My Lawsuit Is Over Now, Time To Vent Thread

[dudeliness]

I'm interested in hearing what pre-meds, medical students and residents think about this subject. Please post your reaction here. More importantly, please click back on the link in the OP, and jump in to the comments on Whitecoat's call room, which is read by quite a few lawyers.

http://www.epmonthly.com/whitecoat/2013/02/it-didnt-feel-like-a-win/

Go there and respond directly to the lawyers, and tell them what you feel about the subject as a prospective doctor, or doctor in training. Let them know what you think about "the cost of doing business" before you have to do it in court.

Tell them what you think about the fact that you have an 80% chance of having a lawsuit filed against you in your career if in a low-risk specialty, or 100% in choosing a high-risk specialty.

http://mobile.studentdoctor.net/showpost.php?p=13681755

I'm glad I stumbled onto this thread. As a pre-med, this is one of many aspects of medicine that I haven't thought a lot about. It's scary to think about having that "wedge" driven between me and my patients, and I can imagine how a lawsuit could taint my interactions with patients. As others have mentioned, I hope that I'm able to properly cope with the stress of any eventual malpractice suits I encounter.
That being said, I really wish there was a way (besides a counter-suit) to hold lawyers more accountable for the cases they decide to take up. Maybe if they, or their clients, had to give specific reasons for why they were dropping charges? I'm sure they'd probably figure out some legal jargon to admit they were wrong without actually admitting anything.

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[Perrotfish]

"Low Yield" ?

As if there were an "acceptable suit rate" to be measured.

You won't be singing the same song when you get hit with yours, amigo. There is no "yield" when it comes down to personal sanity.

... and yes, I know about the flipside of my argument; "Zero risk! Do ALL the tests, LOLZ!"... but it comes down to "assumption of the risk".

We can't assume it all. All the time.

By low yield I mean in EM the odds are that you're giong to get sued often, but pay out little, so a cap on the total payout probably doesn't affect your lifetime career risk or the amount you'll pay for malpractice insurance. On the other hand in Peds you get sued once in a lifetime, but for everything you own and 50 million more, so living in a state with a malpractice cap is essential. A state with a low cap on malpractice damages (like Lousiana, for example) essentially eliminates the risk of lawsuits for pediatricians without significantly affection the misery faced by EM.

I'm torn on how I feel about lawsuits. On the one had I think that lawsuits seem to have a 'struck by lightning' quality that makes me really dislike them. On the other hand I have seen multiple hopsitals/physician groups that enforced dangerously low standards of care so that they could shore up profit margins or leave earlier. It does seem like we deserve to be sued as much as any other industry. Maybe the public would be more receptive to change if, rather than always talkig about how we can hamstring the lawyers and make lawsuits impossible, we could talk about how to make lawsuits more accurate and judgements more fair. Like you said, I'm sure I'll feel differently when I'm being sued, but like a previous poster mentioned, that's why I-bankers think that financial regulation is unfair. The people being negatively affected by a policy aren't necessarily the ones who should be analyzing it.

I like the idea of hunting down professional witnesses. Intersting the latest AAP news had an article on this. Apparently there has been successful lobbying to limit the testimony of witnesses who make a living giving false testimony. Some of the more interesting 'expert' laws they mentioned were laws which requierd a certain perentage of time spent in clinical practice, laws which required physicians to be boarded in the correct field (no Ob/GYN experts testifying against EMs), and most interstingly a Maryland law which DQ'd anyone who spent more than 20% of his working life giving testimony.

 

[Birdstrike]

It does seem like we deserve to be sued as much as any other industry... Like you said, I'm sure I'll feel differently when I'm being sued, but...

It's time to pick a side. There's no playing it both ways here. You're either for us or against us; either for yourself or against yourself. You're absolutely right, you'll feel differently when it's you being cross examined in a deposition, or by a lawyer determined to convince a jury you're a butcher not a healer. I wish I could tell you some of the outrageous, inflammatory and baseless accusations and questions asked of me during my depositions designed to rattle me and potentially plant seeds of suspicion in potential jurors minds.

Consider this graph, again:

http://www.nejm.org/na101/home/lite...production/images/large/nejmsa1012370_f4.jpeg


Can you possibly think that 100% of physicians who choose high-risk specialties deserve to be sued?


100%?


What other profession, be it teacher, dog catcher, banker, or biologist, deserves a 100% chance of being sued?


It's absofrickin'lutely outrageous, and abusive. Call a spade a spade. Call a rat a rat.


As a resident and Medical Doctor, can you truly believe that 80% of physicians who choose the lowest risk specialties deserve to be sued?

EIGHTY PERCENT?

Of LOW RISK specialties?!

Do you deserve to be sued for malpractice, because you have either an 80%, or 100% chance of being sued depending on which fork in the road you take?

Consider the other lines on the graph (indemnity payment = "found guilty or forced to pay to make it go away"):

Do you truly believe that 20% of Pediatricians (low risk) commit true malpractice, and that 70% of general and neurosurgeons (high risk) commit true negligence/malpractice?


Are 20% of Pediatricians so negligent that they deserve to be put on trial and found guilty of malpractice?

Are 70% of Neurosurgeons truly so negligent, they need to be put on trial and found guilty of malpractice?


You are a resident. You are a doctor. You could be at work tonight, or in your front yard playing with your kid (or neice/nephew/cousin) and a cop could roll up, asking for you, with a special delivery.

Will you deserve it? Because I didn't and I don't.

 

[RustedFox]

By low yield I mean in EM the odds are that you're giong to get sued often, but pay out little, so a cap on the total payout probably doesn't affect your lifetime career risk or the amount you'll pay for malpractice insurance. On the other hand in Peds you get sued once in a lifetime, but for everything you own and 50 million more, so living in a state with a malpractice cap is essential. A state with a low cap on malpractice damages (like Lousiana, for example) essentially eliminates the risk of lawsuits for pediatricians without significantly affection the misery faced by EM.

I'm torn on how I feel about lawsuits. On the one had I think that lawsuits seem to have a 'struck by lightning' quality that makes me really dislike them. On the other hand I have seen multiple hopsitals/physician groups that enforced dangerously low standards of care so that they could shore up profit margins or leave earlier. It does seem like we deserve to be sued as much as any other industry. Maybe the public would be more receptive to change if, rather than always talkig about how we can hamstring the lawyers and make lawsuits impossible, we could talk about how to make lawsuits more accurate and judgements more fair. Like you said, I'm sure I'll feel differently when I'm being sued, but like a previous poster mentioned, that's why I-bankers think that financial regulation is unfair. The people being negatively affected by a policy aren't necessarily the ones who should be analyzing it.

I like the idea of hunting down professional witnesses. Intersting the latest AAP news had an article on this. Apparently there has been successful lobbying to limit the testimony of witnesses who make a living giving false testimony. Some of the more interesting 'expert' laws they mentioned were laws which requierd a certain perentage of time spent in clinical practice, laws which required physicians to be boarded in the correct field (no Ob/GYN experts testifying against EMs), and most interstingly a Maryland law which DQ'd anyone who spent more than 20% of his working life giving testimony.

This makes my brain hurt. You deserve to be sued for willfull lack of acting in your own rational best interest.

 

[Birdstrike]

(Warning: do not post anything about a current case, anyone else's current case or one that could still be refiled.)



Attendings, come on.

I'm not asking you to give your name. I'm not asking you to reveal specifics about your lawsuit or trial that would allow you, the patients or lawyers to be identified (in fact, please don't). I definitely don't want you to post about an ongoing trial or one dismissed without prejudice that could be refiled (since anything you post could be used as evidence). You don't have to say if you won, lost, settled, did everything right or did everything wrong.

But, I do think this issue needs to come out of the shadows. It's wrong what's happening to us. If you at least post how a past suit or the general threat suits has affected you personally, the way you practice, or your relationship with patients, I think it would be very beneficial to many people.

Or, if you think it's "no big deal" and just "the cost of doing business" or "you're overreacting" I think that would be helpful, too.




(Again, do not post anything about a current case, anyone else's current case or one that could be refiled.)
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[la gringa]

scares me to death when i think about it... i know i wouldn't handle it well emotionally as i'm very much a people pleaser and hope and pray that my generally very good relationships w/ pts and families will save me in any case where there is a thought of a lawsuit.

and i'll raise my hand and say HELL YEAH i practice defensive medicine! have way, way too much to lose, and have been practicing long enough to know that i could have been burned more than a few times had i not listened to my "spidey sense" about CT's of the head, PE studies, and r/o appy's (whether they caught what i was looking for, or something else).

we practice an art and NOT A SCIENCE... we are all human and until the system is changed more, i feel i have no choice but to use every "art" i have when i am not very very comfortable w/ something to try to approximate the certainty of science as it pertains to patient care in the ED,

 

[Perrotfish]

Can you possibly think that 100% of physicians who choose high-risk specialties deserve to be sued?
.

No, I don't. I think the way the current system works is toxic, and has a lot more to do with the emotional payload of a case than with actual wrongdoing. We are arguably the most litigious society in histoy, and the sytem is unfair to us (we end up constantly feeling hunted) and to our patients (the randomness of successful lawsuits, and the mega millions nature of the payouts, causes the wrong kind of change in the system). No one here is arguing that we don't need to fix something.

That being said, I also think there are a lot of greedy, lazy physicians out there. Don't act lik you haven't seen them. I've seen a primary care practice that had streamlined patients so that they would see a new patient every 4 minutes. An ED that expected its docs to see 8-10 patients per hour. A community hospital where the 'attendings' are physically present in the hospital for less then an hour a day to round on the entire service and let the nurses run it for teh other 23. Many physicians who blindly sign of on the charts of a dozen 'physician extenders' who they fleece of half of their earned income without supervising their care in any meaningful way. And, of course, all the old f--ks who are just too lazy to read and continue to practice perfect 1970s medicine. When these physicians hit a lawsuit, they're not being sued for 'one mistake', they're being sued for knowingly participating in a system that endangered every patient and eventually killed one in a way that was horrific enough to sue over.

There are a lot of physicians who guard their time and their bank acounts a lot more carefully than their patient's lives, and I think that's a direct result of a system where we're almost unregulated. As we deal primarily with government insurance agencies, the free market doesn't week out low performers, and even the stupidist, laziest physician is an incredible earning asset for a hospital system by virture of his license. And its almost impossible to take our licenses, our professional organizations are almost toothless once you leave residency. The hospitals and groups that we work for aren't any better, they're all for profit (whether or not they are legally 'non-profit') and often create the unsafe situations we buy into. Out patients can't even go around us, obtaining perscription medicines without our participation is actually a crime: we are the only industry in America that has the right to act as a gatekeeper between consumers and a product they want to buy. Once we leave residency the ONLY thing keeping us honest, other than our consciences, is the threat of litigation. If you take that away, patient's have no recourse left when something happens to them as a direct result of physician negligence. That's not fair to the patients.

I'm saying if we want to change the system, we need to not just eliminate it, but rather give patients some alternative way of holding bad physicians and bad hospital systems accoutnable. Is there a system that you think would be fair, other than just eliminating the lawsuits and leaving nothing in their place? Do we need more government inspectors and regulations, like the chemical and pharm industries? Should we just work from with a socialized medical system, and have an internal review process, like most of the rest of the free world? Or is there some way to morph our current system of litigation into something that's not quite this toxic? Any other ideas?

 

[dotopmr]

No, I don't. I think the way the current system works is toxic, and has a lot more to do with the emotional payload of a case than with actual wrongdoing. We are arguably the most litigious society in histoy, and the sytem is unfair to us (we end up constantly feeling hunted) and to our patients (the randomness of successful lawsuits, and the mega millions nature of the payouts, causes the wrong kind of change in the system). No one here is arguing that we don't need to fix something.

That being said, I also think there are a lot of greedy, lazy physicians out there. Don't act lik you haven't seen them. I've seen a primary care practice that had streamlined patients so that they would see a new patient every 4 minutes. An ED that expected its docs to see ten patients per hour on an average shift. There are lots of private hospitals where the 'attendings' are physically present in the hospital for less then an hour a day to round on the entire service and let the nurses run it for teh other 23. When these physicians hit a lawsuit, they're not being sued for 'one mistake', they're being sued for knowingly participating in a system that endangered every patient.

There are a lot of physicians who guard their time and their bank acounts a lot more carefully than their patient's lives, and I think that's a direct result of a system where we're almost unregulated. As we deal primarily with government insurance agencies, the free market doesn't week out low performers, but as we are essentially unregulated except for the minimal requirements of licensing. Out patients can even go around us, obtaining perscription medicines without our participation is actually a crime. Once we leave residency the ONLY thing keeping us honest, other than our consciences, is the threat of litigation. Its almost impossible to take our licenses, our professional organizations are almost toothless once you leave residency, the hospitals and groups that we work for are for profit (whether or not they are legally 'non-profit') and often create the unsafe situations we buy into. That's not fair to the patients.

I'm saying if we want to change the system, we need to not just eliminate it, but rather give patients some alternative way of holding bad physicians and bad hospital systems accoutnable. Is there a system that you think would be fair, other than just eliminating the lawsuits and leaving nothing in their place? Do we need more government inspectors and regulations, like the chemical and pharm industries? Should we just work from with a socialized medical system, and have an internal review process, like most of the rest of the free world? Or is there some way to morph our current system of litigation into something that's not quite this toxic?


Pardon me for being frank -- you sound damn and stupid. Good luck in real world

 

[Esquire]

As a former transactional lawyer and future doc, my thoughts are:

1. Insurance and asset protection should be a priority for any professional. Forming a P.C., offshore trust accounts, tail coverage, etc.

2. If you did not meet the professional standard of care, then you should be held accountable.

3. The large accounting firms once pushed for the right to own/purchase law firms. They would have decimated existing law practices and the multimillion dollar incomes of law partners. Lawyers fought back, and it is now illegal for non-lawyers to own a law firm or otherwise pose any conflict of interest with the professional independence of a lawyer.

Physicians screwed themselves because they traded professional independence for employee status. Hospitals/insurance/government pretty much tell docs how to practice medicine. EM docs churn through whatever patients per hour their MBA bosses tell them to, or else. It is the worst of both worlds: you have little professional independence because you're treated as an employee, but you are treated as professionals when it comes to personal liability; meanwhile, your bean counter boss (who makes mutiples of your income) has no personal liability. That's ridiculous.

4. In Canada, EM is the second lowest paid specialty (under $200k), because of 8-hour shift restrictions and the legal climate. There is an aggressive stance against settling lawsuits and losers pay legal fees. In America, EM is the highest paid 3-year specialty and eclipses some IM subspecialties that require twice as much training. The extra $50,000-$100,000 you command for practicing in America is mostly to compensate for litigation risk. Would American EM docs trade their current income and lawsuit risk for a sub-$200k income and minor risk of lawsuits?

5. EM is increasingly popular with med students as shown by increased EM Step scores. Until students shun EM, there will be no incentive for politicians, MBA's, and lawyers to change anything about the current legal system.

 

[RustedFox]

As a former transactional lawyer and future doc, my thoughts are:

1. Insurance and asset protection should be a priority for any professional. Forming a P.C., offshore trust accounts, tail coverage, etc.

2. If you did not meet the professional standard of care, then you should be held accountable.

3. The large accounting firms once pushed for the right to own/purchase law firms. They would have decimated existing law practices and the multimillion dollar incomes of law partners. Lawyers fought back, and it is now illegal for non-lawyers to own a law firm or otherwise pose any conflict of interest with the professional independence of a lawyer.

Physicians screwed themselves because they traded professional independence for employee status. Hospitals/insurance/government pretty much tell docs how to practice medicine. EM docs churn through whatever patients per hour their MBA bosses tell them to, or else. It is the worst of both worlds: you have little professional independence because you're treated as an employee, but you are treated as professionals when it comes to personal liability; meanwhile, your bean counter boss (who makes mutiples of your income) has no personal liability. That's ridiculous.

4. In Canada, EM is the second lowest paid specialty (under $200k), because of 8-hour shift restrictions and the legal climate. There is an aggressive stance against settling lawsuits and losers pay legal fees. In America, EM is the highest paid 3-year specialty and eclipses some IM subspecialties that require twice as much training. The extra $50,000-$100,000 you command for practicing in America is mostly to compensate for litigation risk. Would American EM docs trade their current income and lawsuit risk for a sub-$200k income and minor risk of lawsuits?

5. EM is increasingly popular with med students as shown by increased EM Step scores. Until students shun EM, there will be no incentive for politicians, MBA's, and lawyers to change anything about the current legal system.

Sure, once we have a clear and precise "standard of care" for each situation, that'll be easy to settle.

 

[Siggy]

Sure, once we have a clear and precise "standard of care" for each situation, that'll be easy to settle.

Not only that, since the "standard of care" is essentially "what everyone else does," practicing evidence based medicine means that you often aren't providing the standard of "what everyone else does" if you're an early adopter. Furthermore, without early adopters, there will be no change.

 

[Perrotfish]

Not only that, since the "standard of care" is essentially "what everyone else does," practicing evidence based medicine means that you often aren't providing the standard of "what everyone else does" if you're an early adopter. Furthermore, without early adopters, there will be no change.

That's not necessarily true. A reasonable middle ground is that all 'early adoption' should be in the form of IRB approved clinical trials. When there is a proponderance of evidence based on those clinical trials, your professional group should adopt a new policy statement which sets the new standard of care, and then everyone else should start practicing to that standard all at once.

A great example of this system in action is the Pediatric vaccine schedule. There are no 'early adopters' to giving live flu to younger children, or switching out Tetanus boosters for TDaP boosters, the experimentation was all done in regulated trials and then we all get an annual update about what we're supposed to be doing.

Obviously that doesn't work for every situation, but we can certainly develop a large number of professional algorithims to govern common situations.

 

[docB]

As a former transactional lawyer and future doc, my thoughts are:

1. Insurance and asset protection should be a priority for any professional. Forming a P.C., offshore trust accounts, tail coverage, etc.

2. If you did not meet the professional standard of care, then you should be held accountable.

3. The large accounting firms once pushed for the right to own/purchase law firms. They would have decimated existing law practices and the multimillion dollar incomes of law partners. Lawyers fought back, and it is now illegal for non-lawyers to own a law firm or otherwise pose any conflict of interest with the professional independence of a lawyer.

Physicians screwed themselves because they traded professional independence for employee status. Hospitals/insurance/government pretty much tell docs how to practice medicine. EM docs churn through whatever patients per hour their MBA bosses tell them to, or else. It is the worst of both worlds: you have little professional independence because you're treated as an employee, but you are treated as professionals when it comes to personal liability; meanwhile, your bean counter boss (who makes mutiples of your income) has no personal liability. That's ridiculous.

4. In Canada, EM is the second lowest paid specialty (under $200k), because of 8-hour shift restrictions and the legal climate. There is an aggressive stance against settling lawsuits and losers pay legal fees. In America, EM is the highest paid 3-year specialty and eclipses some IM subspecialties that require twice as much training. The extra $50,000-$100,000 you command for practicing in America is mostly to compensate for litigation risk. Would American EM docs trade their current income and lawsuit risk for a sub-$200k income and minor risk of lawsuits?

5. EM is increasingly popular with med students as shown by increased EM Step scores. Until students shun EM, there will be no incentive for politicians, MBA's, and lawyers to change anything about the current legal system.

I agree with this. Not happy about it but it's true.

I would take a pay cut of a third or more if I could be assured of not being sued unless I did something grossly negligent (not winning, not getting sued).

 

[RustedFox]

I agree with this. Not happy about it but it's true.

I would take a pay cut of a third or more if I could be assured of not being sued unless I did something grossly negligent (not winning, not getting sued).

I would take a pay cut as well. Maybe not a third, but a definite cut. I gotta get out of debt at some reasonable rate.

 

[Birdstrike]

5. EM is increasingly popular with med students as shown by increased EM Step scores. Until students shun EM, there will be no incentive for politicians, MBA's, and lawyers to change anything about the current legal system.

The most powerful vote, is when one votes with his feet.

 

[StevieStud]

EM docs churn through whatever patients per hour their MBA bosses tell them to, or else. It is the worst of both worlds: you have little professional independence because you're treated as an employee, but you are treated as professionals when it comes to personal liability; meanwhile, your bean counter boss (who makes mutiples of your income) has no personal liability. That's ridiculous.

and peeps wonder why I hate administrators

 

[SpaceLeftBlank]

I'd much rather go after their 'expert' witnesses. I think we should be discrediting them through our respective societies. Deboard them or something like that. If we take care of them, the lawyers won't have anyone to come after us with. The next time they testify, all the defense has to point out is that this guy is known to provide bad/questionable testimony.

That's an interesting concept. I've seen enough of my cases where even I could see that the plaintiff's expert was saying something outlandishly wrong about what the alleged "standard of care" is.

Of course, the flip side of that is that occasionally, the same thing happens on the defense side. But I'd hope that most physicians would be just as upset with bad expert testimony protecting actual malpractice as they would be with bad expert testimony attacking competent medical care.

 

[SpaceLeftBlank]

Ultimately we are hobbled by the facts that the lawyers love med mal as an industry

Not as much as you think. On the defense side, a lot of lawyers are getting out of it because the insurance companies and hospitals are pushing rates down prohibitively low. And in states with tort reform (like mine) there are actually a lot fewer cases to handle. I'm one of the rare "true believers" (i.e., I'm doing this because people I respect (like my wife) are physicians and I think that a lot of lawsuits are filed as money grabs without regard to the impact on the physician's reputation and livelihood) plus I'm an appellate lawyer, and there are always other kinds of lawsuits to defend out there.

and the politicians (who are lawyers) believe that our med mal insurance is a great, unfunded safety net.

Well, it's not just lawyers or politicians who think this--everyone thinks lawsuits are no big deal because "hey, they have insurance." These people are often the first to complain about rising insurance rates, too, and are usually too dumb to connect the two.

The public likes the possible jackpots.

In my experience, this drives most medical-malpractice lawsuits. I don't think it's any accident that most of the med-mal appeals I handle are filed by middle- to lower-income plaintiffs. It's not like relatively wealthier people are immune to bad medical results or malpractice (or even things like slip-and-falls), but I do think they're less likely to file personal-injury lawsuits.

 

[med2UCC]

4. In Canada, EM is the second lowest paid specialty (under $200k), because of 8-hour shift restrictions and the legal climate. There is an aggressive stance against settling lawsuits and losers pay legal fees. In America, EM is the highest paid 3-year specialty and eclipses some IM subspecialties that require twice as much training. The extra $50,000-$100,000 you command for practicing in America is mostly to compensate for litigation risk. Would American EM docs trade their current income and lawsuit risk for a sub-$200k income and minor risk of lawsuits?.

This is not true. There may be shift limits in parts of Canada but where I practice there are certainly none, as our current shifts range from 7-14 hours in length depending on the hospital, and there is no limit to how many shifts you can work in a week or month. Most of us make above $200,000.00 if working full time. I work part time EM and part time FP and last year made almost $300,000.00. That was without killing myself, generally seeing between 2-3 patients/hr. We have excellent consultant coverage and good relationships with most of our colleagues. And very few lawsuits. Cheers,
M

 

[Birdstrike]

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#birdstrikeinjectstruth

 

[Socrates25]

It does seem like we deserve to be sued as much as any other industry.

Except we dont get "sued as much as any other industry" we get sued at much higher rates. Studies show that 75% of physicians will get at least one claim filed against them in their lifetime of practice. Show me one other profession that even comes close to that. Hell even LAWYERS dont get sued at that high of a rate.

 

[Socrates25]

That's an interesting concept. I've seen enough of my cases where even I could see that the plaintiff's expert was saying something outlandishly wrong about what the alleged "standard of care" is.

The fundamental flaw in the legal system is that it says you have to break a "standard" of care in order to be guilty of malpractice. And yet the courts pull a bait and switch and blindly accept any rogue hired gun's "expert" testimony about what the "standard" is

Standards are not, and can NOT be set by individuals. Standards are set by communities. But courts dont accept "testimony" by organizations, they only accept hired guns who have a very good reason to lie in the courtroom.

The medical malpractice system is based on a lie. That is what pisses me off more than anything else. Dont lie to me and tell that I have to break a "standard" to be guilty of malpractice when we all know that's a bull****, bald-faced LIE.

 

[SpaceLeftBlank]

Except we dont get "sued as much as any other industry" we get sued at much higher rates. Studies show that 75% of physicians will get at least one claim filed against them in their lifetime of practice. Show me one other profession that even comes close to that. Hell even LAWYERS dont get sued at that high of a rate.

Well, I'd be interested to see the study that supported your figures. The figures I've seen are much lower (I'll see if I can find the cite), and certainly, the filings in my state have dropped dramatically (not that I mind that too much, given that my wife is a physician and there are plenty of other lawsuits for me to work on defending). Of course, all of that is exactly zero consolation for the physician who gets sued. That's a point that sadly seems to evade a lot of people, including, even more sadly, a lot of lawyers. And for some specialties, the rate I've seen is still high enough to give one pause.

Lawyers get sued an awful lot around these parts, but there's no tort reform applicable to us, so anyone with an ax to grind and $150 (and sometimes less) can file their legal-malpractice suit. Aside from the crazy prisoner who has nothing better to do than sue his free, court-appointed defender, the legal-mal suits I seem to defend often come from people who simply decide they're not going to pay their legal bill, and decide to sue for malpractice instead after the lawyer asks if maybe they could get paid.

That's another thing those of you physicians who have it can thank tort reform for: I have no doubt that there are some people in my state who would gladly file med-mal suits in response to an attempt by their doctors to have their bills paid, if it were easier to do so.

 

[Lokhtar]

I don't have all the answers but perhaps a solution might be to have medical malpractice lawsuits heard by a panel of experts - some physicians, some public health people, patient advocates, some lawyers, etc - but all with training and education to come to an appropriate decision. And that's what they would be doing all day, every day - so by sheer experience and knowledge, it's much harder to 'pull the wool over their eyes', so to speak.

That happens in some countries, and I think it works well. It would certainly stop some of the more ludicrous awards. As long as patients have faith that they are getting a fair hearing, it could work. I mean, as I think everyone can attest, the very vast majority of people, even when they have terrible outcomes, and even when there are mistakes made, don't end up suing. So it's a small percentage of payouts that are driving the high premiums, and perhaps just as importantly, a lot of the negative attitudes and modes of practice that no one in healthcare likes. And I think physicians would prefer it too.

I mean, I consider myself an educated person but even now I'm in no position to judge what an appropriate standard of care is in a particular specialty, and certainly I wouldn't have been prior to medical school...(of course, the same can be said about other fields too, like tax law). Unless it's completely clear cut like someone coming in with a BAC of .2 and doing surgery or something, how could a jury possibly be fair (in either direction)?

 

[SpaceLeftBlank]

I don't have all the answers but perhaps a solution might be to have medical malpractice lawsuits heard by a panel of experts - some physicians, some public health people, patient advocates, some lawyers, etc - but all with training and education to come to an appropriate decision. And that's what they would be doing all day, every day - so by sheer experience and knowledge, it's much harder to 'pull the wool over their eyes', so to speak.

That happens in some countries, and I think it works well. It would certainly stop some of the more ludicrous awards. As long as patients have faith that they are getting a fair hearing, it could work. I mean, as I think everyone can attest, the very vast majority of people, even when they have terrible outcomes, and even when there are mistakes made, don't end up suing. So it's a small percentage of payouts that are driving the high premiums, and perhaps just as importantly, a lot of the negative attitudes and modes of practice that no one in healthcare likes. And I think physicians would prefer it too.

This is something a lot of malpractice-defense lawyers (like me) think makes sense, too. The truth is that a rather significant percentage of people don't understand science and medicine enough. If plaintiffs' lawyers were being intellectually honest about their motivations, they'd agree, because the truly indefensible cases would probably have just as hard a time getting past such a panel (as I've mentioned before, the questionable standard-of-care testimony can just as easily be brought to bear by the defense, as well).

 

[Silent Cool]

Bird,

Would you still pick medicine again as a career? Would you recommend it to your kids? Have you thought about re-training in a different field?

 

[RustedFox]

Bird,

Would you still pick medicine again as a career? Would you recommend it to your kids? Have you thought about re-training in a different field?

I'm never having kids, but I would not recommend it to any youngster out there.

 

[Silent Cool]

I'm never having kids, but I would not recommend it to any youngster out there.

RF,
What would you pick or recommend instead? Also what are your general reasons?

thanks

 

[docB]

I agree with RF. I have always said that EM is a good place to be but medicine is not a field I'd choose again.

For EM the thing that is killing the specialty is the now slavish adherence to self contradictory metrics. Every patient must be seen immediately, dispoed quickly, denied services and made blissfully happy. All while dealing with all the time sensitive issues that roll into the ER (STEMI=90 min, CVA=tPA in <60min from door, meningitis, testicular torsion, pneumonia, etc.).

Medicine as a field is getting buried in paperwork and insurance issues which increase overhead while reimbursement drops. It's a fatal cycle.

 

[WilcoWorld]

For EM the thing that is killing the specialty is the now slavish adherence to self contradictory metrics.

ding Ding DING!

I've lately decided to internally say scr3w it to the metrics, and instead focus on what I think is important (taking good care of patients). Trying to accomplish mutually exclusive goals will drive a sane man crazy. When they hired me, they hired a physician. That's what I intend to give 'em, not some automaton. Let 'em fire me if that's what it comes to (I doubt it will).

 

[Mt Kilimanjaro]

Those of you who say you'd not choose medicine again: what would you choose instead?

 

[TrumpetDoc]

Those of you who say you'd not choose medicine again: what would you choose instead?

Would not do again.

Would have simply continued in music.
If not that...prob law...heck, may be going that route if medicine continues to suck.

 

[RustedFox]

What would I do instead ? Hmm....

Maybe some biotech gig or something like that; its what my wifey did for years and she really dug it and made some nice coin doing it. My *dream job* would be to be a golf club pro, but there's little money in that.

Brewmaster also seems like a nice option.

I'll think on this and post again in a bit. Just woke up.

 

[WilcoWorld]

What would I do instead ? Hmm....

Maybe some biotech gig or something like that; its what my wifey did for years and she really dug it and made some nice coin doing it. My *dream job* would be to be a golf club pro, but there's little money in that.

Brewmaster also seems like a nice option.

I'll think on this and post again in a bit. Just woke up.

Heck, I might become a brewmaster yet...

 

[RustedFox]

I've lately decided to internally say scr3w it to the metrics, and instead focus on what I think is important (taking good care of patients). Trying to accomplish mutually exclusive goals will drive a sane man crazy. When they hired me, they hired a physician. That's what I intend to give 'em, not some automaton. Let 'em fire me if that's what it comes to (I doubt it will).

I'm on-board with this. I've been pretty vocal about it too when nursing staff does things like "hustle" me.

 

[Birdstrike]

Bird,
Would you still pick medicine again as a career? Would you recommend it to your kids? Have you thought about re-training in a different field?

I could give the knee jerk answer and easily say, "No", but it's not that simple. I don't regret any decisions I've made (career wise). You make the best decision at the time with the information you have and move on. Asking, "Would you do it over?" isn't a valid question because you don't get to do it over. If you keep kicking yourself with that thought (in high pitched whiny voice), "I should have done this, I should've done that..." because you think "the other" is so perfect, what would you do if you tried "the other" and it turned out as imperfect as that which you previously thought would be great, too?

I don't live my life that way. Do your best, go as far as you can, change course if needed, take the good with the bad and keep moving. Don't second guess yourself and don't let other "second-guessers" make you do the same.

Would I recommend it to my kids, or what you are really asking is: would I recommend it to you?

I have as many answers to that question, as there are people asking. I always promised I'd tell my kids not to go into Medicine (my kids are too young to be choosing careers right now, other than "unicorn trainer" or "barbie princess", two fields which I'm very bullish on right now.) Though I've told myself I'd discourage them, when they look up and say, "I want to do what you do, Daddy!" I find myself pround and wanting them to follow in my footsteps, thinking they'd be great at it some day. Will I push them towards it or dissuade them? No. Will I tell them the pro's and con's without candy coating it? Yes.

So what should they do, what should you do....?

Find what will make them (you) happy. What that is, only they (and you) can truly know. What I think, means nothing.

There are great things about being a doctor. There are tremendous, stresses, demands and downsides. Some people would love to be a movie star; others would hate the attention and scrutiny of fame. You have to find what's best for you.

That being said, I wouldn't recommend borrowing $250,000 then choosing the lowest paid specialty in medicine. I wouldn't recommend some specialties with brutal lifestyles. But again, what I think matters little. Some people like having to work all day, go home, get woken up a 2 am to come in a do the same surgery they've done 1,000 times, then have to work all day again with hardly any sleep, over and over again, for their whole life. Good. We need people to do that. Some specialties are wiser choices than others. That being said, are they all bad? No.

I do know that any "good" job, 6-figure job or desireable job will have hassles, headaches and challenges. There's no easy (legal) money.

Have I thought about retraining in a different field other than EM? Yes, and in fact I did. A different field other than Medicine? Thought about it. Haven't done it. Yet. (Probably won't, but wouldn't rule it out.)

I agree with RF. I have always said that EM is a good place to be but medicine is not a field I'd choose again.
For EM the thing that is killing the specialty is the now slavish adherence to self contradictory metrics. Every patient must be seen immediately, dispoed quickly, denied services and made blissfully happy. All while dealing with all the time sensitive issues that roll into the ER (STEMI=90 min, CVA=tPA in <60min from door, meningitis, testicular torsion, pneumonia, etc.).
Medicine as a field is getting buried in paperwork and insurance issues which increase overhead while reimbursement drops. It's a fatal cycle.

Agree, EPs are put in the most impossible situations, with the most unreasonable expectations and the least appreciation of any specialty. It's unacceptable, wrong and unsafe. If demands like these were place on commercial airline pilots, there would be a congressional investigation and hearings.

Those of you who say you'd not choose medicine again: what would you choose instead?

Here's the rub.

It's awesome to be the Wall Streeter... until the market crashes.
I know doctors who quit medicine to become lawyers.
I know lawyers who quit medicine to become doctors; businessmen who quit medicine to find a more meaningful career; doctors who quit medicine to make more money as businessmen.

It's easy to say "What I'm doing is terrible."
It's not that simple.

There's pro's, there's con's. Know them. Then pick what' right for you.

Find your path.

 

[FSU2013]

Have I thought about retraining in a different field other than EM? Yes, and in fact I did.

?

 

[RustedFox]

Heck, I might become a brewmaster yet...

Being involved in the restaurant/beverage business has always been on my list. Sports pub or something like that would be interesting to get into (I think). I've worked in every single position in a restaurant/bar (busboy, host, server, bartender, etc), and I'm familiar with the foibles of the food and beverage business.

Ideally ? Golf pro by day, barman by night. Sounds like a good life to me.

 

[Silent Cool]

Being involved in the restaurant/beverage business has always been on my list. Sports pub or something like that would be interesting to get into (I think). I've worked in every single position in a restaurant/bar (busboy, host, server, bartender, etc), and I'm familiar with the foibles of the food and beverage business.

Ideally ? Golf pro by day, barman by night. Sounds like a good life to me.

Tough business, though. One of my cousins was a brewmaster. That brew is now gone.
He's an EMT now.

 

[Silent Cool]

I could give the knee jerk answer and easily say, "No", but it's not that simple. I don't regret any decisions I've made (career wise). You make the best decision at the time with the information you have and move on.

There's pro's, there's con's. Know them. Then pick what' right for you.

Find your path.

Bird, thanks for the great response. 'preciate it.

 

[docB]

My dream job would be to be a distiller. I'd make docB's Old Fashioned Smokey Sippin' Whiskey. I would dress like Col. Sanders and never be 100% sober again.

realistically I wish I'd gone military and then law enforcement. I think I'd fit well in that field. When I was making carer choices 911 was a decade off so I had no way to know that the sacred cow for funding in 2013 would be federal law enforcement. But that's what I wish I'd done. I know there are people who have left law enforcement to come to medicine but as Birdstrike alluded to, everyone has to find their own thing.

 

[RustedFox]

Tough business, though. One of my cousins was a brewmaster. That brew is now gone.
He's an EMT now.

Yeah, food/beverage is tough, but there's little chance you'll be sued for malpractice, and if someone gets drunk/rude/hostile, you simply have police/security get them out of your hair... you don't have to kowtow to them and worry about their "satisfaction".

 

[Birdstrike]

... if someone gets drunk/rude/hostile, you simply have police/security get them out of your hair... you don't have to kowtow to them and worry about their "satisfaction".

This is not even remotely unique to the "medical field", but only to emergency medicine. Do you think an allergist kow tow's to a "drunk/rude/hostile" patient and worries about their "satisfaction"? Derm? Plastics? Rad onc? Cards? Office-based family practice?

Hell no.

Only EMTALA-ruled, hospital-based patient care. The businessmen use EMTALA as a sledgehammer to shake more dollars out of your tree.

It's wrong.

It's also bad for patients:

http://www.epmonthly.com/whitecoat/2012/02/a-death-knell-for-press-ganey/

 

[SpaceLeftBlank]

If not that...prob law...heck, may be going that route if medicine continues to suck.

Hmmm. I'm not sure I can recommend that, although I've run across a couple physicians-turned-lawyers (and one who does both) who seem happy enough.

 

[SpaceLeftBlank]

Yeah, food/beverage is tough, but there's little chance you'll be sued for malpractice, and if someone gets drunk/rude/hostile, you simply have police/security get them out of your hair... you don't have to kowtow to them and worry about their "satisfaction".

Spoken like someone who's never defended a "dram-shop" lawsuit before.

 

[la gringa]

ding Ding DING!

I've lately decided to internally say scr3w it to the metrics, and instead focus on what I think is important (taking good care of patients). Trying to accomplish mutually exclusive goals will drive a sane man crazy. When they hired me, they hired a physician. That's what I intend to give 'em, not some automaton. Let 'em fire me if that's what it comes to (I doubt it will).

i have the same philosophy. i tell my director the same. i do my best EVERY MINUTE OF EVERY SHIFT.

my priorities in a nutshell:
1. patient care quality
2. prioritizing sicker patients (only time speed is important)
3. patient satisfaction (med mal protection and physician satisfaction)
4. teamwork with nurses
5. speed/metrics

if a patient needs a 5 hr ED visit to feel better and avoid a transfer or admission and an ED bed/nurse/doc are available... WHO CARES IF THEY ARE THERE 5 HOURS??? if it's a busy night and the CT scanner is tied up, WHAT CAN I DO? cancel needed studies? if there are 5 psych pts in the department tying up beds and techs... WHAT CAN I DO ABOUT THAT? can go on and on, obviously.

right now i'm listening the nurses talking about "rounding" and "benchmark goal" and "behavioral change". i'm about to vomit. this ED is #1 or #2 every month in a large hospital system in pt satisfaction and likelihood to recommend. wtf?

 

[TheWeeIceMan]

What would I do instead ? Hmm....

Maybe some biotech gig or something like that; its what my wifey did for years and she really dug it and made some nice coin doing it. My *dream job* would be to be a golf club pro, but there's little money in that.

Brewmaster also seems like a nice option.

I'll think on this and post again in a bit. Just woke up.

I worked at a country club all through high school and college and was considering working my way up as a professional. The job and pay are pretty bad as an assistant pro, but once you land a head pro or director of golf position, the job can be pretty cush. My boss used to say his job was "the easiest way he could think of to make 6 figues." It's probably not what you guys are used to in EM, but you can make decent money if you find the right position/course.

 

[Birdstrike]

I worked at a country club all through high school and college and was considering working my way up as a professional. The job and pay are pretty bad as an assistant pro, but once you land a head pro or director of golf position, the job can be pretty cush. My boss used to say his job was "the easiest way he could think of to make 6 figues." It's probably not what you guys are used to in EM, but you can make decent money if you find the right position/course.

Awesome. I've been looking to transition into that exact field. Do you know of any openings for a golf pro that can occasionally break 100, winter rules, when the conditions are just right?




"And do you know what the Lama says? Gunga galunga...gunga -- gunga galunga." - Carl Spackler

 

[Substance]

i have the same philosophy. i tell my director the same. i do my best EVERY MINUTE OF EVERY SHIFT.

my priorities in a nutshell:
1. patient care quality
2. prioritizing sicker patients (only time speed is important)
3. patient satisfaction (med mal protection and physician satisfaction)
4. teamwork with nurses
5. speed/metrics

if a patient needs a 5 hr ED visit to feel better and avoid a transfer or admission and an ED bed/nurse/doc are available... WHO CARES IF THEY ARE THERE 5 HOURS??? if it's a busy night and the CT scanner is tied up, WHAT CAN I DO? cancel needed studies? if there are 5 psych pts in the department tying up beds and techs... WHAT CAN I DO ABOUT THAT? can go on and on, obviously.

right now i'm listening the nurses talking about "rounding" and "benchmark goal" and "behavioral change". i'm about to vomit. this ED is #1 or #2 every month in a large hospital system in pt satisfaction and likelihood to recommend. wtf?

Can't you guys just say no? Sure, the admin might fire you, but emerg is a very portable field. Mba types need to be told to stick to their field while you stick to yours. The minute they make any suggestion or demand that interferes with patient care, they are practicing medicine and that's illegal. Tell them to shove it.

 

[Tiger26]

To Birdstrike and others, do we have the ability to countersue for lawsuits? Seems like it would be reasonable to ask for attorney's fees, time involved, and pain suffering.

Having had a pretty vile interaction with drug seeking patient recently that ruined my evening, I can empathize with how much it drags you down to go through one of these.