medical chart reviews for income during residency

[lawmd]

while in medical school I did some medical chart reviews for a local law firm. I am getting ready to start my residency and would like to continue to do this on a very limited part time basis to make a little extra cash. Basically it consisits of the lawyer contacting me with potential cases, I review them to see if there is any potential negligence. Then reviewing the literature and pointing the lawyer in a direction, names of potential experts, etc... Most of the cases I have done had no merit, but there have been some with gross negligence. I am not serving as an expert witness, will not testify in court. It is basically background work. Have any of you done this while in residency? Did you tell your program director? Any conflicts of interest? your thought would be appreciated... Thanks.

---

Members don't see this ad.

 

[MacGyver]

1) There is NO WAY IN HELL a medical student knows what constitutes "gross negligence"

2) Relationships between lawyers and doctors should be outlawed.

3) You are sleeping with the enemy, and deserve to be tarred and feathered.

 

[lawmd]

discharging someone with history of lumbar disk herniation (for which he had surgery) presenting with numbness in the legs, inability to urinate, no bowel movement for 4 days, worked as a plumber, and the symptoms started after lifting a heavy object. He was told to "buy some Depends" by the ED physician- this would constitute gross negligence. He had cauda equina syndrome and is currently wearing Depends, full time. Would this constellation of symptoms not trigger most 4th year med students that something was wrong. Missing this would classify as gross negligence.

 

[kinetic]

discharging someone with history of lumbar disk herniation (for which he had surgery) presenting with numbness in the legs, inability to urinate, no bowel movement for 4 days, worked as a plumber, and the symptoms started after lifting a heavy object. He was told to "buy some Depends" by the ED physician- this would constitute gross negligence. He had cauda equina syndrome and is currently wearing Depends, full time. Would this constellation of symptoms not trigger most 4th year med students that something was wrong. Missing this would classify as gross negligence.

Hey, sounds like he took the ED physician's advice.






I had to do it, even if I detest ED docs.

 

[edinOH]

Why do you detest ED docs?

 

[lawmd]

MacGyver-would it be sleeping with the enemy if the work were for the defense attorney?

 

[DrQuinn]

lawmd-

I did what you did throughout medical school, and suppose technically "still do" as a resident (although they havent' contacted me in a year and a half, I'm still on their list, so I still put it on my CV). I did 100% defense work, and gave my opinions, looked up articles/publicatoins, responded to depositions, etc. I learned a helluva lot and i'm sure it helped my application for residency. also it has unfortunately made me think about getting a JD sometime in the future (I need some instant gratification first though because of med school/residency).

Q, DO

 

[NaeBlis]

1) There is NO WAY IN HELL a medical student knows what constitutes "gross negligence"

2) Relationships between lawyers and doctors should be outlawed.

3) You are sleeping with the enemy, and deserve to be tarred and feathered.

MacGyver is a bad bad man. 🙂


http://www.bbspot.com/News/2004/06/macgyver.html

 

[Vukken99]

HOw can a medical student know enought to help defense attorneys.

Look at the credential for some expert witness physicians.

it is really foolish in my opinion.

What money buys...even someone's soul...

What a disgraceful situation this is.......

We are accepting more and more stupid people in medicine....sorry but this is how i feel...

 

[calidoc2004]

whats this type o f stuff pay? where do you sign up?

 

[kinetic]

whats this type o f stuff pay? where do you sign up?

The same place you trade in your soul.

 

[Mirror Form]

The same place you trade in your soul.

seriously man, if you fools want to sell your souls to devil go for it, but don't make excuses for yourselves

 

[Gleevec]

So medical students are deciding which cases law firms will pursue in attacking doctors?

And some Benedict Arnolds are helping the prosecutors out.

Traitors, we should send you all to Guantanomo Bay, or the medical equivalent, family practice in rural Montana.

 

[NotChoCheez!]

I actually laughed when I read that. I grew up in a small town in Montana...where my dad was a practicing family physician. 🙂

 

[lawmd]

Selling your soul, give me a break. depends on how you approach it. I have learned an awful lot from doing this. you get to see how the other side works, what types of mistakes are being made and can take that knowledge with you so that you don't make the same mistakes with your patients. Am I doing it to screw physicians, of course not. no one can argue that there aren't physicians who make mistakes, we all will, I will, even those with God-Complexes will... In medical school we are taught that all attorneys are the devil. this isn't true in al cases. Is it fair to say that all physicians are ego maniacs who want to live on the golf course and drive a Benz?-No! you can take that mentailty with you and try to introduce a law that would allow physicians to not treat med-mal lawyers, kind of contradicts the hippocratic oath that we all swore to uphold doesn't it. Am I influencing the legal system? No-I am offering an opinion that will hopefully prevent some frivolous cases from going anywhere. I err on the side of the physician. no attorney wants to take a case that doesn't have merit. they have to invest a significant amount of money into the case before it even goes to trial. By doing this I also have someone who I can call if I ever have any legal questions. Like someone has said before-everyone hates lawyers until they need one. It can't hurt to have one on your side from the beginning.
I simply called around to a few firms, told them what I could offer and then met with them. They regularly hire nurses to do this type of stuff but highly value the opinion of a med student or resident who can give a little more insight. It has been a great learning experience.

 

[tetris]

LawMD, 2 questions for you:

1. Would you give some examples of negligence or errors you found in charts you reviewed?

2. Did you mention this job in your ERAS application or discuss it during interviews? if so, how did the interviewers react?

Thanks.

 

[lawmd]

That is my point exactly. most of these cases do not have any merit at all. out of 20 that I have reviewed, only 2 have gone to the next step. This consists of getting more records and the attorney talking to practicing physicians to get their opinion on standards of care. Then they might try and find an expert in the field. I am doing a small amount of work at the very beginning of the case, that is all. I am not involved, nor do I want to be involved, in these later steps. I do not know, nor care, if they go on. That is the decison of the attorney and the practicing physicians/experts and his client.

The attorney recieves hundreds of requests to take cases. they might take 1-2% of them. he has little to no medical experience. the question to me is "does this have any merit?" an 80 year old lady with terminal cancer having a one day delay in diagnosis of pneumothorax has no merit. an epesiotomy that went bad due to a common surgical problem-infection-has no merit. The attorney might see a bad outcome and get emotionally involved with the patient. I am objective and can bring my limited experience to tell the attorney that this is a common thing that the surgeon had no control over. This might prevent the attorney from taking such a frivolous case. This is the overwhelming majority of cases...

Do some frivolous cases make it to the courtroom? Yes. I have not read much on the subject, but have heard tales of the defense attorney being very slack and not having a good defense, expert witness who change their story, etc... One could argue that this is the fault of the defense attorney.

The case I mentioned earlier-cauda equina-The patient had the classic constellation of symptoms for this condition and the physician documented them in the chart. at no time, even with a repeat visit to the same physician, with worsening of symptoms, did he even entertain the diagnosis of ANY neurological problem-much less cauda equina. This would constitute negligence in diagnosing a condition. If this was you or your father, would you want an attorney to look at or take the case? Or would you turn a blind eye under the assumption that no physician can do anything wrong.

I could care less if he decides to take the case or not. As I said earlier, I err on the side of the physician. The attorneys I have worked with do the same. they do not want to invest $100K into a case that has no potential to win.

In terms of residency. I did not start doing this until late M4. I have discussed this with my PD and he has no problem with it. The only issue has been with residency work hours as this would be considered moonlighting. I would never consider doing a case from anywhere close to where I live, with any physician I would ever come into contact with or who is affilliated with any hospital close to where I live. Most have been from out of state.

Would I paste it all over my CV, probably not, given the current attitude of people regarding this. If you could look at it objectively-for a moment-look at the learning potential. I am learning from the mistakes of others. Isn't that what M&M is for? I basically am getting paid a little to study and read up on different medical conditions that I might not know much about. I have the opportunity to teach the attorney something, and I get to learn a little about the medical maplractice system at the same time. And preventing frivolous suits from going forward. It is an interesting process. I have always despised lawyers myself. The opportunity presented itself and I tried it, on the recommendation from a friend who did it while in school. As with everything you do, you can determine what you want to get out of it. I understand why some of you would consider it to be selling your soul, I really do. But also look at it for the potential to learn. You can learn from your enemies or you can continue to ignore it and wait for your day to come, which it probably will to all of us.

Someone had stated earlier that an M4 couldnt possibly help a defense attorney. Why not. They don;t have any medical experience either. Of course expert witnesses have more to offer. They also charge $500+ an hour and some even charge $10,000+ just to LOOK at the case. If I could find a few articles that would help the physician and maybe the names of an expert witness, or even a similar case that would help the physician, can you tell me that that doesn't help the defense attorney? I have contacted several defense attorneys and would MUCH rather work with them, but have recieved little response.

Of course an M4 or beginning resident has limited experience. That is why noone would ever rely on my opinion to make or break a case. the idea is that I do have a knowledge base that is useful. The attorney's other option is to pay a paralegal for 10 hours of work for what I can do in 1 hour.

 

[docB]

The case I mentioned earlier-cauda equina-The patient had the classic constellation of symptoms for this condition and the physician documented them in the chart. at no time, even with a repeat visit to the same physician, with worsening of symptoms, did he even entertain the diagnosis of ANY neurological problem-much less cauda equina. This would constitute negligence in diagnosing a condition. If this was you or your father, would you want an attorney to look at or take the case? Or would you turn a blind eye under the assumption that no physician can do anything wrong.

I do not believe that no physician can do anything wrong. When it comes to med mal I take the attitude that there but for the grace of God go I. I might not have missed this one and you clearly believe that you wouldn't have but I screw up from time to time and so will you. I hope that when I do I won't have a lawyer on me about it. Med mal is a horrible business. It ends careers, many unjustifiably, and it ruins lives. Until it gets fixed I believe that anyone who works for or testifies for plaintiff attorneys is part of the problem.

 

[Mirror Form]

Med mal is a horrible business. It ends careers, many unjustifiably, and it ruins lives. Until it gets fixed I believe that anyone who works for or testifies for plaintiff attorneys is part of the problem.

I agree with you 100%. Lawmd has given a great argument as to why it's beneficial TO HIM to review charts for lawyers. And it's so easy for lawmd to mention a few cases that are supposed to justify his actions. But as a whole med mal is causing enormous damage to our nations health care. Lawmd is contributing to that, and he's doing it for no other reason but to help himself. Typical behavior for lawyers, it's all about taking care of #1.

 

[devildoc2]

LawMD,

how many law firms did you write to? And how many of them agreed to pay you for it? How much do you get paid, is it a per hour or per claim basis? and how many claims did you review in say a month's time?

 

[DrQuinn]

Like I posted above, I was a paralegal for a med mal defense firm throughout medical school. I actually broke open quite a few cases. The person who had the job before me was the laziest SOB RN who didn't know much about anything. Atleast I knew basically the pathophys and knew where to look (i.e. pubmed/medline, certain texts, etc). One case was about to go to settlement but I found this really great article about meningitis and the case was actually DROPPED because of what I found.

I'm not sure why you think I "sold my soul" for working for a defense firm...
🙄
Q, DO

 

[unregistered]

Have to agree with LawMD on this one. Although some may consider what he does "sleeping with the enemy", to me it seems that as long as he offers a reasonable opinion then he may actually be doing some good. The problem with medical malpractice is not it's existence. Medical malpractice is supposed to serve a purpose: compensate those who have been harmed by medical negligence and encourage physicians to treat patients the way they should. The problem is that the current medical malpractice system does acheives neither of these goals because the majority of malpractice settlements occur in situations with a high emotional component where little negligence actually occured. And the vast majority of of patients seriously harmed due to negligence are never compensated. An interesting quote from an editorial in the New England Journal (Studdert DM, Mello MM, Brennan TA. Medical malpractice. N Engl J Med 2004;350:283-292). The author is speaking about a study in New York that reviewed medical records from over 30,000 hospital discharges and 3500 malpractice claims:
"Only 2 percent of negligent injuries resulted in claims, and only 17 percent of claims appeared to involve a negligent injury. Weiler et al. have suggested the analogy of a traffic cop who regularly gives out more tickets to drivers who go through green lights than to those who run red lights."
The reason for this is that juries consist of lay people and most attorneys have little medical knowledge or training and pursue cases that they are likely to win, regarless of the degree of negligence and whether or not it led to the harm. If people like LawMD can at least offer there opinion to malpractice attornies then maybe at least the more scupulious attornies (if they exist) might be persuaded to pursue malpractice cases more on the facts and whether there was negligence and deviation from the standard of care.

 

[Mirror Form]

Have to agree with LawMD on this one. Although some may consider what he does "sleeping with the enemy", to me it seems that as long as he offers a reasonable opinion then he may actually be doing some good. The problem with medical malpractice is not it's existence. Medical malpractice is supposed to serve a purpose: compensate those who have been harmed by medical negligence and encourage physicians to treat patients the way they should. The problem is that the current medical malpractice system does acheives neither of these goals because the majority of malpractice settlements occur in situations with a high emotional component where little negligence actually occured. And the vast majority of of patients seriously harmed due to negligence are never compensated. An interesting quote from an editorial in the New England Journal (Studdert DM, Mello MM, Brennan TA. Medical malpractice. N Engl J Med 2004;350:283-292). The author is speaking about a study in New York that reviewed medical records from over 30,000 hospital discharges and 3500 malpractice claims:
"Only 2 percent of negligent injuries resulted in claims, and only 17 percent of claims appeared to involve a negligent injury. Weiler et al. have suggested the analogy of a traffic cop who regularly gives out more tickets to drivers who go through green lights than to those who run red lights."
The reason for this is that juries consist of lay people and most attorneys have little medical knowledge or training and pursue cases that they are likely to win, regarless of the degree of negligence and whether or not it led to the harm. If people like LawMD can at least offer there opinion to malpractice attornies then maybe at least the more scupulious attornies (if they exist) might be persuaded to pursue malpractice cases more on the facts and whether there was negligence and deviation from the standard of care.

The example of gross negligence provided by lawmd is a no brainer in terms of ethics. But what lawyers usually pay people to do is to carefully examine charts looking for any little thing that could even insinuate negligence. For example, if something wasn't documented via the usual protocol, or the specimen was put in a different place then usual, of if the doc used 1 ml of 0.5% instead of 2 ml's of 0.25%, etc, etc, etc. All they need is a tiny shred of evidence to bully doctors into settling outside of court for any bad outcome.

 

[doctalaughs]

Supporting the current medmal environment is supporting scum.

Every injured patient should be compensated whether negligence was involved or not. We should have a no-fault system. Injuries are compensated without blaming the doctors... And without lining the pockets of malpractice lawyers who take 50% of all funds that could go to victims...

 

[gmonavydoc]

yea I WANNA GET IN ON SOME OF THIS ACTION. I'M A GP OUT OF RESIDENCY.

 

[lawmd]

QUOTE:If people like LawMD can at least offer there opinion to malpractice attornies then maybe at least the more scupulious attornies (if they exist) might be persuaded to pursue malpractice cases more on the facts and whether there was negligence and deviation from the standard of care.[/QUOTE]

Thank you. this exactly what I am saying. One case that I mentioned, the epesiotomy, was with an attorney who was all upset becasue this young girl ended up with a nasty, festering 4th degree perineal wound that required revisions and had a protracted course. The physician who delivered her child was prompt to return her calls and see her in the office. she delayed her visit and waited to return to him. by the time she did, it was a bad scene. the attorney wanted to go gangbusters on this doctor. I told him that it was not the doc's fault. One-infections happen. Two-the patient did not go to the doctor when things started to turn for the worst. Third the physician called her and asked her to come in. He did things correctly. I pointed this out to the attorney and he did not pursue the case. If he wanted to, that is fine with me. He could invest $15k into it and lose his ass. So, who did I help-the doctor, hands down. If he had pursued the case, it would have cost the lawyer, the patient, and the physician a considerable amount of money, time, and HIS REPUTATION most importantly.

Quoted from Sledge-
For example, if something wasn't documented via the usual protocol, or the specimen was put in a different place then usual, of if the doc used 1 ml of 0.5% instead of 2 ml's of 0.25%, etc, etc, etc. All they need is a tiny shred of evidence to bully doctors into settling outside of court for any bad outcome.

That is ridiculous. I thought that as well before I started doing this. They want gross negligence. If you think that an attorney would take a case based on this very weak example, you are wrong. An intelligent attorney wants the missed C-cpine that resulted in quadriplegia, the missed tension PTX that killed the patient, the missed PE becasue no lower extremity US was ordered, not because of 2cc's of 0.25% lidocaine were used... If there is an attorney who decides to pursue this, he will lose alot of money and the defense attorney will have a field day on him.

Another quote from Sledge-
But what lawyers usually pay people to do is to carefully examine charts looking for any little thing that could even insinuate negligence.

What they pay me to do is look for GROSS NEGLIGENCE. No attorney has come to me while wringing his hands and said "hey there, find something so I can hang this doctor. I want to steal all his money." Understand that they do not want to invest money into something that has no merit. Try it for yourself-ask any attorney this question. If I were asked to do this, I simply would not work for this attorney. I do not agree with that and would not play a role in such behavior. If the attorneys had more intelligent people to do this type of work, maybe less of these cases would go forward. Instead they rely on paralegals who might have the same mindset.

I agree-the medmal system sucks. It scares the hell out of me also. By doing this, I am learning about it, so that when I get the call, I will be better prepared. Like Quinn said-I am preventing some of these BS claims from going forward, so I feel as though I am helping the system some. I am not attempting to be an expert witness whose opinion can be bought for $10K I remain objective, all the attorneys I work with insist on it actually. THEY DO NOT WANT A CASE WITH NO MERIT, bottom line.

The most important thing I have learned, from the cases that do go forward and from the attorneys is to communicate and document on the chart. Yeah, they teach us that in school, but when you have the opportunity to see the cases where those two crucial elements aren't in place, you see why it is important. It sticks with you a little more. I will take these lessons with me and it will do three things. 1-lower my chances of getting named in a suit, 2-allow me to take better care of patients, and 3-be a better physician. Three things that are of the utmost importance to me.

Thank you all for replying.

 

[juddson]

Selling your soul, give me a break. depends on how you approach it. I have learned an awful lot from doing this. you get to see how the other side works, what types of mistakes are being made and can take that knowledge with you so that you don't make the same mistakes with your patients. Am I doing it to screw physicians, of course not. no one can argue that there aren't physicians who make mistakes, we all will, I will, even those with God-Complexes will... In medical school we are taught that all attorneys are the devil. this isn't true in al cases. Is it fair to say that all physicians are ego maniacs who want to live on the golf course and drive a Benz?-No! you can take that mentailty with you and try to introduce a law that would allow physicians to not treat med-mal lawyers, kind of contradicts the hippocratic oath that we all swore to uphold doesn't it. Am I influencing the legal system? No-I am offering an opinion that will hopefully prevent some frivolous cases from going anywhere. I err on the side of the physician. no attorney wants to take a case that doesn't have merit. they have to invest a significant amount of money into the case before it even goes to trial. By doing this I also have someone who I can call if I ever have any legal questions. Like someone has said before-everyone hates lawyers until they need one. It can't hurt to have one on your side from the beginning.
I simply called around to a few firms, told them what I could offer and then met with them. They regularly hire nurses to do this type of stuff but highly value the opinion of a med student or resident who can give a little more insight. It has been a great learning experience.

You are wasting your breath. No amount of reasoned argument is going to turn this group.

Judd

 

[juddson]

I agree with you 100%. Lawmd has given a great argument as to why it's beneficial TO HIM to review charts for lawyers. And it's so easy for lawmd to mention a few cases that are supposed to justify his actions. But as a whole med mal is causing enormous damage to our nations health care. Lawmd is contributing to that, and he's doing it for no other reason but to help himself. Typical behavior for lawyers, it's all about taking care of #1.

Are you even reading what I am reading. LawMD said that one of the reasons he does this is to play some part in preventing frivilous lawsuits from going to court. Moreover - though he does not mention it - to the extent that he does this sort of work for plaintiff's attorneys, he may be playing some part of securing compensation for a patient who has been injured wrongfully.

As yet there is had been NO nuance in this thread (I'm not all the way through it yet, though). Not once have those who dislike the med mal tort system suggested that in same cases injuries are caused by the negligence of physicians, and that in those cases compensation is rightfully due. Rather, this unthinking hatred of all things attorneys touch causes the lot of you to throw out the baby with the bathwater. To hell with patients who have been genuinely wrongfully injured - if you help that patient (or god forbid, her attorney) to secure compensation, you are doing the work of the devil and will inheret hell. This is an unthinking position because it either (1) ignores (or refuses to admit) the existence of meritorious lawsuits, or (2) admits they exist but doesn't give a damned about them anyway. Both are execrable positions.

Judd

 

[Febrifuge]

Maybe it won't quiet the squalling, but those of us who I like to hope are in the majority think this is interesting and now we know more about it. I spent a summer interning for the local Public Defender's office, back in the day. I was looking at investigation and court documents for evidence of police and prosecution misbehavior. I never thought there could be something along those lines in the medico-legal world. When I get smarter, I'm going to look into this area.

It's amazing the stuff students can learn if they have a smidge of knowledge and the time to go digging in the details a little.

 

[juddson]

The example of gross negligence provided by lawmd is a no brainer in terms of ethics. But what lawyers usually pay people to do is to carefully examine charts looking for any little thing that could even insinuate negligence. For example, if something wasn't documented via the usual protocol, or the specimen was put in a different place then usual, of if the doc used 1 ml of 0.5% instead of 2 ml's of 0.25%, etc, etc, etc. All they need is a tiny shred of evidence to bully doctors into settling outside of court for any bad outcome.

On what basis do you make this claim? LawMD has not suggested that he has been asked to "examine charts looking for any little thing that could even insinuate negligence".

I suspect this is just an impression you have - no doubt because it falls in nicely with the paradigm you have set out for plaintiff's attorneys.

Judd

 

[docB]

This is an unthinking position because it either (1) ignores (or refuses to admit) the existence of meritorious lawsuits, or (2) admits they exist but doesn't give a damned about them anyway. Both are execrable positions.

I agree with #2. The med mal system is so flawed, out of control and frightening that I would like to "throw the baby out with the bath water." IF the system were changed to seek out true negligence rather than bad outcomes I would be more sympathetic toward plaintiffs. As the system is now everyone on the plaintiff's side is part of the problem. This is not an "execrable position." It's the position of someone who spends every minute of every day at work with a gun to the back of his head. It's the position of someone who lies awake in bed at night thinking he should have documented better on that one pt so the chart would be more defensible. It's the position of someone whose career could end and his home be taken away and his family ruined because a lawyer got a jury to feel sympathy for a plaintiff.

 

[Mirror Form]

Thank you. this exactly what I am saying. One case that I mentioned, the epesiotomy, was with an attorney who was all upset becasue this young girl ended up with a nasty, festering 4th degree perineal wound that required revisions and had a protracted course. The physician who delivered her child was prompt to return her calls and see her in the office. she delayed her visit and waited to return to him. by the time she did, it was a bad scene. the attorney wanted to go gangbusters on this doctor. I told him that it was not the doc's fault. One-infections happen. Two-the patient did not go to the doctor when things started to turn for the worst. Third the physician called her and asked her to come in. He did things correctly. I pointed this out to the attorney and he did not pursue the case. If he wanted to, that is fine with me. He could invest $15k into it and lose his ass. So, who did I help-the doctor, hands down. If he had pursued the case, it would have cost the lawyer, the patient, and the physician a considerable amount of money, time, and HIS REPUTATION most importantly.

Quoted from Sledge-
For example, if something wasn't documented via the usual protocol, or the specimen was put in a different place then usual, of if the doc used 1 ml of 0.5% instead of 2 ml's of 0.25%, etc, etc, etc. All they need is a tiny shred of evidence to bully doctors into settling outside of court for any bad outcome.

That is ridiculous. I thought that as well before I started doing this. They want gross negligence. If you think that an attorney would take a case based on this very weak example, you are wrong. An intelligent attorney wants the missed C-cpine that resulted in quadriplegia, the missed tension PTX that killed the patient, the missed PE becasue no lower extremity US was ordered, not because of 2cc's of 0.25% lidocaine were used... If there is an attorney who decides to pursue this, he will lose alot of money and the defense attorney will have a field day on him.

Another quote from Sledge-
But what lawyers usually pay people to do is to carefully examine charts looking for any little thing that could even insinuate negligence.

What they pay me to do is look for GROSS NEGLIGENCE. No attorney has come to me while wringing his hands and said "hey there, find something so I can hang this doctor. I want to steal all his money." Understand that they do not want to invest money into something that has no merit. Try it for yourself-ask any attorney this question. If I were asked to do this, I simply would not work for this attorney. I do not agree with that and would not play a role in such behavior. If the attorneys had more intelligent people to do this type of work, maybe less of these cases would go forward. Instead they rely on paralegals who might have the same mindset.

I agree-the medmal system sucks. It scares the hell out of me also. By doing this, I am learning about it, so that when I get the call, I will be better prepared. Like Quinn said-I am preventing some of these BS claims from going forward, so I feel as though I am helping the system some. I am not attempting to be an expert witness whose opinion can be bought for $10K I remain objective, all the attorneys I work with insist on it actually. THEY DO NOT WANT A CASE WITH NO MERIT, bottom line.

The most important thing I have learned, from the cases that do go forward and from the attorneys is to communicate and document on the chart. Yeah, they teach us that in school, but when you have the opportunity to see the cases where those two crucial elements aren't in place, you see why it is important. It sticks with you a little more. I will take these lessons with me and it will do three things. 1-lower my chances of getting named in a suit, 2-allow me to take better care of patients, and 3-be a better physician. Three things that are of the utmost importance to me.

Thank you all for replying.

Once again, you describe the world that you work in as if it was some utopia where everybody does the right thing. I'm sorry, but if med mal lawyers practiced the way you're describing, we wouldn't be having a huge crisis in health care right now. Something definitely isn't adding up.

Lets get one things straight, the ONLY reason lawyers want to find gross negligence in their charts is b/c it's one factor that will increase the chances of them making money. All this ethics crap has NOTHING to do with their decision making process. Likewise, if you have a cute girl w/ a bad outcome, they'll pour over those charts looking for every little tiny detail because they know that if that patient goes in front of a jury they'll likely get some nice cash. Gross negligence is simply one of many factors lawyers use to determine what is the best money making oppurtunity. There are other factors though, and they'll screw anybody they have to, ruin anybody's career for no reason, screw the nations health care system, all to make themselves richer. Their reputation as scum bags has been earned over and over again. But go ahead and justify your work in any way you can to help yourself sleep better at night.

 

[Mirror Form]

I suspect this is just an impression you have - no doubt because it falls in nicely with the paradigm you have set out for plaintiff's attorneys.

Judd

Not an impression, an observation.

 

[Mirror Form]

This is an unthinking position because it either (1) ignores (or refuses to admit) the existence of meritorious lawsuits, or (2) admits they exist but doesn't give a damned about them anyway. Both are execrable positions.

Judd

As a doctor I'm concerned about doing the most good for people. It's good that some bad doctors have been forced to retire and some patients got compensated. But I don't think that a handful of lawyers and unfortunate patients getting filthy rich off of malpractice is even on the same level as the closing of many trauma centers, ER's, etc. The damage being done to health care by med mal is far greater then the good. Therefore, until the system is reformed, I'll do all I can to bring attention to the matter and fight against med mal. As opposed to certain other people, who see it as an oppurtunity to make a buck.

 

[juddson]

I agree with #2. The med mal system is so flawed, out of control and frightening that I would like to "throw the baby out with the bath water." IF the system were changed to seek out true negligence rather than bad outcomes I would be more sympathetic toward plaintiffs. As the system is now everyone on the plaintiff's side is part of the problem. This is not an "execrable position." It's the position of someone who spends every minute of every day at work with a gun to the back of his head. It's the position of someone who lies awake in bed at night thinking he should have documented better on that one pt so the chart would be more defensible. It's the position of someone whose career could end and his home be taken away and his family ruined because a lawyer got a jury to feel sympathy for a plaintiff.

You seem to be suffering from some sort of persecutory anxiety, paricularly if it interferes with your work.

Judd

 

[juddson]

Lets get one things straight, the ONLY reason lawyers want to find gross negligence in their charts is b/c it's one factor that will increase the chances of them making money. .

Lets get one thing straight, the ONLY reason oncologists want to find matastic desease in their patients is b/c it's one factor that will increase the chances of them making money. Without cancer, there is no need for oncologists.

It's stupid statements like this that make it difficult to take your seriously.

Judd

 

[Mirror Form]

You seem to be suffering from some sort of persecutory anxiety, paricularly if it interferes with your work.

Judd

You're such a hypocrit! You're making this big deal about it's unethical for doctor's to take a stand against med mal lawyers b/c of your reasons #1 and #2. But the same arguments could be turned around. Why isn't it an unthinkable position to be a med mal lawyer b/c if you are then (1) you refuse to admit that even if you occasionally do good, as a whole you're contributing to a system that is causing much more harm then good or (2) you know that as a whole you're doing more harm then good, but just don't care b/c you're getting rich.

 

[Mirror Form]

Lets get one thing straight, the ONLY reason oncologists want to find matastic desease in their patients is b/c it's one factor that will increase the chances of them making money. Without cancer, there is no need for oncologists.

It's stupid statements like this that make it difficult to take your seriously.

Judd

Are you on crack? Many oncologists are researching ways to cure cancer. If it looses them business in the long run, they'll be happy they helped people and move on to a different area of medicine. This is in stark contrast to med mal lawyers who contribute money to politicians to keep the system as broken as it is.

 

[MoosePilot]

Lets get one thing straight, the ONLY reason oncologists want to find matastic desease in their patients is b/c it's one factor that will increase the chances of them making money. Without cancer, there is no need for oncologists.

It's stupid statements like this that make it difficult to take your seriously.

Judd

Is there really a comparison?

An oncologist finds cancer and then tries to cure it, saving a life.

A lawyer tries to find evidence of malpractice. If he finds it he brings suit. If he wins, then he takes half the person's settlement and they still deal with whatever outcome. It's not like he can find evidence of malpractice in the records, root it out and reverse it.

 

[juddson]

Is there really a comparison?

An oncologist finds cancer and then tries to cure it, saving a life.

A lawyer tries to find evidence of malpractice. If he finds it he brings suit. If he wins, then he takes half the person's settlement and they still deal with whatever outcome. It's not like he can find evidence of malpractice in the records, root it out and reverse it.

It's a stupid statement because it ignores wholesale the notion that an attorney does something legitimate and good when he secures compensation for a patient who has been injured wrongfully. He also makes money when he does this (and does not make a dime when he fails). An oncologist also does something worthwhile and important when she takes on a patient. But she is also paid. Just like an attorney. Oncologists don't work for free.

The comparison is valid because both practitioners would not do what they do without the promise of financial gain. There are no if, ands or buts about this basic principle.

By way of contrast, an oncologist who fails to save the life of his patient is still entitled to her fee.

Judd

 

[juddson]

You're such a hypocrit! You're making this big deal about it's unethical for doctor's to take a stand against med mal lawyers b/c of your reasons #1 and #2. But the same arguments could be turned around. Why isn't it an unthinkable position to be a med mal lawyer b/c if you are then (1) you refuse to admit that even if you occasionally do good, as a whole you're contributing to a system that is causing much more harm then good or (2) you know that as a whole you're doing more harm then good, but just don't care b/c you're getting rich.

No. It is unethical for the doctors to take an unprincipled stand against the medical malpractice system. One of these unprincipled stands would include advocating an awards capping system that does not differentiate between those who have been slightly injured and those that have been seriously injured.

I 100% reject the notion that the legal tort system does more harm than good on balance. It is an imperfect system, many parts of which need principled reform, but the biggest crises in medical care are due to the vast numbers of uninsured and under-insured, the refusal of doctors to work in lower-income areas and the 30% waste in the system due to medical insurance company largesse. The typical doctor still makes 600% of the average wage in the US, even with high malpractice rates.

I am on record here advocating reforms to the liability system - reforms designed to correct the root problem with the med mal system, which is that lay juries determine negligence of professionals.

Mine is not an unthinking position.

Judd

 

[MoosePilot]

It's a stupid statement because it ignores wholesale the notion that an attorney does something legitimate and good when he secures compensation for a patient who has been injured wrongfully. He also makes money when he does this (and does not make a dime when he fails). An oncologist also does something worthwhile and important when she takes on a patient. But she is also paid. Just like an attorney. Oncologists don't work for free.

The comparison is valid because both practitioners would not do what they do without the promise of financial gain. There are no if, ands or buts about this basic principle.

By way of contrast, an oncologist who fails to save the life of his patient is still entitled to her fee.

Judd

And a lawyer that gets an unjustified settlement also gets a huge fee. You presuppose that every case that's won is won on its merits.

The fact is the doctor saves lives. The lawyer doesn't change anything, he just moves money around to compensate for something which already happened.

 

[Sessamoid]

You presuppose that every case that's won is won on its merits.

I'm pretty sure Juddson has never said that, nor does he believe that.

The fact is the doctor saves lives. The lawyer doesn't change anything, he just moves money around to compensate for something which already happened.

That may be true that malpractice lawyers only move money around, but it's a vital role which needs to be done. The problem is that it's sometimes done very badly.

 

[doctalaughs]

I 100% reject the notion that the legal tort system does more harm than good on balance. It is an imperfect system, many parts of which need principled reform, but the biggest crises in medical care are due to the vast numbers of uninsured and under-insured, the refusal of doctors to work in lower-income areas and the 30% waste in the system due to medical insurance company largesse. The typical doctor still makes 600% of the average wage in the US, even with high malpractice rates.

Judd

It is more than an imperfect system -- it is a broken system which does more harm than good. You really think that the majority of cases involve gross negligence? I don't consider making a sincere mistake (even one a 4th year med student could pick up after doing research) constitutes gross negligence. Consider a radiologist who reads hundreds of studies a day. Is he bound to miss a spot over his career that could lead to cancer, no matter how careful he is? Of course! Could another doctor look at that film and see the spot and say "how could he miss that?" Of course. That is the kind of case that medmal lawyers love, and sue for, and make millions. Real negligence is when a surgeon opens up a patient then leaves him on the table for an hour to go cash a paycheck at the local bank (happend). Not a bad diagnosis call or missing the symptoms once.

The thing that is so f*cked up about this system is the horrible percentage of patients that really do get compensated. 1-2% of injured patients get their day in court and only 5% of those see any money. The rest of the money goes in the lawyer's pocket, or is spent on defense, or in million dollar verdicts for the few who win. Why can't we look at no-fault systems and leave the court for real negligence. I guarantee if patients had a way to get a reasonable compensation package without blaming the doctors they would leave medmal lawyers in droves.

 

[Mirror Form]

It is an imperfect system, many parts of which need principled reform, but the biggest crises in medical care are due to the vast numbers of uninsured and under-insured, the refusal of doctors to work in lower-income areas

I agree these are big issues, but they don't take away from med mal also being a big issue, which you seem to be implying. Furthermore, although you do admit that the med mal system needs reforming, you have no comment on the fact that lawyers are preventing med mal from being reformed. Why so quiet on the issue? And you might be interested to know that part of the reason a lot of doctors don't want to work in low income areas is b/c those patients are statistically more likely to sue. But once again, lawyers would never admit any fault on their part. It's all just the greedy doctors.

 

[Sessamoid]

And you might be interested to know that part of the reason a lot of doctors don't want to work in low income areas is b/c those patients are statistically more likely to sue.

A common misconception. One study several years ago found that middle income patients were those most likely to sue. Doctors don't like working in low income areas because they don't get paid much (or at all sometimes) to work there. Nobody likes to be forced to work for free.

 

[Mirror Form]

A common misconception. One study several years ago found that middle income patients were those most likely to sue. Doctors don't like working in low income areas because they don't get paid much (or at all sometimes) to work there. Nobody likes to be forced to work for free.

Yes, but if you're a doctor you're not just working for free. You're also assuming a huge liability at the same time. Theres a big difference b/w working for free w/o risk, and working for free while jeopardizing your career.

 

[Sessamoid]

Yes, but if you're a doctor you're not just working for free. You're also assuming a huge liability at the same time. Theres a big difference b/w working for free w/o risk, and working for free while jeopardizing your career.

Yah, I've been doing this for some years now, so I'm pretty familiar with the concept. But this relates to the current discussion how?

 

[Mirror Form]

Yah, I've been doing this for some years now, so I'm pretty familiar with the concept. But this relates to the current discussion how?

How? Juddons brought up the issue that one of major problems with medicine is b/c doctors don't want to work in low income areas. He did this as a way to take the focus off of med mal as in issue. My point was that lawyers and med mal are also partially responsible for the difficulty of recruiting doctors to work in low income areas.

 

[MacGyver]

Lawyers remind me of big pharma drug companies. just like the drug companies, they argue that if you cap their rates, they wont be able to fight for the consumer.

Of course its a bull**** red herring, and its about damn time somebody called them out on it.