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Lying to patients, or being rude to them, is not ethical nor acceptable. Neither, however, is it malpractice.

1. You ophthal "lied" to you by telling you that they did not do X procedure rather than telling you that they would not do it for you. This is not malpractice. It's rudeness.

2. They referred you to a PA. There is nothing wrong with this, as long as addressing your complaint is within the PA's scope of practice. And, since you seemed to be fixed by the PA, it apparently was. You might not have wanted to see a PA, but that's your opinion. Should the opthal have told you that you would be seeing a PA? Probably. It's also possible that they simply referred you to a different office who then triaged you to a PA, and the opthal might not have known. Regardless, this is not malpractice.

3. The only time this would be malpractice is if the delay caused by you needing to see someone else caused further (irrepairable) injury and the ophthal should have known that. Which does not appear to be the case here.

Take a deep breath. I totally understand that you are really pissed at this doc. And, I totally agree with you that he/she was a jerk and shouldn't have treated you like this. And, this is a great example demonstrating that docs who have poor interpersonal skills tend to get sued more often. But, after taking all of those deep breaths (since the next thing I am going to say is probably going to upset you), can you see that your desire to sue the ophthal is in some ways similar to the person in the car wreck you describe suing you? That guy is upset. His car is wrecked and it's not "his fault". He wants someone else to pay for it and all the problems it has caused. You're not really to blame, but he's mad at you anyway.

Wait a second, you say. These cases are totally different. IN the car wreck above, this was not my fault at all. Some guy hit me, and left the scene. I'm not the bad guy, I shouldn't be sued. In my medical case, the ophthal was like the guy who left my hit-and-run scene, not like me.

But, really? If you were to ask the ophthal's opinion, I expect he/she would say "I saw this guy. I recommended treatment. He wanted something different. I referred him to someone who provided the service he wanted. Which he got." Even if your outcome had not been good, that wouldn't have been the fault of the original ophthal. Just like the car crash wasn't your fault. Or was it? Maybe you were speeding? Maybe you were distracted?. Perhaps you should have flashed your lights to make sure people saw you were stopped? This is the kind of thinking I was referring to in my post, and is why "malpractice" is hard to define. Much like your responsibility for the car crash.
 
...however, is it malpractice.

1. You ophthal "lied" to you by telling you that they did not do X procedure rather than telling you that they would not do it for you. This is not malpractice. It's rudeness...

...I totally agree with you that he/she was a jerk and shouldn't have treated you like this...
I definately do not know all the facts around this angered patient. I do not think anyone does. thus, I reserve judgement and will not "totally agree" to the above assessment.

Reality is, most patients only remember a small portion of what their physician actually says/tells them. Then, what they remember is filtered through their emotions about the encounter. The case described provides only a few points that everyone that understands malpractice can agree upon:

1. There was no agreement/meeting of the minds between the patient and first healthcare provider (provider "A").
2. The patient was referred to another provider (provider "B") that apparently was competent to provide the care the patient sought.
3. The patient was satisfied with the care provided by provider "B"
4. The patient does NOT like provider "A".

Did someone lie? I don't know. The conversation between patient and provider "A" could very well have involved far more then just "...I don't do that...". Maybe it was something like "...I don't do that...." without a follow-up by patient. Maybe if asked, provider "A" would have said, "I don't do that under these circumstances and/or for these reasons, etc....".

But, through all this convoluted anger, somehow someone comes to the conclusion that they can sue a provider "A" for a complication from treatment received by provider "B".... in legal parlance, the prima facie case of malpractice is severely lacking.... I know most Americans believe we should be compensated just for lowering the toilet seat after urinating.... but, you don't get compensation because your pissed-off.

JAD
 
It goes both ways- just like I may have overreacted, you guys here also come up with many maybes to justify the doctor's actions. As long as you understand that, I am fine with your comments.

As far as suing the doctor, you are right that he did not commit "malpractice" technically; however, in a courtroom I think I would not have too much trouble proving that he was negligent (this is part of malpractice). Patient X requires removal of a growth. After suffering for a month or more, she finally is able to see doctor F. Dr. F decides to prescribe "home remedy" that the patient has already tried and that did not work so patient X points out an alternative which Dr. F initially told her did not exist. Now Dr. F concedes the point, but is angry and refers her to another office because he claims he does not do the procedure. After suffering for three more weeks, she finally is admitted and surprisingly is facing a PA with little experience to do a complex procedure that even if successful generally, could scar a very visible area of her body. Patient X is even told by the PA that Dr. F is much more experienced in that area, but he refers his patients to the PA for some of procedures because he doesn't want to deal with them. Patient X has been suffering long enough and cannot reschedule an appointment with another doc since that could take many more months to deal with so she goes ahead with the procedure because she has no other option at that point.

The above is a similar scenario to mine with somewhat different details for privacy. I am not going to reveal everything - you already have enough information to make a preliminary judgment. In this case Dr. F was negligent. He referred the patient to a far lesser professional without ASKING for her permission or informing her first so that she could make different arrangements. Thereby, Dr. F obligated patient X to use a PA. If something went wrong, Dr. F would be responsible. Let's not forget, PAs, about which so many docs complain as well, can't do a thing without a doctor telling them. Had Dr. F referred the patient to another DOCTOR, then it would be completely ok.

Th accident analogy would be applicable if patient X was referred to another doctor, not a PA. And unfortunately there aren't many alternatives to malpractice. If you really want to do away with malpractice, you need to come up with tangible checks and balances for doctor-patient relationships. Maybe there should be a publicly accessible point system where each patient is able to rate and comment on the doctor and every single potential patient of the doctor can take a look at that database and decide which doctor to go with. So until we have a system in place to replace malpractice, I think that unjust litigations are going to be around. And if you can't even see that a doctor has made a mistake, has lied, or somehow patronized a patient without trying to come up with every single justification under the sun (by default assuming that it is the patient at fault), then, unfortunately, you are in no position to judge tort reform since you are unable to see both sides of the issue. And herein lies the problem that doctors face. As long as you can't own up to your own shortcomings, never expect the public to be behind you. As a future doctor, I do want to limit the scope of malpractice litigation, but when fellow doctors keeps screwing up and are unable to admit they made a mistake (and hence unwilling to fix it), there is really no hope for the likes of me. As such, I can already see myself turning away from the entire notion of malpractice reform and doing my best for my own patients as an individual doctor and not caring whether some doctor somewhere in the middle of nowhere was sued justly or not. It doesn't really matter. If there is no teamwork, everyone is for himself. And honestly, why should a doctor that does very well with his patients even care about some jerk getting sued "unjustly" on a regular basis? Let's face it, it just doesn't matter.

Unification of doctors - something that will never happen.
 
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Sorry to go off on a tangent, but how does a doc refer someone to a PA??😕

I could see how a doc could refer someone to an NP, since some Np's are in independent practice situations, but I thought that PA's worked in more close association with docs
 
I think this is just getting circular... thus I will probably let this response be it for this growing and changing sets of alternating scenarios.
It goes both ways- just like I may have overreacted, you guys here also come up with many maybes to justify the doctor's actions. As long as you understand that, I am fine with your comments...
Sure, whatever makes you happy.... You admittedly "may have overreacted" and with your vague scenario we are some how suppose to believe/"understand" what? (rhetorical)
...As far as suing the doctor, you are right that he did not commit "malpractice" technically; however, in a courtroom I think I would not have too much trouble proving that he was negligent (this is part of malpractice)...
Malpractice was or was not committed. According to you, malpractice was NOT committed. This is NOT "technically". The "technically" part is apparently your way of expressing that should things have gone badly, you still feel you should be able to sue the provider that did NOT perform the procedure (and whom you dislike).... If a physician refers a patient to another practitioner qualified to provide care, he/she is not responsible for the other practitioner's care and/or complications. The physician that did NOT perform a procedure with an adverse outcome is not "negligent" for that adverse outcome. Again, a physician is not a slave. You can choose to accept the referral or request another... So too, a physician is not obligated to take a patient on as a client. We are not talking about being in the middle of the arctic with only one provider.
...Patient X requires removal of a growth. After suffering for a month or more, she finally is able to see doctor F. Dr. F decides to prescribe "home remedy" that the patient has already tried and that did not work so patient A points out an alternative which Dr. F initially told her did not exist. Now Dr. F concedes the point, but is angry and refers her to another office because he claims he does not do the procedure. After suffering for three more weeks, she finally is admitted and surprisingly is facing a PA with little experience to do a complex procedure that even if successful, could scar a very visible area of her body. Patient X is even told by the PA that Dr. F is much more experienced in that area, but he refers his patients to the PA for some of procedures because he doesn't want to deal with them. Patient X has been suffering long enough and cannot reschedule an appointment with another doc since that could take many more months to deal with so she goes ahead with the procedure because she has no other option at this point.

...In this case Dr. F was negligent. He referred the patient to a far lesser professional without ASKING for her permission or informing her first so that she could make different arrangements. Thereby, Dr. F obligated patient X to use a PA. If something went wrong. Dr. F would be responsible. Let's not forget, PAs, about which so many docs complain as well, can't do a thing without a doctor telling them. Had Dr. F referred the patient to another DOCTOR, then it would be completely ok...
It just got too long to try and answer everything..... Bottom line, Patient x, y, z, etc... chose a home remedy that may or may not have been under the supervision of said physician. Said physician and patient clearly did NOT establish a healthy doctor/patient relationship as patient 1. wanted to dictate the care provided by the doctor and 2. believes they were being lied to. How this "referral" took place without the patient's knowledge or "permission" is unclear.... What is clear is that the physician did not intend to provide the care the patient sought. This was also apparently clear to the patient... so how he/she ended up seeing another provider through a scheduled appointment without knowing.... makes no sense. the patient is before a practitioner.... that somehow is so professional as to declare 1. it is a complex procedure for which they have little experience and 2. the referring physician ~lied to you. Given this information, the patient CHOSE to have the PA perform the procedure. Yes, CHOSE. The patient DID have another option, numerous other options but CHOSE to proceed with care from a provider that apparently expressed less then encouraging qualifications.....

The patient had the options from first arrival of whatever this suffering lesion may have been to : 1. seek out any number of providers. 2. seek out any number of additional opinions. 3. seek out information about the provider he/she was apparently having a ~surprise appointment with.... Please, if you have an appointment to see someone.... it is not too hard to figure out are they a janitor, NP, PA, physician, herbalist, etc.... You don't have to sit around for 1 day or 3 weeks and only discover the title the day you are sitting in front of the provider.
...refers her to another office...
Sorry to go off on a tangent, but how does a doc refer someone to a PA??...
As for the "surprise" or unauthorized referral...to a PA; it's not even worth trying to address that theory.... Bottom line, per your statement, patient was referred to "another office". The PA worked in said other office. Presumably, the PA worked under a physician/s within that office and those would be the physician/s accountable should the PA have committed malpractice. They are also the individuals that determine if the PA is authorized to provide the care and it is the patient that consents... ALL of this occurs outside the realm and control of the the original referring physician.

You didn't like the first healthcare provider. you didn't trust the first healthcare provider.
You admittedly consented and accepted care from the next provider. You admittedly got good quality care from the second provider. Yet, you are still trying to make some sort of case that, just in case, supposing things didn't work out..... well, "technically" you should have some recourse to extract your pound of flesh out of the provider that you didn't like, you didn't trust, and you didn't move forward with for your care... I think that about sums it up...You may need some counseling to get over your unresolved anger issues....+pity+
 
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As far as suing the doctor, you are right that he did not commit "malpractice" technically; however, in a courtroom I think I would not have too much trouble proving that he was negligent (this is part of malpractice). Patient X requires removal of a growth.

Dude... no. Just no. Literally nobody but you thinks this was something you could have won a lawsuit over. I don't know of anybody who refers directly to PAs, I'm sure he referred you to another practice and they decided your complaint was in the PA's scope of practice which has nothing to do with the first guy. It wasn't a violation of the standard of care, there wasn't any resultant harm (a requirement to even sue at all), it wasn't malpractice. Just move on with your life and let this thread go on to something worthwhile.
 
Dude... no. Just no. Literally nobody but you thinks this was something you could have won a lawsuit over. I don't know of anybody who refers directly to PAs, I'm sure he referred you to another practice and they decided your complaint was in the PA's scope of practice which has nothing to do with the first guy. It wasn't a violation of the standard of care, there wasn't any resultant harm (a requirement to even sue at all), it wasn't malpractice. Just move on with your life and let this thread go on to something worthwhile.
I gots to agree.... also, forgot to point another important aspect in my last response, so for completion sake, I will address it:
...Dr. F ...refers her to another office because he claims he does not do the procedure. ...Patient X is even told by the PA that Dr. F ...refers his patients to the PA for some of procedures because he doesn't want to deal with them...
At least two very important points if we are to believe the scenario:

1. PA referred to throughout the scenario apparently suggests or states the physician from the OTHER OFFICE (i.e. referring office) is a liar. This point the angry patient holds close to his/her heart like ten commandments written in stone from on-high.
2. PA states the apparently experienced physician from the OTHER OFFICE (i.e. referring office) has as a common/customary practice/routine to refer these procedures to the office/practice at which this PA works. The first physician/referring practice does not like to perform these procedures and often refers them to another office/practice in town. This is apparently within the normal/customary practice of the referring specialist. It stands to reason that the receiving office/practice is customarily used to receiving and treating these kinds of diseases/illness. Or at least that is the message the PA delivered. This point seems lost on the unfortunate victim patient.

But, as is true USA entitled victim mentality, the contradiction is ignored and selective hearing employed. Why in God's name would anyone want a complex procedure to be performed by a specialist that does not want to do them and as a practice refers them to another office/group/practice??? And, how can said referal be malpractice!!!! The negligence if any is for a PA to declare limited experience with a complex procedure and then proceed to offer and perform said procedure.... again, it has absolutely NOTHING to do with the referring physician and a great deal to do with the PA and his/her supervising physicians.
 
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As said above, Dude, no. Physician X did not commit malpractice nor was he negligent no matter how you twist the story. You have failed to show tort of neglience which is required for malpractice.

You have to establish all four elements of negligence for a successful medical malpractice claim:

A duty was owed: a legal duty exists when a provider undertakes care or treatment of a patient. Physician A elected NOT to undertake your care and treatment. It doesn't matter whether he lied to you, was arrogant and thought he was God, or frankly just didn't liked you. He has NO duty toward you other than to refer you elsewhere where you can get the treatment you need once he decides to terminate the patient - physician relationship. He did not refer you to a PA but rather a colleague's office, which he apparently does frequently; it was that office that decided the PA was able to provide the service you sought. Once I or any other physician refers you elsewhere (for whatever reason), there is no duty to affirm that you received the treatment, were happy with the treatment or to follow-up on any possible complications.

A duty was breached: Physician X would have failed to conform to the relevant standard of care. Since he had no duty, the duty cannot be breached. Even if he did have a duty, a known complication of a procedure (which you DID NOT have) is not malpractice as long as the provider conformed to the community definition of standard of care. It is not a breach of duty not to provide you care. As JAD notes, he is not your personal slave to do whatever you want.

The breach of duty caused an injury: The breach of duty was a proximate cause of the injury. YOu have claimed no injury although I suppose you might make claim for emotional injury (which is lame) due to your preferring Physician A and then feeling slighted when he denied you the treatment you sought.

Damages: Without damages there is no basis for a claim, regardless of whether the medical provider was negligent. You had no damages.

Your whole argument is ludicrous and an example of why I have to spend so much time, money and effort making sure that I protect myself from patients with some ignorant definition of what malpractice and negligence are.
 
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Don't be so naive as to think that the $500,000 maximum will remain limited to those that took TARP money. especially once we become de facto government employees.
Just food for thought!

Correction: Obama's policies in general is the next step of a nefarious socialist scheme to move the US as rapidly towards socialism as possible. Setting up the infrastructure for the government to take over health care is just one of many aspects of this plan. Salary caps of any level on any profession are EVIL. Limiting anyone's success is ridiculous. The only thing it does is make poor people feel better temporarily by "sticking it to the rich". How is a salary cap in any field going to improve anything? It WON'T

You are a jackass. But, for the moment we still live in a free country and you have the right to speak your mind. I hope you appreciate it while you still have it!

and the sky is falling

and the communists are coming to get us

and fluoride in our tap water is part of the communists' evil ploy to gain control of our minds!!!
...and ...and

The thing that impresses me most about wall street is their uncanny ability to recruit the very people they're RAPING (blue collar/midwest) to fight for them!

In the mean time,
Haldol 1mg PO TID- Take that to your neighborhood walgreens
 
In his example one patient sued her specialist even though her injury attorneys told her that the fault was with her primary doctor.

A competent attorney would not intentionally sue the doc not at fault, and not sue the doc actually at fault. In addition to being highly unethical and virtually guaranteeing he/she would not be paid for the time spent on the case, it would expose the lawyer him/herself to a malpractice action.
 
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As said above, Dude, no. Physician X did not commit malpractice nor was he negligent no matter how you twist the story. You have failed to show tort of neglience which is required for malpractice.

You have to establish all four elements of negligence for a successful medical malpractice claim:

A duty was owed: a legal duty exists when a provider undertakes care or treatment of a patient. Physician A elected NOT to undertake your care and treatment. It doesn't matter whether he lied to you, was arrogant and thought he was God, or frankly just didn't liked you. He has NO duty toward you other than to refer you elsewhere where you can get the treatment you need once he decides to terminate the patient - physician relationship. He did not refer you to a PA but rather a colleague's office, which he apparently does frequently; it was that office that decided the PA was able to provide the service you sought. Once I or any other physician refers you elsewhere (for whatever reason), there is no duty to affirm that you received the treatment, were happy with the treatment or to follow-up on any possible complications.

A duty was breached: Physician X would have failed to conform to the relevant standard of care. Since he had no duty, the duty cannot be breached. Even if he did have a duty, a known complication of a procedure (which you DID NOT have) is not malpractice as long as the provider conformed to the community definition of standard of care. It is not a breach of duty not to provide you care. As JAD notes, he is not your personal slave to do whatever you want.

The breach of duty caused an injury: The breach of duty was a proximate cause of the injury. YOu have claimed no injury although I suppose you might make claim for emotional injury (which is lame) due to your preferring Physician A and then feeling slighted when he denied you the treatment you sought.

Damages: Without damages there is no basis for a claim, regardless of whether the medical provider was negligent. You had no damages.

Your whole argument is ludicrous and an example of why I have to spend so much time, money and effort making sure that I protect myself from patients with some ignorant definition of what malpractice and negligence are.

Excellent post. No lawyer in his right mind would take a case like this. None.
 
He did not refer you to a PA but rather a colleague's office, which he apparently does frequently; it was that office that decided the PA was able to provide the service you sought. Once I or any other physician refers you elsewhere (for whatever reason), there is no duty to affirm that you received the treatment, were happy with the treatment or to follow-up on any possible complications.

Although I generally agree with your post, Negligent Referral can lead to a malpractice claim. When referring a patient, it is important to refer to a qualified provider. A doctor should make clear to the patient that he is referring him to Dr. X, not "Dr. X's office". If the referring doctor is aware (or even if he isn't sometimes) that a PA is doing a procedure, especially if Dr. X didn't see the patient first, it can lead to a malpractice claim if something goes wrong.

http://www.thefreelibrary.com/Negligent+referral+is+a+valid+claim,+court+says.-a054939489
 
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Although I generally agree with your post, Negligent Referral can lead to a malpractice claim. When referring a patient, it is important to refer to a qualified provider. A doctor should make clear to the patient that he is referring him to Dr. X, not "Dr. X's office". If the referring doctor is aware (or even if he isn't sometimes) that a PA is doing a procedure, especially if Dr. X didn't see the patient first, it can lead to a malpractice claim if something goes wrong.

http://www.thefreelibrary.com/Negligent+referral+is+a+valid+claim,+court+says.-a054939489

Interesting...however, the case was 10 years ago (did you have any follow-up as to whether it was successful), in Pennsylvania (THE prime state for ridiculous legal claims and pay-outs; its no wonder the insurance rates are so high there), and the claim was that the referring physician KNEW that the practitioner was incompetent. That is not the case here as Physician A frequently refers patients who want the procedure Excelsius was asking for to this other practice.

We all have to have a process for referring patients - whether for treatments we don't provide or in the case of patients we are terminating (for whatever reason). And yes, those providers we refer to have to be competent. I am not sure where my legal level of involvement stops. Am I required to choose someone who is BC? How do I know whether or not another specialist is good at what they do except for "what I hear?" Patients ask me all the time to refer them to a new PCP, or other specialist. I really have no idea who is competent, who is nice, etc. except for those I have directly observed in practice. Its really ridiculous to assume that I would know.

Back to the "case" above, Physician A has to refer Excelsius to someone who provides the services he desires. This is something I do all the time with non-compliant patients before I terminate them (as I'm sure you do as well). I agree that if you refer someone to another provider who does NOT provide the services there is a problem.

It sounds like from his post that he DID refer to someone who provides the services (we don't know whether he referred Excelsius to the PA, which is unlikely, but the procedure appeared to be in the scope of practice of the PA, even if the PA felt that Physician A was the better provider). It was my impression from Excelsius' description that he was referred to a certain physician or at least "Ophtho Big Group A" and was suprised that he was seeing a PA. Therefore, it appears that he was referred to a physician practitioner. I am also under the impression that this is not a case of negligent referral as the PA or the group referred to is capable of performing the procedure, which they did in Excelsius' case, and without complication.

So while it is true that Negligent Referrals can be a source of a claim, it does not appear that is the case in this ludicrous story in which an arrogant entitled patient (Excelsius) didn't get what he wanted, failed to do his due diligence to see who provided the care and treatment, tried to force a practitioner to do what HE wanted, consented to a procedure from a provider he didn't want and now is considering legal action not because he had a complication but because he's mad the the ophthamologist who referred him.
 
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Yep, I think we can come up with any number of cases that may exist on the books or twist and turn the scenario originally provided or give a "...similar scenario to mine with somewhat different details for privacy..." .

In the end, you need malpractice to have any sincere expectation of compensation for malpractice. In the case described, the whiner states there was no malpractice..."...you are right that he did not commit "malpractice"...".🙁
 
...
So while it is true that Negligent Referrals can be a source of a claim, it does not appear that is the case in this ludicrous story in which an arrogant entitled patient (Excelsius) didn't get what he wanted, failed to do his due diligence to see who provided the care and treatment, tried to force a practitioner to do what HE wanted, consented to a procedure from a provider he didn't want and now is considering legal action not because he had a complication but because he's mad the the ophthamologist who referred him.

Kimberli, out of all people, I am very surprised to hear these things from you. Someone like, Jack, ok, I don't know him. He's just probably another regular SDNer. But I was of very different (positive) opinion about you and have always thought highly of you. Your attacks are indeed gratuitous in this case and they are the only ones that hit close to home for me. You made some assumptions and then based on the same came to a conclusion about what sort of a person I am and who is at fault here.

This is a theoretical discussion about why the doctor-patient relationship is broken. If anything, this thread is further evidence of that and ominous of much more trouble to come for doctors. I have nothing to prove in this forum or anything to gain or lose. For some reason you assume that I "intend" to take action against the doctor, whereas I have never seriously considered that. Please go back and reread what I said - IF my procedure was a failure, then I might have considered implicating the doctor. I don't have much experience in the malpractice aspects of law, but I would allow the courts to take care of that. I am not an expert in malpractice, nor are you or anyone else here a lawyer, regardless of how much you think you know about law from the horror cases you have heard and other hearsay.

Please, let's forget even the theoretical discussion of litigation. You know what is the most disturbing part of almost every response here? It's that by default, everyone here (except aPD, more or less, whom I salute) automatically assumed that the patient is the only one at fault and that the doctor did nothing wrong. Forget malpractice, I am talking about basic ethics and respect towards your patient. Yes, Kim, you're right, I guess I am the entitled bastard even though the dr. is the one who lied to me about treatment options, deceived about the referral until it was too late and I couldn't back out (did you even read that part?), and referred me to an office in a terrible neighborhood with clearly deficient facilities even though there was another great ophthalmologist in the SAME building who DOES do that procedure (my current optho doc whom I found out myself and who is great).

Anyway, I am pretty disappointed by the accusations. Like I said before, I would gladly take any constructive criticism if you could have the decency to admit that what the doctor did was at least disrespectful and perhaps unethical. But I guess I am the only one at fault here. What a clusterf*ck. And it is interesting that some of you assume that I am very angry about this and about to sue the doctor whereas my anger only lasted about 30 minutes during which I was taking to the PA more than a year ago. After that I just changed my doc and moved on. This thread about doctor-patient relationship reminded me of that and I brought it up. If I was really upset about something like this, I wouldn't be wasting my time writing about it on an anonymous forum full of doctors many of whom could be biased. I would have taken my case where it belongs - be it the legal system or the hospital administration. You guys are clearly upset about what I had to say and somehow project that anger on to me. I am not really upset by your responses either, but I am worried what kind of future is there going to be for upcoming doctors like me who value respect towards patients. I see doctors being treated like **** left and right and all you ever hear doctors do is blame, blame, blame, blame. Let's cut the crap please. The fault clearly does not lie only with the patient. If you really never even give the benefit of a doubt to the patient, then you're right, maybe by the time I get to practice medicine the field will be so ****ed up that it won't make it worthwhile for me.

I hope one day we will have a national database of doctor ranking system by patients and by peers. I suspect that those who complain about malpractice so much will be the ones most affected even if we do take away malpractice and replace it with the point system. Then we'll see the same doctors come to SDN or write articles bitching and moaning about the unfairness of the point system. Anyone wants to take a shot at such a system already, perhaps?

This is actually lame. I am sorry I angered anyone. That was not my intention at all. I will likely go back and delete everything I said here. It's just not worth it. Sorry.
 
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Kimberli, out of all people, I am very surprised to hear these things from you. Someone like, Jack, ok, I don't know him. He's just probably another regular SDNer...
I'm at a loss as to how I should take this....:scared:I have read your comments a few times..... for those not wanting to look backwards:
...In terms of doctors, there are some who don't even deserve to practice. These guys are careless and not knowledgeable. What they do is spoil the reputation of all doctors. As a result, malpractice litigation becomes ubiquitous - the public thinks all doctors deserve it and the government believes that it's the right way to keep doctors in check. Insurance costs go up, doctors become frustrated, care less about patients, more mistakes take place, and the vicious cycle keeps going. I think that if the doctor is happy with his job, he'll tend to care more about his patients and make less mistakes. So one place that needs reform is the residency. It seems to traumatize a lot of doctors so that by the time they are out, they are pissed and want to make up for all those years of disrespect they had to endure. Patient care is not the first thing on their mind. Combined with unfair malpractice costs, the situation becomes far worse. That's the problem here: everyone is concentrating on that one guy who sues the company for his own misuse of the tire, yet no one is paying attention to the bigger picture.

Residency should be a much more controlled environment. Many premeds go into medicine for good reasons. Sure, many of these reasons are too idealistic, but you don't want to break every single positive bone in their body even before they finish residency. That, combined with malignancy in medicine, will forever warrant the downward fall of all doctors because the profession is eating itself from inside out while the government is trying to contain the zone of influence by squeezing in the outer edges. I only see doctors blame the system, patients, and everyone else (including in this forum). I have never seen anyone trying to also look into the problems that doctors themselves are responsible for... Sooner or later we'll see a implosion since the path is not changing, except for the worse...
...Blink by Malcolm Gladwell? ...he makes a point that the probability for a doctor to be sued depends mainly on his patient interaction skills, and not his technical skills. In his example one patient sued her specialist even though her injury attorneys told her that the fault was with her primary doctor...

I had a personal encounter with a UCSF optho who thought he was god. When I suggested a procedure in a conversation, he became very defensive and even though admitted that the procedure was fine, he referred me to a PA in another hospital because he said he doesn't do those procedures. I didn't like this and after talking to the PA found out that the given optho actually does the given procedure. I was not happy about that since I would much rather have a much more experienced doc do the procedure on such a sensitive area. Anyway, the procedure went great, but had it failed even a bit, I would be suing the optho doc for not doing the procedure himself and referring me to someone else. After this incidence I switched my optho and found out from the nurse that I am not the first one to do that. This doctor is going to be sued in the future, multiple times. I wouldn't care if he lost a case where he wasn't at fault. ...
Yes, it is unethical for a lawyer to take the case, but it happens all the time. And this is not just limited to doctors. Just take a look at collision injury. Here is a classical example: some time ago I was involved in a hit-and-run. Someone hit my car and flew away on the freeway while my car spun out of control and came to rest. I did not hit any cars and came to rest in the middle lane. All the cars stopped. In the carpool lane, a car stopped, but the car behind him did not and hit that car. So the guy who hit that car from behind sued ME for $200K even though there were no injuries, he was at fault for speeding, he was at fault for hitting another car from behind, and I was not even involved in the accident! I drafted a letter about the ethics of his lawyer to the state bar. It's a ridiculous claim, but it still has wasted my time. So I am not sure you can enforce justice only in the malpractice arena. You'd have to change the entire ethics regulations for attorneys.

I agree in general with your last point, but in my case I think I was correct. Yes, a doctor is not obligated to perform a service. And had my optho been straightforward enough to refer me to another optho, that would be great. I did that myself later anyway. However, he 1.Sent me to a PA informing me first and finding out whether it was ok with me. I thought that I was going to see another optho and didn't find out until the day of the procedure that it was PA and had wasted weeks waiting for the appt. 2. He lied to me that he does not perform the given procedure. You bet I would take this to court and likely win. If you think that treating a patient with such disrespect is ok, then you might come across this same problem in the future yourself. Again, it is completely ok to refuse service and refer to another DOCTOR, but don't f-ing brush a patient off to a PA and lie to him just because your ego was hurt and you don't want to admit your personal vendetta by calling up another doctor and asking him to take your patient (would love to hear the reason why the patient is being referred!).
It goes both ways- just like I may have overreacted, you guys here also come up with many maybes to justify the doctor's actions. As long as you understand that, I am fine with your comments.

As far as suing the doctor, you are right that he did not commit "malpractice" technically; however, in a courtroom I think I would not have too much trouble proving that he was negligent (this is part of malpractice). Patient X requires removal of a growth. After suffering for a month or more, she finally is able to see doctor F. Dr. F decides to prescribe "home remedy" that the patient has already tried and that did not work so patient X points out an alternative which Dr. F initially told her did not exist. Now Dr. F concedes the point, but is angry and refers her to another office because he claims he does not do the procedure. After suffering for three more weeks, she finally is admitted and surprisingly is facing a PA with little experience to do a complex procedure that even if successful generally, could scar a very visible area of her body. Patient X is even told by the PA that Dr. F is much more experienced in that area, but he refers his patients to the PA for some of procedures because he doesn't want to deal with them. Patient X has been suffering long enough and cannot reschedule an appointment with another doc since that could take many more months to deal with so she goes ahead with the procedure because she has no other option at that point.

The above is a similar scenario to mine with somewhat different details for privacy. I am not going to reveal everything - you already have enough information to make a preliminary judgment. In this case Dr. F was negligent. He referred the patient to a far lesser professional without ASKING for her permission or informing her first so that she could make different arrangements. Thereby, Dr. F obligated patient X to use a PA. If something went wrong, Dr. F would be responsible. Let's not forget, PAs ...can't do a thing without a doctor telling them. Had Dr. F referred the patient to another DOCTOR, then it would be completely ok.

Th accident analogy would be applicable if patient X was referred to another doctor, not a PA. And unfortunately there aren't many alternatives to malpractice. If you really want to do away with malpractice, you need to come up with tangible checks and balances for doctor-patient relationships. Maybe there should be a publicly accessible point system where each patient is able to rate and comment on the doctor and every single potential patient of the doctor can take a look at that database and decide which doctor to go with. So until we have a system in place to replace malpractice, I think that unjust litigations are going to be around. And if you can't even see that a doctor has made a mistake, has lied, or somehow patronized a patient without trying to come up with every single justification under the sun (by default assuming that it is the patient at fault), then, unfortunately, you are in no position to judge tort reform since you are unable to see both sides of the issue. And herein lies the problem that doctors face. As long as you can't own up to your own shortcomings, never expect the public to be behind you. As a future doctor, I do want to limit the scope of malpractice litigation, but when fellow doctors keeps screwing up and are unable to admit they made a mistake (and hence unwilling to fix it), there is really no hope for the likes of me. As such, I can already see myself turning away from the entire notion of malpractice reform and doing my best for my own patients as an individual doctor and not caring whether some doctor somewhere in the middle of nowhere was sued justly or not. It doesn't really matter. If there is no teamwork, everyone is for himself. And honestly, why should a doctor that does very well with his patients even care about some jerk getting sued "unjustly" on a regular basis? Let's face it, it just doesn't matter.

Unification of doctors - something that will never happen.
I just don't appreciate your points. In particular, the insistence of NO choice, NO OPTION, etc..... Best regards.:beat:
 
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Excelsius, only the most misguided delusional physician would claim that their colleagues aren't sometimes at fault. We all know that some of our colleagues can be rude, lack sympathy and in some cases, are negligent and/or dangerous. Do physicians blame others for their faults? Sure. But they also spend a lot of time lambasting themselves for their perceived shortcomings, probably more so than many other professions. We know that our failings can be life-threatening. No one ever said that the patient was always at fault. However, IMHO you have failed to show us where the physician was at fault. At every step, it appeared that your duty to yourself was not demonstrated.

And perhaps I did make assumptions that were baseless. However, they were based on information you provided. You have made numerous posts in which you claim that it is fair to sue physicians just because you don't like them, or don't like the outcome. I cannot be faulted for assuming that you feel this way. This is an internet forum - and just as you have assumed you know my personality based on what I've written here, I've done the same with you. Its all we have to go on. Perhaps I went too far but I cannot recall being as angered about a post as I was with yours, in a long time.

IMHO it doesn't matter whether or not you actually tried to file a claim against Physician A. The mere fact that you said it, you considered it, is offensive to me. I work in a very litiginous specialty and every week I see people who have failed to receive the standard of care for their disease elsewhere. Yet none of them profess any desire to sue the other physician involved in their care and these are people with cancer. Sympathetic people who might win in some cases if they took their treatment to litigation.

I find it offensive for patients who have an expected complication to consider that malpractice. I find it offensive that patients seem to have no clear knowledge of what neligence and malpractice is, and a belief that it doesn't really matter because "insurance will take care of it", completely ignoring the psychological and economic damage even a dismissed claim takes on the physician. I find it offensive that patients seem to think they know best, have the temerity to call me by my first name, assume that the Porsche in the parking lot is mine, and discount the 14 years of education and clinical experience as worth anything and they'll just sue if they don't like my attitude, my referral patterns, the outcome of their treatment or any known complications. My 3 million dollar policy is not there to protect patients from their own inability to listen to our discussion of the risks, to avoid reading the 8 page consent form I give them, or to protect them because they didn't like me, their prognosis, their scar, any complications or side effects or the outcome of their treatments. It is there to protect me against malpractice; something which the public has broadened the popular definition far outside the legal definition.

So yes, I did read your earlier posts and more than once. And yes, I was angry and I was not the only one. You are probably unable to read what you've written through our eyes and see how harmful, how hurtful and frustrating it is. We have spent years of our lives training and educating ourselves, have gone without sleep and food for extended hours, gone into enormous debt, all in an effort to make your life better. I have sacrified my body, my friendships, my romantic and family relationships in pursuit of this goal. As of Jan 1, I will be paid less for what I do because of insurance reimbursement changes. So yes, I am angry that the mere fact that you didn't like who provided your care made you even think about malpractice because I know you represent John Q. Public who thinks the same way. Damn it - there's not enough cheese on my hamburger. Someone's gonna get sued!

You failed in your own due diligence to find out who was providing your care. If I make an appointment to see a physician, I ask who I'll be seeing (as in many offices you are seeing the PA or the NP), and certainly would if I was having a surgical procedure. Unless you had an appointment with the physician (which you verified at time of appointment) and they switched you at the last minute to the PA, you have no reason to complain. And yet, even when you were dismayed at a PA providing your care (especially when they claimed that they didn't do it as well as Physician A), you didn't leave. You consented to the procedure. I fail to see who is at fault here if you were unhappy except you.

Finally, have you verified with Physician A that he actually does the procedure you want? Just because the PA told you he did doesn't mean that he does or that he does it in all cases. In my short career, I have also heard patients tell me that another provider told them I did something I don't do, or vice versa (that I didn't do something I do do).

There is nothing wrong with a national database except that it cannot be objective. Patients cannot evaluate medical care; as long as they can get an appointment, their doctor is nice and their scar looks good, they got good medical care as far as they know. Similarly how can I rank my colleagues unless I directly work with them? Every year I get a request from Phoenix Magazine to rank the Top Doctors. Outside of putting my own name on the list, how am I supposed to know which cardiologist is best, which pain doctor, etc.? Its all hearsay, from patients and colleagues. One of the cardiologists on the list last year was an ass to me on the phone about a mutual patient when I called to see if he could go off his Plavix. If I were like a typical patient, when that survey comes around this year, I'd give him a bad rating because of his attitude, even though it has nothing to do with his skills as a cardiologist.

So I'm sorry if you felt that I misunderstood who you are. It can be difficult on an internet forum to really get a feel for someone and maybe you were just venting, but honestly your claims were ludicrous. It wouldn't have even mattered to me if you'd had a known complication; you still would not have proved the tort of negligence and to claim to have done so infuriates me. I will apologize for my assumptions about you but I will not apologize for being angry over what your words represent.
 
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and the sky is falling

and the communists are coming to get us

and fluoride in our tap water is part of the communists' evil ploy to gain control of our minds!!!
...and ...and

The thing that impresses me most about wall street is their uncanny ability to recruit the very people they're RAPING (blue collar/midwest) to fight for them!

In the mean time,
Haldol 1mg PO TID- Take that to your neighborhood walgreens

It is clear from examining who Obama appointed as czars that he plans on advancing the progressive, socialist agenda as quickly as possible. It is also equally clear that the American public wants no part of socialism.

In poll after poll, over 50% of Americans do NOT approve of either of the health care bills out there. Yet the Senate is meeting tonight to pass it, planning to vote at 1 am. Our representatives have strayed away from the idea of representing their constituents.


Proponents of socialism most frequently respond to being called out by name calling and attacking, rather than having a rational conversation.
 
... IF my procedure was a failure, then I might have considered implicating the doctor. I don't have much experience in the malpractice aspects of law, but I would allow the courts to take care of that. I am not an expert in malpractice, nor are you or anyone else here a lawyer, ....

Yeah, Dr. C. is the bomb. And from what I know, her post on the 4 parts of negligence is right on, and is almost the same as malpractice in general.... there was an injury, the physician was the "proximate cause" of the injury, et cetera, et cetera, ad nauseum.

This snippet illustrates a big part of the issue.

People consider, and DO, implicate everyone - from the triage nurse to the chief of cardiology (who never saw the patient).

Moreover, people will file a lawsuit for nothing and "let the courts take care" of it. They have NOTHING to lose by doing so. They don't even have to pay their attorney unless they win the case. The doctor loses either way - just because the complaint is filed. If you've ever overheard on a train or something how nonchalantly people ask...
"oh he said this, but it turned out to be that"
"are you gonna sue?"
"I might"
It's infuriating. And that's how it is out there. Its just become the way things are done in the U.S and A. When things don't go as predicted.

And on a final note, Law2Doc IS a lawyer
 
Although I generally agree with your post, Negligent Referral can lead to a malpractice claim. When referring a patient, it is important to refer to a qualified provider. A doctor should make clear to the patient that he is referring him to Dr. X, not "Dr. X's office". If the referring doctor is aware (or even if he isn't sometimes) that a PA is doing a procedure, especially if Dr. X didn't see the patient first, it can lead to a malpractice claim if something goes wrong.

http://www.thefreelibrary.com/Negligent+referral+is+a+valid+claim,+court+says.-a054939489

Here's a more recent case which references the above: http://www.columbiapa.org/courts/opinions/civil/HERB V. SPOCK_GMC_ 82-00 Sum. Jud. 9-15-04.pdf

Essentially the Pennsylvania courts have decided that if you KNOWINGLY refer someone to an INCOMPETENT practitioner (how that is determined I do not know), then you MAY be potentially liable for any complications. However, in the above case (a PCP who did not refer a patient to an oncologist after the patient was being seen by surgical specialists) was dismissed because he appropriately referred the patient to a specialist and had no duty to follow-up on that care and/or whether or not the treatment received was complete.

Further of interest is that Pennsylvania courts have NOT made the same ruling in terms of legal malpractice. That is an attorney referring a client to an incompetent attorney cannot be held liable for any legal malpractice that may occur.

So it still seems to me that in the case we are discussing, Physician A had no knowledge of any incompetence (which does not appear to be an issue anyway) and therefore, cannot be held liable for any complication (of which there is none).
 
...
And perhaps I did make assumptions that were baseless. However, they were based on information you provided. You have made numerous posts in which you claim that it is fair to sue physicians just because you don't like them, or don't like the outcome. ...

Ok, allow me to clarify this misunderstanding: I absolutely do not feel this way. What you read was my discussion from a book by Gladwell where he described a patient suing a doctor just because she didn't like him. I did not say I agree with it in the least. I just mentioned it because I found it very surprising and wanted to make a point as to how much more important it is to respect your patient than to make sure she gets every single test under the sun to avoid litigation - you can actually get away with a mistake even when you're at fault if you show your patient you care about her. Any patient who sues the doctor only because she doesn't like her is unethical. Also, almost every procedure has a possible side effect. Should you be suing a doctor for that? NO. Because a side effect about which the patient is informed is NOT a mistake. So I don't know, maybe I did not communicate my thoughts properly, but I hope this clarifies that I absolutely do not condone suing a doctor simply because of not liking her. If my post made you think that that's how I operate, then I can understand why you would get so upset.

As far as a referral goes - I don't know. Maybe I was naive to assume that the doctor was going to refer to me to another doctor. That's how it has always worked for me. Maybe I shouldn't have trusted him from the beginning and checked as to whom the referral was directed. I saw a name on the referral and assumed that the person was a doctor. I had no reason to doubt that I would not be referred to a doc. And as far as him not knowing about the PA, that is not the case because he referred to a branch that was associated with his office and I was not the first patient to be referred from that particular doctor to that particular PA. The PA was fully aware of the situation and thought that it was weird - that's what made me so nervous. I know, you are blaming me for accepting the service even though I wasn't comfortable. But please, think about what the patient has to go through as well. Some patients have to wait for many weeks or even months to see a specialist (you visit your PCP, get a referral, then go to the specialist...). How easy do you think it is for a patient to just throw away an appointment after a total of two or more months of waiting and sometimes being in pain, only to refuse a service at the last moment? It is just not that simple.

...
We have spent years of our lives training and educating ourselves, have gone without sleep and food for extended hours, gone into enormous debt, all in an effort to make your life better. I have sacrified my body, my friendships, my romantic and family relationships in pursuit of this goal. As of Jan 1, I will be paid less for what I do because of insurance reimbursement changes. So yes, I am angry that the mere fact that you didn't like who provided your care made you even think about malpractice because I know you represent John Q. Public who thinks the same way. Damn it - there's not enough cheese on my hamburger. Someone's gonna get sued!
Again, not only do I agree, but I am also much more familiar with this cruel reality than the average patient. However, even though I know this, I also think that the patient still deserves basic respect. I could be wrong, but from the posts I have seen from you, I would not think that you are someone who would disrespect a patient in any way. I would be surprised if you have ever been sued. But here is the other side of the coin. You see, you want your patients to be well informed about all the legal aspects of malpractice and at the same time be emotionally isolated from the treatments they receive. But all of us have the same quintessential human flaw imprinted in our DNA and sculpted into the structures of our limbic system - it is just not that easy to separate emotion from every day issues. The brain is specifically connected in a way that it has to involve emotion even if the pain experienced is purely physical. You can cut your finger and have your amygdala activated. So just like a patient can get angry and sue the doctor just because he has had a bad experience, you as a doctor also have emotional reactions to that based on the sacrifices you have made to become a doctor. Every time something happens, you remember that, your life and overall unsatisfaction, and that gets factored into how you judge your own patients or the legal system as a whole. I don't blame you for that because the system is indeed harsh. The other aspect is being informed about the journey before undertaking it. It would be best to go into this field having as much a priori knowledge about the sacrifices involved as possible. But again, I can't blame you for this either because you can't always know the situation until you experience it. In the same way, just realize that you can't always expect a patient to be informed about the procedures and make a level-headed, unemotional decision regarding any mishaps. And believe me, if the doctor is rude, it does not help his cause at all and makes the emotional detachment almost impossible.

There can be an entire discussion about sacrifices and whether all of them are necessary. I obviously don't know your situation, but I know that it is possible to be happy as a doctor because I know two docs who are doing just great. Their secret was to balance their lives early on (both are non-trad). The issue of sacrifice is not just limited to doctors - almost every professional who is involved in her practice intensely makes a lot of sacrifices (the lawyer with whom I have worked for the last several years works every single day and it is not uncommon for her to go over 70 hours a week). We all have that problem - we're so focused on the final goal that we completely forget the NOW. There are so many great quotes and treatises about this issue that you'd think people would be better informed. I can't really spend a lot of time discussing this aspect, but I have been guilty of the same vice. It has been only recently that I stopped and tried to analyze my life and its trajectory. I realized that I don't have to be a hermit to reach my goals and I have been slowly changing many aspects of my life. The end result is that I get to enjoy the journey and smell the roses, and at the same time, I am able to perform better at my tasks because I am fulfilled in all areas. I just don't want to look back one day when I am old and regret that I wasted my youth and my entire life. Very hard work and enjoyment are not mutually exclusive. In many cases, the former isn't even worth anything without the latter. Let's face it - very few of us are true martyrs. Our goal is financial stability. Financial stability is for enjoying life. If that notion can't be fulfilled, then I think life is a failure. Yes, it can be fulfilling if you love your work and love working with patients, but how many here can say that that's all they need? It doesn't work that way. People like Gandhi are few and far between. And the last Jesus was over 2000 years ago. Ah the irony of medschool application and what they expect you to say...

...
Finally, have you verified with Physician A that he actually does the procedure you want? Just because the PA told you he did doesn't mean that he does or that he does it in all cases. In my short career, I have also heard patients tell me that another provider told them I did something I don't do, or vice versa (that I didn't do something I do do).
Well, as you could already see from my posts: the doc said he doesn't do the service. The PA said that he does. I just recalled another detail - the PA said that the doc had done the same procedure on his (PA's) wife. Of course, now we can say maybe he was lying? I don't know why he would do that, but I don't think that's relevant really. If one person treats you with respect and another person patronizes you, whose words are you going to believe? By default, it is the PA here. This is a physicians forum, so obviously Jack mentioned it right in his first response that the PA could be lying. This is the part of displacing blame on anyone but the doctor and that's the issue.

There is nothing wrong with a national database except that it cannot be objective. Patients cannot evaluate medical care; as long as they can get an appointment, their doctor is nice and their scar looks good, they got good medical care as far as they know. Similarly how can I rank my colleagues unless I directly work with them? Every year I get a request from Phoenix Magazine to rank the Top Doctors. Outside of putting my own name on the list, how am I supposed to know which cardiologist is best, which pain doctor, etc.? Its all hearsay, from patients and colleagues. One of the cardiologists on the list last year was an ass to me on the phone about a mutual patient when I called to see if he could go off his Plavix. If I were like a typical patient, when that survey comes around this year, I'd give him a bad rating because of his attitude, even though it has nothing to do with his skills as a cardiologist.

We will never have a perfect system. However, even with all the shortcomings, this can be a good system. If a patient writes: "Yes, doctor A cured me, but he was a jerk" it will not be so difficult to find another comment saying "Doctor B cured me, and he was very courteous." With a large sample size, bias will be insignificant and I would much rather go to a humane doctor in some unknown hospital who performs just as well as that jerk in Beverly Hills. This might be a good way to comb through the bad apples. Quality of care would increase and the number of malpractice claims would decrease. You might be a good doctor, but if you have many fellow doctors who treat their patients with disrespect, your cause is hurt. You are directly affected by some unknown doctor so that when that patient comes to you, she is already defensive and expects you to try to screw her just like her friend's doctor.

Anyway, I hope there are no hard feelings. I obviously don't know as much as you do since you are a practicing physician who deals with this system intimately on a daily basis. I don't mind constructive criticism.
 
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Moreover, people will file a lawsuit for nothing and "let the courts take care" of it. They have NOTHING to lose by doing so. They don't even have to pay their attorney unless they win the case. The doctor loses either way - just because the complaint is filed.

I completely agree. The one thing about the Canadian system that I do like is that if there is no evidence to back up someone's claim, the person who filed the claim is responsible for all legal fees.

The politicians and even the medical societies keep fighting for (in my mind) trivial things like caps on malpractice payouts, etc. Fighting for something that would make people think twice (or even better, three times) before suing would be beneficial as well.
 
...The one thing about the Canadian system that I do like is that if there is no evidence to back up someone's claim, the person who filed the claim is responsible for all legal fees.

....Fighting for something that would make people think twice (or even better, three times) before suing would be beneficial as well.
How about....
...If a plaintiff was informed by the judge [at the time of filing a suit] and ...signed a contract stating/acknowledging....

"I acknowledge that should a judgement return that finds the defendant met the standard of care and committed no act of malpractice, I will personally assume all legal costs associated with defending against the charges I am making"

I assure you people would think twice about filing.... even if their physician was a jerk.
 
Good, then its settled.

We should all get together an lobby for that stipulation in medical malpractice. Where if someone brings a frivolous lawsuit to the courts, they are responsible for the legal fees.
 
...We should all get together an lobby for that stipulation in medical malpractice. Where if someone brings a frivolous lawsuit to the courts, they are responsible for the legal fees.
Not just that... but, we should strive for a mandatory statement on the record to the plaintiff and attorney to that effect. Further, should ask the plaintiff to basically make a "plea" of understanding on the record.... Judges give "jury instructions" all the time. Judges have defendents... make a clear statements of understanding consequences when serving as their own attorney, etc... They should give ~plaintiff instructions too.

I think a good number of plaintiffs when faced with this would seriously think twice about raising a vindictive claim in the name of "malpractice"....
 
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