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Gleevec

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What specialties are generally sued the most, whether legitimately or frivolously.

Id imagine ob/gyn, ER, and plastics would make the list?
 

Fermata

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Neurology
Radiology
Ob/gyn
Anesthesiology

The last two are self-explanatory. The first two get sued a lot because they see a high volume(more cases/scans = higher probability for being sued).

A lot of times you hear about odds of being sued are reduced if the patient likes you. That may also account for neuro and rads.
 
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Docxter

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The highest sued are radiologists who do a lot of mammography (in some states, most women with breast cancer who have previously had a mammogram, even a normal one, automatically sue). Next is OB/GYNs doing a lot of high-risk obstetrics (poor childbirth outcome and developmental delay in the child). Third are neurosurgeons (poor outcome including weakness, paresis, wound infections, and blindness). Then it's anesthesiologists. Then come plastic surgeons and EM.

BTW, signing a paper that you won't sue, still doesn't take away the right to sue.
 

beyond all hope

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ER docs get sued a lot, mostly because any time a patient has an adverse outcome at any time in the hospital, the lawyer carpet-bombs all names on the chart, including the ER doc who saw the patient 13 days before the event. Also high-volume, critical patients, inadequate information, trauma, and lack of a good doctor-patient relationship make it very high risk. (I've heard only 2nd to OB)

I have heard that Rads, Gas and OB are high-risk, but I never heard Neuro. I would challenge Fermata to find a source for that statement.

Psych patients are high-risk, frequently-suing patients, and yet Psychiatry is considered a low-risk profession. Go figure.
 

margaritaboy

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I heard that Psych and Family were the least sued specialties, maybe because they do have good opportunity to establish a doc-patient relationship through continuity.
 

edinOH

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Originally posted by louren
Why is anesthesia highly sued?

Probably because they are always working opposite of a surgeon. Anytime something goes wrong for the pt on the surgical side, odds are good the anesthesiologist will get named in the suit as well.
 

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I read that there is a county in Florida where some 90% of the neurosurgeons working there got sued last year. The avg physician gets sued at least once during their career. I think that ob/gyns are the most commonly sued with an avg of being sued ~3-4 times during their careers. Anesthesiologists get sued a lot over pain management issues and adverse outcomes associated with anesthesia administration. FP's are most commonly sued for cancer misdiagnosis (a delay in cancer diagnosis greater then six months following the onset of what are usually "vague" symptoms is regarded as malpractice at most places), psychiatrists are sued for patient suicides and inappropriate relations with their patients (althought due to the patient population, a good number of these cases turn out to be false).
 

edmadison

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Originally posted by yaah
Hey, does anyone know if a doctor has ever sued a patient for failing to take their recommendations?

I hope this is a joke, but since I love to be pedantic, I will comment. First, the ethical ramifications are bad. "I'm sorry Mrs. Smith, you haven't be taking your calcium. I have filed suit against you in court for "punitive damages" of 1,000,000.' Second what would the cause of action be?

Ed
 

Doc Ivy

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Originally posted by edmadison
I hope this is a joke, but since I love to be pedantic, I will comment. First, the ethical ramifications are bad. "I'm sorry Mrs. Smith, you haven't be taking your calcium. I have filed suit against you in court for "punitive damages" of 1,000,000.' Second what would the cause of action be?

Ed

I agree with the above, you would have a hard time showing what your damages are
 

edmadison

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Originally posted by Doc Ivy
I agree with the above, you would have a hard time showing what your damages are

Not only is a question of no real damages (other than a nominal waste of time), it a question of having a legally recognized cause of action, such as breach of contract or tortious injury (assault, negligence).

Ed
 
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ortho2003

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Hey, does anyone know if a doctor has ever sued a patient for failing to take their recommendations?

It is pretty ridiculous for a doctor to think about suing for non-compliance, since there are no damages. However, it is not so ridiculous for insurance companies, or the government, in the case of medicare and medicaid, to sue for their money back for non-compliance. If a patient is non-compliant with medical advice, he/she is basically wasting the money of the insurer, and most likely creating more cost to the insurer in the long run by having more visits and hospitilizations. The insurance companies would never be able to break even in these kinds of cases unless it was non-compliance after a major procedure such as a liver transpalnt patient drinking. Even then, they would only break even if the pt was independently wealthy. I guess that is the nice thing about being the consumer (or recipient in the case of medicaid/care) in the US health care system...you can file suit an make a killing, but you can't be held responsible for your own actions at all.
 

avendesora

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I was surprised during my Rads rotation how much those guys get sued. A lot of the time it's the "carpet bombing" effect someone else described. In fact, the guys at my school couldn't stop talking about it. The one guy has like 3 pending cases -- he told us he ripped all the covers off his phone books (our all have ambulance-chaser ads on the back) :)

Regarding the average doc getting sued several times -- that's not so bad, except that in some areas even one suit, even if it's not successful, can raise malplactice rates or even make it impossible to get insurance. This was for OB's somewhere out east - I read an article on it a while back.
 

carrigallen

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one major issue is the malpractice insurance itself. In Pennsylvania, there are some specialities which simply no one will insure! They are too high risk..no insurance company wants to take the chance, no matter how high the premium they collect.

It also depends on the demographics / jury population. In philadelphia (high ratio of uneducated/poverty) the juries are easy to persuade/manipulate, so the majority of even frivolous lawsuits are either settled or awarded damages.
 

Goober

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Originally posted by avendesora


Regarding the average doc getting sued several times -- that's not so bad, except that in some areas even one suit, even if it's not successful, can raise malplactice rates or even make it impossible to get insurance. This was for OB's somewhere out east - I read an article on it a while back.

You hit the nail on the head. I know one doc who was sued 3 times in 20 years. Two of the cases were dropped and one case he was forced to settle by the insurance company even though he wanted to fight. The insurance company dropped him the next year and he could not get insurance from anybody in the state. So he had to uproot his whole family, sell his house,pull his kids out of school and move to another state where he could get insured.
 

2112_rush

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Originally posted by beyond all hope
Psych patients are high-risk, frequently-suing patients, and yet Psychiatry is considered a low-risk profession. Go figure.

I think it would be hard to establish malpractice in something as abstract as the mind. I mean a pt with a mood disorder can't say that a doc's malpractice caused their illness, nor if their treatment is unsuccessful can they say it was because the doctor was incompetent.
 

Hayduke

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Back on the suing the patient thing...

If someone says, "Give me drugs/save my toenail/ take care of me now I can't miss my Price is Right rerun/(insert any other manipulating demand)...or I will sue you."

Why don't physicians serve it back? Isn't this a threat? Aren't these folks trying to force their will on providers? Is that not a definition of intent?

Have I missed the boat?

H
 

Energon

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I read an article in Time (June 17th 2003 i think) that had a break down on a lot of the specialties. Neuro surgery, Ortho spine and OB GYN lead the pack with gas, EM and peds pulmonology coming in second place.
 

tum

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Hayduke said:
Back on the suing the patient thing...

If someone says, "Give me drugs/save my toenail/ take care of me now I can't miss my Price is Right rerun/(insert any other manipulating demand)...or I will sue you."

Why don't physicians serve it back? Isn't this a threat? Aren't these folks trying to force their will on providers? Is that not a definition of intent?

Have I missed the boat?

H

it would be interesting to see a case where a physician sued a patient for emotional damages. or a student sued an attending. or a resident a nurse. or a lab tech a janitor.
 

jawurheemd

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Least sued specialty -- medical toxicology -- or last I heard. Probably because there aren't a lot of us to go around and there are some who don't realize that we're doctors. Also, our patients are trying to kill themselves -- if they die because they overdosed on something -- who's fault is it?

Too bad my other specialty is EM.
 

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I know I have heard of some cases where the doctors sued the patients and won. Does anyone know of any case details? Has anyone else ever heard of this?
 

EctopicFetus

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ortho2003 said:
It is pretty ridiculous for a doctor to think about suing for non-compliance, since there are no damages. However, it is not so ridiculous for insurance companies, or the government, in the case of medicare and medicaid, to sue for their money back for non-compliance. If a patient is non-compliant with medical advice, he/she is basically wasting the money of the insurer, and most likely creating more cost to the insurer in the long run by having more visits and hospitilizations. The insurance companies would never be able to break even in these kinds of cases unless it was non-compliance after a major procedure such as a liver transpalnt patient drinking. Even then, they would only break even if the pt was independently wealthy. I guess that is the nice thing about being the consumer (or recipient in the case of medicaid/care) in the US health care system...you can file suit an make a killing, but you can't be held responsible for your own actions at all.
Since they cant sue to get their money back perhaps what they can do is threaten to take away the insurance of these patients OR increase their premiums for non-compliance. The problem is a normative one which is how do you prove they are non-compliant? There is doctor-patient confidentiality and if the MDs were to snitch on their patients then they would not be honest with docs. But I like where u r going with this Ortho.
 

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Here is a list from the website http://www.dcmsonline.org/legislative/2003 Berman Final Report.doc (a report on Florida malpractice). This is in decreasing prevalancy of being sued (100% of Neurosurgeons surveyed had been sued, 0% of Allergist Immunologist had been.) This is specific only to Floriday, and some of the samples are a bit small, but I would imagine it is near representative for the frequency throughout the general medical population.

Of note, anesth is pretty far down. I attribute that to the fact that there are few bad anesth outcomes--it is a generally safe procedue, safer than the surgery in almost all cases. My opinion is that malpractice cases are much more closely tied to bad outcomes than they are to bad practice, and this list seems to support that (not that Allergy is not a valuable service, but what bad outcomes can occur?)

Neurosurgery
Vascular Surgery
Cardiovascular or Thoracic Surgery
General Surgery
Radiology
OB-GYN
Emergency Medicine
Other Surgical
Infectious Diseases
Radiation Oncology
Cardiology
Physical Medicine & Rehabilitation
Neurology
Pulmonary
Gynecology
Pediatric Medical Specialties
Orthopedic Surgery
Anesthesiology & Pain Management
Otolaryngology
Urology
Pediatric Surgery/Surgical Specialties
Internal Medicine
Ophthalmology
Plastic Surgery
Hematology?Oncology
Pathology
Other Medical
Gastroenterology
Podiatry
Family Practice and General Practice
Dermatology
Unidentified Specialty
Nephrology
Pediatrics
Psychiatry
Endocrinology
Rheumatology
Allergy and Immunology
 

OzDDS

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Facing criticism: Cosmetic surgeon sues over postings by a former patient

By Anne Barnard, Globe Staff, 9/24/2002

It's not every day that a doctor sues his patient, but Dr. Joel J. Feldman, a face-lift specialist and former board member of the American Society of Aesthetic Plastic Surgery, felt that he had no choice.

Lucille Iacovelli, a gardener from Cape Cod, had posted dozens of messages in Internet chat rooms, calling him a ''butcher.'' She posted pictures of her face, showing what she called bad results from cosmetic surgery that Feldman supervised at Massachusetts General Hospital. The last straw came in March, when a South Shore woman walked into Feldman's office at Mount Auburn Hospital, brandished Iacovelli's photographs, and canceled her surgery.

Feldman sued Iacovelli for defamation in Suffolk County Superior Court, contending she had purposely contorted her face in the photos and subjected him to ''public scandal, infamy, and disgrace.'' In May, he won a court order requiring her to remove any misleading photos or defamatory statements from the Internet; the case is pending.

Feldman v. Iacovelli is an extreme case, but it highlights sensitive issues in cosmetic surgery, where every procedure is optional, success is subjective, and patients wear the results on their faces. And it points to new anxieties in the doctor-patient relationship: When can doctors shut down criticism with legal action, and when does patient empowerment veer into harassment?



Iacovelli, 52, who lugs around an accordion file of medical journal articles on plastic surgery, said Feldman was trying to silence her after she went public with concerns she could not get addressed within medicine. She said it made sense to use a medium increasingly used both to advertise and to critique cosmetic procedures, the Internet.

''Originally, I admit, I wanted to name and shame them,'' she said of Feldman and other doctors involved in her care. ''Now I want to warn other people: This is a dangerous business. If something bad happens, you may never be able to get any answers.''

But Iacovelli's case is complex. Her surgeons suspect she suffers from a psychological disorder that distorts her view of her body and of surgical results they say are normal. Before the court order, a Suffolk County judge already had barred her from contacting Feldman or the two younger surgeons who did her face lift and nose job, Dr. Daniel N. Driscoll and Dr. Melissa R. Schneider. That ruling came after she sent letters, saying they should ''rot in hell'' and offering to mail them her severed head after her death so they could dissect it and find out what went wrong.

The dispute comes amid a push for more openness about bad medical outcomes. State medical boards, including Massachusetts', have posted more malpractice and discipline records on the Web. Nonprofit organizations rate doctors; one group, Public Citizen, compiles a list of ''Questionable Doctors.'' Patient Web sites, overflowing with chat about ''good'' and ''bad'' doctors, have proliferated, especially in cosmetic surgery, an out-of-pocket business where every doctor's livelihood depends on good reviews from patients.

But doctors fear that the information could be taken out of context, misinterpreted by laypeople, or used as a vehicle for revenge by disgruntled patients, regardless of the merits of a case.

''There has to be some outlet for patient discussion,'' said Driscoll, 38, who performed Iacovelli's face lift and worries that she will unfairly damage his Newton-based practice. ''But there's a lot of room for misrepresentation.''

At the same time, observers of cosmetic surgery say the balance of power still rests with doctors, and that it is hard for patients to get objective evaluations of surgeons' work.

Joan Kron, who writes Allure magazine's Scalpel News column and has covered cosmetic surgery for 10 years, said there is lots of biased information on such Web sites as Faceforum.com. But most of it, she suspects, is not criticism but praise, planted by doctors' office assistants or friends.

Criticism of doctors is ''even smaller than a drop in the bucket'' in the sea of promotional Web sites that helped triple the number of annual cosmetic procedures between 1997 and 2001, said Deborah Sullivan, an associate professor of sociology at Arizona State University and the author of ''Cosmetic Surgery: The Cutting Edge of Commercial Medicine in America.''

''The vast majority of media coverage of cosmetic surgery is nothing more than an infomercial,'' said Sullivan.

Between Iacovelli's Web campaign and her doctors' court filings, her medical record has become unusually public. Court records and interviews with Iacovelli, Driscoll, and Feldman paint a complex picture:

Iacovelli had two surgeries at Massachusetts General Hospital, both performed at discounted rates by surgical residents, under the supervision of senior doctors. Driscoll did the face lift in November 1997, supervised by a senior doctor who has since died; eight weeks later, Schneider did the nose job as Feldman looked on.

At first, Iacovelli was pleased; pictures show her beaming, with a smooth neck and face. Later, she grew dissatisfied. The pictures she posted on the Web, taken a year after surgery, seem to show her neck looking wrinkled again.

Feldman said her pose exaggerated the problems; Iacovelli denies it. Feldman says face lifts that start to sag after a year are within the spectrum of expected results, especially on patients with Iacovelli's ''stretchy skin''; Iacovelli believes her face sagged because the second surgery came too soon after the first.

Iacovelli wanted to sue, but a lawyer told her he could not get an expert witness to back her argument. Her psychotherapist, Ted Powers of Plymouth, urged Feldman to meet with her about corrective surgery, according to a letter Iacovelli showed the Globe. But an MGH psychologist diagnosed her with body dysmorphic disorder - in which patients with an unrealistic body image seek excessive surgeries - and prescribed therapy instead.

Still, Feldman said, he almost contacted her: ''All I wanted to do was make her happy.'' But he pulled back when her letters became frightening. ''Enjoy your [smile] while you still can,'' she wrote to all three doctors. ''It may be permanently wiped off your face when you least expect it.''

Iacovelli, who is known as The Flower Lady at the Quashnet Valley Golf Club in Mashpee, where she works as a gardener, says she never would have turned violent.

Barred from contacting the doctors, Iacovelli moved her campaign to the Web. And when Boston Magazine named Feldman a top surgeon, she said, she slipped her pictures into copies ''in every newsstand, in every Stop & Shop - everywhere!''

Meanwhile, she had a third surgery in Indiana, which left her face and neck looking smooth but, she says, left her with painful neurological problems. And the Mass. General doctors moved on, viewing the case as a reminder to screen their patients carefully. Their lawyer, William J. Dailey III, said they always had Iacovelli's interests at heart.

But after a patient's daughter went online to look up Feldman's address, and found Iacovelli's photos instead, he decided to sue to defend ''my reputation and the caring that I've given to my patients.''

After the court order this summer, Iacovelli took down the chat-room postings. But the photos can still be found in a Hotmail account that anyone can access if Iacovelli gives them the user name and password.

''She is an intense person,'' said Erika Hahn of North Falmouth, a friend. ''... Any normal person would have given up a long time ago.''

Anne Barnard can be reached at [email protected].

This story ran on page B1 of the Boston Globe on 9/24/2002.
? Copyright 2002 Globe Newspaper Company.
 

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regarding the florida berman report: page 17 talks about doctors self-insuring, or "going bare." i thought this was an interesting topic. here is an article:
Self-insurance is viable alternative to malpractice coverage; "going bare" for a number of years can save money when assets are set aside and properly protected - Practice Management Cosmetic Surgery Times, April, 2004 by Bill Gillette
basically, carrying high limit insurance attracts lawsuits. if you practice without insurance, you're less likely to be sued b/c the award will be much less.
 

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So what if a patient gets abusive and threatening during a visit? Can you kick the crap out of him and toss his ass out in the street, or would that upset Mr. Edwards?
 

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go bare and put all your assets in your spouses name....

Quote from Hayduke
"Back on the suing the patient thing...

If someone says, "Give me drugs/save my toenail/ take care of me now I can't miss my Price is Right rerun/(insert any other manipulating demand)...or I will sue you."

Why don't physicians serve it back? Isn't this a threat? Aren't these folks trying to force their will on providers? Is that not a definition of intent?

Have I missed the boat?"

yes we have missed the boat. In South Carolina, physicians make 2x what attorneys make, but physicians only contribute a pittance in comparison to their congressman who can lobby for their cause. PHYSICIANS ARE LAZY WHEN IT COMES TO THIS!! We want our rights protected but who here has written a letter to their congressman? How many physicians are in the House and Senate-I think one, Bill Frist. Until we get off of our asses and out of our Porsches and off the golf course, we will continue to get trampled on and have to pay $50-100K a year for malpractice insurance. The attorneys are smarter than we are. Don't whine about it-do something and write a letter and get involved. I think the idea of striking is impossible given our responsibility, but if we did, I bet the laws would change quickly.
 
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