment (VERY BAD THING IF YOU ARE THE DEFENDANT) - they won't go "Oh, he's an MD. He knows what he is talking about." Why else would GNC and other health food supplement stores become so popular?


Don't worry about the lawyer going after you because you're a DO. Lawyers aren't that stupid to bash a profession that is recognized by the AMA, various specialty colleges, the state board of medicine, the military, etc. Laywers also know juries won't be swayed by the lower gpa/mcat argument - these same juries take health advice from their neighbors, the teenage kid working behind the counter of the local health supplement store (is it healthy? well, the bottle says it's all natural so it must be healthy and good for you), from relatives, etc.

Just practice the standard of care. That won't mean that people will not try to sue you. But for lawyers willing to take the case on commission (no fees unless I win), they will less likely take cases that are hard to win - because they lose money if they lose.

So when a 16 year old crack addict (with no hx of prenatal care) comes in drunk to the ED and gives birth prematurely - don't be surprise if the baby isn't 100% healthy and fine. Also don't be surprise if the lady sues you because her baby isn't fine (sees commercials on TV - if you're baby is not perfect, it's not your fault. I'm John Doe, Esq and I can get money for you). But also don't be surprise when the judge tosses it out or the juries side with the defendant (the doctor). Unless of course the jury hates doctors and want to screw the establishment - then you are screwed - which is why insurance companies settle even though the case is easily defendable.

Wow - long response. Summary - DOs aren't more liable than MDs. Both are screwed by the malpractice lottery. Practice standard of care (of one of the school of thoughts) and you can defend yourself in most cases. Insurance companies don't care if you are right or wrong - they always pick the safest / cheapest option.

 

[DrQuinn]

Groupy is right.

It is about Standard of Care that is the issue in medical malpractice claims.

You will be sued. More than once. More in some specialties. That is inevitable. But you may NEVER go to court. You may also NEVER have to settle. You just need to practice "good medicine." The phrase standard of care is a little more "legal" than I would prefer for medical students or even residents. You just need to practice good medicine.

"Worst Headache of my Life" -> CT/LP

"Headache, Fever, Stiff Neck" -> CT/LP

"Abdominal pain" -> Appendicitis until proven otherwise

"Stepped on a sea urchin" -> X-ray, clean the wound, leave open.

"Chest Pain" -> MI, PTX, PE, Dissection, Esophageal Rupture, pneumonia until proven otherwise

"Leg pain" -> DVT, Compartment Syndrome until proven otherwise

(That's why I like Emergency Medicine. Everything is "until proven otherwise")

Just practice GOOD MEDICINE (i.e., do what you're supposed to) and you will be fine.

People sue not based on negligence but based on two things:
1) My doctor didn't care/talk to me (preventable)
2) Bad outcome (not preventable)

Q, DO

 

[Idiopathic]

I saw the same show (I think it was Oprah). The guest on the show was Dr. Sanjay Gupta, who is the CNN medical expert, and is also a practicing neurosurgeon in the Atlanta area. He is in an interesting position, but makes good points that if patients make greater strides to take care of themselves (i.e. patient advocacy in the hospital, being more educated), then they can take care of some of the potential problems before they become fatal. This behavior will help both the patients and the physicians.

 

[Shinken]

Group_theory and Quinn, I hear you. But the fact still remains that good doctoring and following the standard of care doesn' t always ensure a good outcome. Such is life. Some things can't be cured and some people will die. The average Joe doesn't always accept the fact that doctors aren't God.

The article I referred to is a perfect example. A good doctor that followed standard of care was sued and spent four years in prison as a murderer. The short story: a terminal patient with cancer all over her internal organs was in pain and no longer responding to her pain medication (she was unable to make decisions). The family asked the doctor to administer something stronger. The doctor cautioned that the stronger drug might depress her respiratory system and hasten death. The family understood and approved the new treatment. The patient died. The family sued. The doctor was found guilty of murder. Simple and scary. All protocols were followed and consent was obtained (of course, during the trial the family claimed they didn't know the new treatment could hasten death). Part of the problem was that the jury didn't know what the standard of care was for terminal patients. All the jury knew was that a human being died prematurely because of a drug administered by the doctor.

I'm not making this into an MD vs DO issue at all! I'm just justifiably concerned about being one of the unlucky few that become the victim of a clueless jury. The jury is composed of a cross section of "regular" people, not physicians (I don't mean that in a bad way). Go out on the street on a busy intersection. Look at the people around you. Picture them all sitting in front of you deciding your fate. Scared?