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Medicine Can Be A Taunting, Vicious Profession At Times
By Birdstrike MD
Not too long ago, I was busy at work seeing patients. The secretary yelled, “Dr. Birdstrike, there’s a phone call for you.”
“Alright,” I said. “Transfer it over.” I answered the phone.
“Hello, Dr. Birdstrike, this is ***** ****** from the ****** State Medical Board,” said a jabbing, deep military sounding voice.
“Uh…hello,” I said. I felt a jolt of electricity in my chest. This wasn’t a phone call I expected nor wanted. The state —-ing medical board? What, the…?
“I’m calling to notify you, we’ve received a formal complaint about your medical practice and I’ve been assigned as the lead investigator.”
At this point, the adrenaline was pumping through my veins, and my heart beating fast enough, that I didn’t hear much of what he said after that. He might as well have told me I had brain cancer and had 6 agonizing weeks to live. Although I have been sued before, though never convicted by a jury, of medical malpractice, I’d come to realize that whole process was more about one group of lawyers fighting with another group of lawyers, to get money from an insurance company, with a doctor and a patient as mere pawns in the game. It’s a game that can feel very personal, but ultimately isn’t, and is mostly about the trophy hoped for by the plaintiff’s attorneys: Award money. But a complaint from the medical board? It’s honestly something I never thought I’d have to face, having been someone that’s always performed at a very high level during my career, at all of it’s stages, not every having faced any significant concerns regarding my performance. Also, in my personal life, I am, for lack of a better word, a rule follower.
After, the initial shock dissipated, his words gradually faded back into the ear of my consciousness. He gave me the name of the patient and the stated complaint. I remembered the patient, but I didn’t remember any particularly bad outcome, or any negative interaction or administrative complaint at the time. The accusation appeared out of place and baseless. He explained the process: I was responsible for providing a written response to the medical board within 15 days. After that, there would be an investigation. After an undetermined period of time, the complaint would either be dismissed outright, dismissed with a non-disciplinary letter of warning which would go in my medical-license file, or if neither of those, then I’d have to go before the medical board for a hearing. A licensing hearing? The entire thought of any of this was horrifying. News headlines of doctors who had lost their licenses for egregious and horrible misconduct flashed like shocking, intrusive, strobe-light banner-notifications across the home-screen of my brain.
I did nothing wrong. Why is this happening to me? This is insane? What the —-? Am I going to lose my license? No way, I’m going to lose my license. I did nothing wrong. Nothing even happened. Wait, what happened? Did anything happen? No, nothing did. But what if I get some rogue medical board or the case is reviewed by someone with an axe to grind or from a totally different specialty? Miscarriages of justice happen all the time. Don’t they? Questions bounced around my brain like a silver pinball.
I slowed my breathing down. I logged into the medical record scanning through charts and reports like a DVR player on fast forward. Wait….They have no case.
THEY. HAVE. NO. CASE.
I started to get angry, very angry. Just like my lawsuit, where I was falsely accused of malpractice, never committed malpractice and was ultimately dropped from the case, because I didn’t commit malpractice. There was also nothing wrong here. I took a deep breath, slowed my breathing down, and dug further into the chart.
It was a patient I’d seen on more than 1 occasion over several weeks. I had ordered an X-ray. On the same day the patient had my X-ray done, the results of which were largely unremarkable, the patient had another imaging study done, that had been ordered by another doctor, of a different specialty. It was an imaging study I knew immediately was not ordered by me, and could not have been ordered by me, because it’s an imaging study I don’t even order. But wait a minute….WAIT A MINUTE.
I looked closer at the report. “Ordering physician: Dr Birdstrike.”
What?! I don’t order this type of test. Literally, ever. I scanned through the order section of the EMR just to make 100%, double-triple-infinitely sure I didn’t order it, and there was none.
I went back to see my waiting patients, doing my best to block this out of my brain for at least the next 3 hours so I could finish my shift. That was an impossible task. When I did finish my shift, I stayed about two hours lately, obsessively coming through page after page of my notes, nurses notes, vital signs, imaging reports, other physicians' consults and other physicians’ orders, printing page after page, making notes.
THERE IT IS!
The order. Dr. ******* ordered it. I went back to my chart. I had even noted the results of the study at the time. The patient knew the specialist had ordered it, and had a follow up plan in place to see the specialist. That’s it! That’s it! That’s it! This is open and shut! The patient was seeing the specialist Dr. *******, who ordered this imaging study around the same time I did. I had seen her for another issue. Although the study he had ordered was abnormal, the patient had no outward signs of complications from it’s findings at the time, no acute emergency medical condition nor any on the day I saw her at all. I documented that, and that she had the appropriate specialist to follow up with, and proceeded to treat her for what she was seeing me on that given day.
Further review of records indicated she had even seen the specialist in question again, after I had seen her. He noted that he had assessed the problem in question, and I never saw her again. What happened to her after that, to this day, I don’t know. Was she alive and well, and just upset that “something was missed”? Was anything even missed? Had she decompensated, gotten sick or had a bad outcome at some point later? ( I sure hope not.) To this day, I still don’t know.
None of the available records answered any of those questions. But what the medical record made clear was, that she had a test ordered by another physician, that showed an abnormality within his scope of practice, and outside the scope of my practice, and I was falsely labeled as the ordering physician. This presumably may have happened because of an X-ray I had ordered at the same facility, on the same day. The patient presumably had my x-ray first, and then had my name put on the second study, by accident from someone in the radiology department who assumed I ordered both tests.
I spent an entire weekend, approximately 24 hours over 3 days looking through charts, compiling records and writing my response. I was a bundle of tension, and barely saw my family that weekend, at all. But after finishing my response, I was confident, I would have and could have, done nothing different. This should be easy to clear up, I thought to myself.
I sent my response, with all 120 pages of medical records to the medical board. (It’s amazing how electronic medical records can create volumes of records from only a few simple patient encounters.) A few days later, I called to confirm that the investigator got them. I asked how soon I’d hear something. He said it would be a “few weeks.” Deep breath…..exhale….
A few weeks went by. A few more weeks went by. Summer became Fall. Fall crept into Winter.
What on Earth could be taking them so long?
During the entire process, 7 months and counting at this point, I felt a dark libelous cloud hanging over head, even when I worked, played with my kids, or laid down to go to sleep at night. I imagined every possible wrong-headed, misguided and misinformed decision a medical board could ever hand down. I wondered if that the fact that it was taking so long, was a bad sign. Was the hammer soon to fall? Could I soon be fighting to save my career due to some confusion and unjust decision?
Of course not, I told myself. There’s literally nothing here. Nothing they could take or even suspend your license for. There’s nothing to even give you a warning about, or even make you take remediation classes for. Your name got placed falsely on someone else’s imaging study, that they were responsible for following up on, and may or may not have. Clearly there’s nothing to worry about, at all, on my end. Right?
As I waited to hear from the state medical board about their decision, the thing that hit me the hardest was how much different a board complaint or action, is from a lawsuit. During medical school, residency and practice, every talks about potential lawsuits, and the need to practice defensive medicine. The threat is omnipresent, and constantly talked about, openly so. But rarely does anyone speak about, or even mention the threat of complaints or actions handled by the medical board. Is it because they’re more rare? Simply more taboo? I’m not sure.
What finally hit home, that I hadn’t spent much if any timing pondering before, is that a medical board issue has the potential to be far, far worse than a lawsuit. In a lawsuit, they truly just want your money. The lawyers don’t want to take your medical license away. They can’t and won’t even try. Although the attorneys will try to convince a jury you’re Satan incarnate, so as to increase their chances of winning the suit, once it’s over they’re happy to walk away and let you keep practicing medicine, in their community. The medical malpractice lawyers are happy to sue as many doctors as possible, but certainly don’t want to stop all the doctors from practicing medicine. If they did, there’d be no one left to sue!
But what really hit home, is that with a medical board complaint, they don’t want your money at all. The person filing the complaint wants to take your license away. They don’t want you to be able to be a doctor anymore. They want to place in motion a process that can truly ruin your life. You can lose your job, not be able to make your house payment. And pretty much everything you’ve worked for your whole life, potentially, is destroyed if the complainant gets their way. At a minimum, the medical board at least has the power to make all that happen, if they want to. A state medical board is much more dangerous than your ten most aggressive medical malpractice attorney’s put together and has far greater power, over you and I, if they choose to wield it. Medicine can be a vicious, taunting, profession at times. They don't tell you this when you're a medical student.
So, after 3 seasons, 5 holiday’s, one kid’s birthday, a spouse’s birthday, and seven months over which the cloud of this whole process hung, I couldn’t take it any more. The silence was killing me. As much as I tried to put the whole affair out of my mind, reminding myself of the strength of my defense and complete lack of actionable mistake or misconduct, I must admit the prospect of the whole process weighed on my mood like heavy, hanging, dark-grey clouds. Part of me hoped it would go away, and that I’d never hear a word about it again. The other part of me was tortured by that idea, wanting a quick resolution, regardless of the outcome. I picked up the phone and called the investigator.
There was no answer.
I left a message. A few hours went by, and there was no return call. Maybe I had the wrong number? Hmm…I don’t know. I’ll give it until tomorrow.
Tomorrow came. Still no return call. Oh, forget it! I wish I’d never called. Just leave me alone. So what if it takes another 7 months?
At that moment, I heard the familiar sound of a piano playing in the background. It was my phone’s ring tone. I ran around the corner and answered. Deep breath.
“Hello?”
It was the deep voice, “I’ve been meaning to call you back. The medical board voted 3 weeks ago…”
Three weeks ago, and you’re just calling me now? What the heck?! Don’t you know that not knowing is what make this torture?
Deep-voice continued, “…and the medical board voted to dismiss the complaint against you.”
Dismiss. DISMISS. And with that, I felt the air start to leak out of the tension that had built inside of me, that was starting to become so permanent, that I almost had forgotten it was there. I was starting to feel lighter already.
“Okay, wow. I guess that’s it then. Is there anything else I need to do?” I asked.
“No,” said the deep voice. “I’ll be sending out a formal letter soon.”
“Okay, thank you,” I said. Although, I wasn’t sure exactly who I was thanking, exactly why or what for. I was wishing so badly, right then and there, that I would have loved to have been a fly on the wall while the board met and discussed this meritless complaint that weighed on me unnecessarily for the better part of a year. It was also unfortunate that the medical board had to spend seven months investigating the wrong person, due to the mislabeling of an imaging study, when they likely had more pressing issues to deal with. “On more thing,” I asked. “Do I have the right to find out who filed the complaint?”
“Yes you do. By state law, you have that right, but you must request that information in writing,” he said, and he gave me his address.
“Thanks for that information, Sir,” I said. “You’ll be hearing from me again, soon. Very soon.”
TO BE CONTINUED
[/I]
Update: I found out today, it was the patient who filed the complaint. I'm actually very okay with this. If it had been another physician, particularly the one who ordered the test in question that I was blamed for (and who was ultimately responsible), it would be an entirely different story. But for a patient to blame the physician whose name is on a diagnostic test, presumingly not knowing the ordering physician was mislabeled, is understandable, particularly after seeing several physicians in a short period of time. I'm now at peace with this, and feel I'm very much able to move on.
By Birdstrike MD
Not too long ago, I was busy at work seeing patients. The secretary yelled, “Dr. Birdstrike, there’s a phone call for you.”
“Alright,” I said. “Transfer it over.” I answered the phone.
“Hello, Dr. Birdstrike, this is ***** ****** from the ****** State Medical Board,” said a jabbing, deep military sounding voice.
“Uh…hello,” I said. I felt a jolt of electricity in my chest. This wasn’t a phone call I expected nor wanted. The state —-ing medical board? What, the…?
“I’m calling to notify you, we’ve received a formal complaint about your medical practice and I’ve been assigned as the lead investigator.”
At this point, the adrenaline was pumping through my veins, and my heart beating fast enough, that I didn’t hear much of what he said after that. He might as well have told me I had brain cancer and had 6 agonizing weeks to live. Although I have been sued before, though never convicted by a jury, of medical malpractice, I’d come to realize that whole process was more about one group of lawyers fighting with another group of lawyers, to get money from an insurance company, with a doctor and a patient as mere pawns in the game. It’s a game that can feel very personal, but ultimately isn’t, and is mostly about the trophy hoped for by the plaintiff’s attorneys: Award money. But a complaint from the medical board? It’s honestly something I never thought I’d have to face, having been someone that’s always performed at a very high level during my career, at all of it’s stages, not every having faced any significant concerns regarding my performance. Also, in my personal life, I am, for lack of a better word, a rule follower.
After, the initial shock dissipated, his words gradually faded back into the ear of my consciousness. He gave me the name of the patient and the stated complaint. I remembered the patient, but I didn’t remember any particularly bad outcome, or any negative interaction or administrative complaint at the time. The accusation appeared out of place and baseless. He explained the process: I was responsible for providing a written response to the medical board within 15 days. After that, there would be an investigation. After an undetermined period of time, the complaint would either be dismissed outright, dismissed with a non-disciplinary letter of warning which would go in my medical-license file, or if neither of those, then I’d have to go before the medical board for a hearing. A licensing hearing? The entire thought of any of this was horrifying. News headlines of doctors who had lost their licenses for egregious and horrible misconduct flashed like shocking, intrusive, strobe-light banner-notifications across the home-screen of my brain.
I did nothing wrong. Why is this happening to me? This is insane? What the —-? Am I going to lose my license? No way, I’m going to lose my license. I did nothing wrong. Nothing even happened. Wait, what happened? Did anything happen? No, nothing did. But what if I get some rogue medical board or the case is reviewed by someone with an axe to grind or from a totally different specialty? Miscarriages of justice happen all the time. Don’t they? Questions bounced around my brain like a silver pinball.
I slowed my breathing down. I logged into the medical record scanning through charts and reports like a DVR player on fast forward. Wait….They have no case.
THEY. HAVE. NO. CASE.
I started to get angry, very angry. Just like my lawsuit, where I was falsely accused of malpractice, never committed malpractice and was ultimately dropped from the case, because I didn’t commit malpractice. There was also nothing wrong here. I took a deep breath, slowed my breathing down, and dug further into the chart.
It was a patient I’d seen on more than 1 occasion over several weeks. I had ordered an X-ray. On the same day the patient had my X-ray done, the results of which were largely unremarkable, the patient had another imaging study done, that had been ordered by another doctor, of a different specialty. It was an imaging study I knew immediately was not ordered by me, and could not have been ordered by me, because it’s an imaging study I don’t even order. But wait a minute….WAIT A MINUTE.
I looked closer at the report. “Ordering physician: Dr Birdstrike.”
What?! I don’t order this type of test. Literally, ever. I scanned through the order section of the EMR just to make 100%, double-triple-infinitely sure I didn’t order it, and there was none.
I went back to see my waiting patients, doing my best to block this out of my brain for at least the next 3 hours so I could finish my shift. That was an impossible task. When I did finish my shift, I stayed about two hours lately, obsessively coming through page after page of my notes, nurses notes, vital signs, imaging reports, other physicians' consults and other physicians’ orders, printing page after page, making notes.
THERE IT IS!
The order. Dr. ******* ordered it. I went back to my chart. I had even noted the results of the study at the time. The patient knew the specialist had ordered it, and had a follow up plan in place to see the specialist. That’s it! That’s it! That’s it! This is open and shut! The patient was seeing the specialist Dr. *******, who ordered this imaging study around the same time I did. I had seen her for another issue. Although the study he had ordered was abnormal, the patient had no outward signs of complications from it’s findings at the time, no acute emergency medical condition nor any on the day I saw her at all. I documented that, and that she had the appropriate specialist to follow up with, and proceeded to treat her for what she was seeing me on that given day.
Further review of records indicated she had even seen the specialist in question again, after I had seen her. He noted that he had assessed the problem in question, and I never saw her again. What happened to her after that, to this day, I don’t know. Was she alive and well, and just upset that “something was missed”? Was anything even missed? Had she decompensated, gotten sick or had a bad outcome at some point later? ( I sure hope not.) To this day, I still don’t know.
None of the available records answered any of those questions. But what the medical record made clear was, that she had a test ordered by another physician, that showed an abnormality within his scope of practice, and outside the scope of my practice, and I was falsely labeled as the ordering physician. This presumably may have happened because of an X-ray I had ordered at the same facility, on the same day. The patient presumably had my x-ray first, and then had my name put on the second study, by accident from someone in the radiology department who assumed I ordered both tests.
I spent an entire weekend, approximately 24 hours over 3 days looking through charts, compiling records and writing my response. I was a bundle of tension, and barely saw my family that weekend, at all. But after finishing my response, I was confident, I would have and could have, done nothing different. This should be easy to clear up, I thought to myself.
I sent my response, with all 120 pages of medical records to the medical board. (It’s amazing how electronic medical records can create volumes of records from only a few simple patient encounters.) A few days later, I called to confirm that the investigator got them. I asked how soon I’d hear something. He said it would be a “few weeks.” Deep breath…..exhale….
A few weeks went by. A few more weeks went by. Summer became Fall. Fall crept into Winter.
What on Earth could be taking them so long?
During the entire process, 7 months and counting at this point, I felt a dark libelous cloud hanging over head, even when I worked, played with my kids, or laid down to go to sleep at night. I imagined every possible wrong-headed, misguided and misinformed decision a medical board could ever hand down. I wondered if that the fact that it was taking so long, was a bad sign. Was the hammer soon to fall? Could I soon be fighting to save my career due to some confusion and unjust decision?
Of course not, I told myself. There’s literally nothing here. Nothing they could take or even suspend your license for. There’s nothing to even give you a warning about, or even make you take remediation classes for. Your name got placed falsely on someone else’s imaging study, that they were responsible for following up on, and may or may not have. Clearly there’s nothing to worry about, at all, on my end. Right?
As I waited to hear from the state medical board about their decision, the thing that hit me the hardest was how much different a board complaint or action, is from a lawsuit. During medical school, residency and practice, every talks about potential lawsuits, and the need to practice defensive medicine. The threat is omnipresent, and constantly talked about, openly so. But rarely does anyone speak about, or even mention the threat of complaints or actions handled by the medical board. Is it because they’re more rare? Simply more taboo? I’m not sure.
What finally hit home, that I hadn’t spent much if any timing pondering before, is that a medical board issue has the potential to be far, far worse than a lawsuit. In a lawsuit, they truly just want your money. The lawyers don’t want to take your medical license away. They can’t and won’t even try. Although the attorneys will try to convince a jury you’re Satan incarnate, so as to increase their chances of winning the suit, once it’s over they’re happy to walk away and let you keep practicing medicine, in their community. The medical malpractice lawyers are happy to sue as many doctors as possible, but certainly don’t want to stop all the doctors from practicing medicine. If they did, there’d be no one left to sue!
But what really hit home, is that with a medical board complaint, they don’t want your money at all. The person filing the complaint wants to take your license away. They don’t want you to be able to be a doctor anymore. They want to place in motion a process that can truly ruin your life. You can lose your job, not be able to make your house payment. And pretty much everything you’ve worked for your whole life, potentially, is destroyed if the complainant gets their way. At a minimum, the medical board at least has the power to make all that happen, if they want to. A state medical board is much more dangerous than your ten most aggressive medical malpractice attorney’s put together and has far greater power, over you and I, if they choose to wield it. Medicine can be a vicious, taunting, profession at times. They don't tell you this when you're a medical student.
So, after 3 seasons, 5 holiday’s, one kid’s birthday, a spouse’s birthday, and seven months over which the cloud of this whole process hung, I couldn’t take it any more. The silence was killing me. As much as I tried to put the whole affair out of my mind, reminding myself of the strength of my defense and complete lack of actionable mistake or misconduct, I must admit the prospect of the whole process weighed on my mood like heavy, hanging, dark-grey clouds. Part of me hoped it would go away, and that I’d never hear a word about it again. The other part of me was tortured by that idea, wanting a quick resolution, regardless of the outcome. I picked up the phone and called the investigator.
There was no answer.
I left a message. A few hours went by, and there was no return call. Maybe I had the wrong number? Hmm…I don’t know. I’ll give it until tomorrow.
Tomorrow came. Still no return call. Oh, forget it! I wish I’d never called. Just leave me alone. So what if it takes another 7 months?
At that moment, I heard the familiar sound of a piano playing in the background. It was my phone’s ring tone. I ran around the corner and answered. Deep breath.
“Hello?”
It was the deep voice, “I’ve been meaning to call you back. The medical board voted 3 weeks ago…”
Three weeks ago, and you’re just calling me now? What the heck?! Don’t you know that not knowing is what make this torture?
Deep-voice continued, “…and the medical board voted to dismiss the complaint against you.”
Dismiss. DISMISS. And with that, I felt the air start to leak out of the tension that had built inside of me, that was starting to become so permanent, that I almost had forgotten it was there. I was starting to feel lighter already.
“Okay, wow. I guess that’s it then. Is there anything else I need to do?” I asked.
“No,” said the deep voice. “I’ll be sending out a formal letter soon.”
“Okay, thank you,” I said. Although, I wasn’t sure exactly who I was thanking, exactly why or what for. I was wishing so badly, right then and there, that I would have loved to have been a fly on the wall while the board met and discussed this meritless complaint that weighed on me unnecessarily for the better part of a year. It was also unfortunate that the medical board had to spend seven months investigating the wrong person, due to the mislabeling of an imaging study, when they likely had more pressing issues to deal with. “On more thing,” I asked. “Do I have the right to find out who filed the complaint?”
“Yes you do. By state law, you have that right, but you must request that information in writing,” he said, and he gave me his address.
“Thanks for that information, Sir,” I said. “You’ll be hearing from me again, soon. Very soon.”
TO BE CONTINUED
[/I]
Update: I found out today, it was the patient who filed the complaint. I'm actually very okay with this. If it had been another physician, particularly the one who ordered the test in question that I was blamed for (and who was ultimately responsible), it would be an entirely different story. But for a patient to blame the physician whose name is on a diagnostic test, presumingly not knowing the ordering physician was mislabeled, is understandable, particularly after seeing several physicians in a short period of time. I'm now at peace with this, and feel I'm very much able to move on.
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