The problem isn't with malpractice lawyers, but with doctors making mistakes

mzeroapplicant

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I'm going to be a doctor, but that doesn't mean I've lost all sense of objectivity. The more I investigate the malpractice issue the more I think it's not so much a problem with the legal system being out of control, but rather a result of real errors among physicians. This article is obviously a bit partisan, but it does present a summary of the really good evidence that the medical establishment needs to focus more on how to make less mistakes and less on capping malpractice claims:

http://www.slate.com/id/2145400/

Discuss.....
 

SanDiegoSOD

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Well, though the issue at hand is not as simple as the title of this thread, it certainly gets to the heart of the matter. Too many errors are made in medicine, and sadly, many are covered up and buried instead of addressed.

But the IOM also found that more than 90 percent of these deaths are the result of failed systems and procedures, not the negligence of physicians.
(taken from the Clinton/Obama article in NEJM)

The medical profession will continue to suffer from malpractice litigation until it cleans up its act. That's a broad statement that implies that the medical community can act as a whole, which is completely incorrect. The fragmented nature of the health care "system" doesnt allow anything of the sort to happen. But as one can see from the examples mentioned in the Slate article, pieces of the system can act and implement comprehensive, process-based change that improves medical care, such as what happened with Anesthesiology. "The sky is falling" cries regarding malpractice that come from doctors and lawmakers will continue to be a self-fulfilling prophecies until change is implemented.
However, certain things can be done in the short term to improve the tort systems, and that's an issue that maybe I'll have time to address later.
 

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mzeroapplicant said:
I'm going to be a doctor, but that doesn't mean I've lost all sense of objectivity. The more I investigate the malpractice issue the more I think it's not so much a problem with the legal system being out of control, but rather a result of real errors among physicians. This article is obviously a bit partisan, but it does present a summary of the really good evidence that the medical establishment needs to focus more on how to make less mistakes and less on capping malpractice claims:

http://www.slate.com/id/2145400/

Discuss.....
I believe the article does a good job of highlighting the dynamics of the issue. It's not just frivolous cases. It's not just doctors making mistakes. But a combination of the two is amounting to headaches for both the legal system and medical establishment. The issue should be attacked on each side accordingly.
 
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mzeroapplicant said:
I'm going to be a doctor, but that doesn't mean I've lost all sense of objectivity. The more I investigate the malpractice issue the more I think it's not so much a problem with the legal system being out of control, but rather a result of real errors among physicians. This article is obviously a bit partisan, but it does present a summary of the really good evidence that the medical establishment needs to focus more on how to make less mistakes and less on capping malpractice claims:

http://www.slate.com/id/2145400/

Discuss.....
I think it's both problems. Doctors make errors, and a lot of civil lawsuit lawyers/clients are blood-sucking vampires (no offense to any lawyers on this forum... I know there are plenty of lawyers who have integrity.)

I don't know how many times I've heard crazy lawsuits because some person had a fluke accident. I've been working in nursing in the last few years, and there are a lot of people out there just looking for something to sue about. Some examples:

#1 - Huge fat woman who refused to use a bedpan argued and argued and argued that she should be able to get out of bed and use a commode. We said no many many times. PT said no. Her docs said no. So, she decided to **** her bed and then refuse to let us change her sheets. She was insane. So we tried dangling her at the side of the bed. That worked alright. We tried standing her up without walking. That worked alright. So, she convinced the nursing staff and the doctor that she could get up to the commode. As soon as we took a step (I'm talking this woman was 400 pounds) she buckled and fell. She sued the hospital, she sued the doctor, and she sued her nurse.

#2 - Best OB doc I know was delivering a baby. The patient was having her 3rd natural childbirth, with the first 2 going flawlessly. She was afebrile, complained of no pain other than contractions, fetal heartbeat was normally irregular, etc. etc. Everything was going perfectly. All of a sudden, her uterus burst. The odds of that happening are around 1 in 10,000, and she had no predisposing factors. The mother survived, and the child died. They sued the doctor. I asked him what happend, and he said he paid her off (settled out of court). I asked him why the heck he would do that! He told me "My lawyer said the medical evidence was highly in my favor, I had done everything correctly, and I had a 90% chance of winning the case in court. So, I asked my lawer 'So that means I have a 10% chance of losing, why?'" Lawyer said "You'd be tried by a jury of human beings... there's never a 100% chance of winning." The doctor immediately said "Settle. I'm not risking my career on a 10% chance."

The entire US is sue happy. People spill coffee on themselves at a coffee shop, burn their skin, and sue the coffee shop. That's the kind of country we live in. Those types of suits very often settle out of court, which costs money. Less money than going to court, but it costs money. That money comes out of insurance. Who pays for doctor's malpractice insurance? Patients do, with higher fees charged by the doctor.

I am positive you could come up with just as many examples for true medical errors as I could come up with bogus malpractice suits made by greedy americans. I think they are both a part of the problem. Unfortunately for us, the only part we can control is our own performance, and I agree with you, we should always be taking steps to limit our mistakes. Our mistakes have huge consequences in people's lives sometimes. So, I'm partially agreeing with you, but I don't think you should take away any of the blame from the greedy American public.

One last point. I often times feel that the expectations for doctors is unrealistic. Doctors are human beings. In every, single job out there that is done by a human, people screw up daily. That includes medicine too. Often times residents will be in hour 20 of a 30 hour shift, and they might not have had enough coffee. Is that their fault? Humans make errors, especially when they are sleep deprived and rushed. The american public wants doctors to be all of the following:

1.) Immediately accessible 24/7.
2.) To not be busy, and spend lots of time with them.
3.) To never make any mistakes.

We're not robots. We're all going to make mistakes. I think medical staff cover them up so much because if there's any hint of an error, in this country that means you'll be sued out of your ass and possibly lose your job. The penalties are too harsh for doctors to want to be honest. Every single doctor I've ever talked to has either been sued, or has a colleague who has been. Most of them have been sued. They aren't allowed to make mistakes, so why would they ever admit to one if they want to continue practicing?
 

Dr. Weebs

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mzeroapplicant said:
I'm going to be a doctor, but that doesn't mean I've lost all sense of objectivity. The more I investigate the malpractice issue the more I think it's not so much a problem with the legal system being out of control, but rather a result of real errors among physicians. This article is obviously a bit partisan, but it does present a summary of the really good evidence that the medical establishment needs to focus more on how to make less mistakes and less on capping malpractice claims:

http://www.slate.com/id/2145400/

Discuss.....
An interesting point that the article glossed over. Of the cases where something negative occurred after care, only 60% of them were from physician wrong-doing. And that's after 10% were thrown out already because there was no medical injury. That was what I was trying to say earlier. That means nearly half of the lawsuits were bogus!!! That's a huge amount!

Interesting statistics in that article... the methodology seems pretty conservative, and yet there were still a lot of errors. I do agree that is pretty scary.
 

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Dr. Weebs said:
An interesting point that the article glossed over. Of the cases where something negative occurred after care, only 60% of them were from physician wrong-doing. That was what I was trying to say earlier. That means 40% of the lawsuits were bogus!!! That's a huge amount!
Um no, the Harvard med study concluded "They found that more than 90 percent of the claims showed evidence of medical injury, which means they weren't frivolous.". So only 10% were bogus. It's just that the physician was liable in 60%.
 

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Dr. Weebs said:
An interesting point that the article glossed over. Of the cases where something negative occurred after care, only 60% of them were from physician wrong-doing. And that's after 10% were thrown out already because there was no medical injury. That was what I was trying to say earlier. That means nearly half of the lawsuits were bogus!!! That's a huge amount!

Interesting statistics in that article... the methodology seems pretty conservative, and yet there were still a lot of errors. I do agree that is pretty scary.
Again, only 10% were bogus. 40% were not bogus, but the physician was not determined to be liable for wrongdoing. That doesn't mean that there wasn't a real injury, a frivolous suit, nor does it mean that someone other than the physician was not ultimately culpable. Suing someone and losing does not make the suit frivolous. Suing someone with no legitimate claim or cause of action makes it frivolous. That was not what Harvard found here.
 

Dr. Weebs

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Law2Doc said:
Um no, the Harvard med study concluded "They found that more than 90 percent of the claims showed evidence of medical injury, which means they weren't frivolous.". So only 10% were bogus. It's just that the physician was liable in 60%.
I'm confused. I know you know more about law than I do so I'm hoping you can make this more clear to me.

What is defined as "medical injury"? Does that mean because of something a medical staff member did incorrectly that there was injury? Or does it mean that there was just some sort of complication due to normal risks of medical procedures? Because if it's the latter that's why I'm arguing here.

Example:

The case I mentioned earlier where the OB delivered a baby and had the uterus burst on him, and the baby died... would that be defined as "medical injury", even though it was just a fluke, and part of the risks of childbirth with no error from the medical staff? There was a death involved... I would assume that technically in a case write-up that would be considered a medical injury, since a baby died during a medical procedure.

A little help? :)
 

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Well, ok, I do admit doctors definitely make errors. Should we condone that? Obviously not, but we have to accept it. We, as doctors, are nothing more than human. Negligent errors are unacceptable, but honest errors will happen. Most other professions are lucky and their errors rarely end up in the morgue. Medicine isn't so lucky, but it's practictioners are still only human.

When malpractice cases take on a true negligent error, I have little problem with those involved other than the physician who didn't care enought to avoid this negligence. What gets me are the succesful cases that attack physicians doing their job. Two examples:

A pediatrician I know had done a simple sports physical for a young boy who wanted to play basketball. He found a heart defect and signed the form stating that the boy was not in appropriate physical condition to play basketball. The physician was subsequently sued for the psychological trauma this boy went through for not playing basketball. The case was eventually settled out of court for a couple hundred thousand. Now come on, was he supposed to coddle the kid's feelings or let him die of a heart attack on a basketball court?

Second, is really just a bunch of documented cases. Several physicians have been sued and settled because they estimated a terminal patients time left incorrectly. When the patient surpassed this expectation, they sued the doctor for being wrong. Shouldn't you be thrilled that you surpassed the expectations and have a little extra time?

If a doctor leaves a towel in the abdomen when closing up on surgery, by all means sue. But these are only part of the cases and often never end up as malpractice cases because the doctor regrets his mistake and is up front and honest with the patient. They fix their mistake and the parties move on. It the cases like the ones I mentioned that give malpractice lawyers a bad name. These cases never should even enter the law office and if a patient does bring them to the lawyer, they should have the courtesy to fellow professionals to make sure they don't leave the office.

To the OP and various others...do you really think we'll never make a mistake? We will. We'll all probably end up killing at least one person because of a stupid mistake. If I could change it, I would, but it's going to happen. If we are sued everytime we make a mistake, we will be very poor. Rather than coming down on your colleagues, why not acknowledge that we are all humans and work to cut down on the mistakes we do make, but don't attack them and say that it's all their fault.
 

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Dr. Weebs said:
I'm confused. I know you know more about law than I do so I'm hoping you can make this more clear to me.

What is defined as "medical injury"? Does that mean because of something a medical staff member did incorrectly that there was injury? Or does it mean that there was just some sort of complication due to normal risks of medical procedures? Because if it's the latter that's why I'm arguing here.

Example:

The case I mentioned earlier where the OB delivered a baby and had the uterus burst on him, and the baby died... would that be defined as "medical injury", even though it was just a fluke, and part of the risks of childbirth with no error from the medical staff? There was a death involved... I would assume that technically in a case write-up that would be considered a medical injury, since a baby died during a medical procedure.

A little help? :)

According to the link attached to that Harvard Study reference, "More than 90% involved a physical injury, which was generally severe (80% resulted in significant or major disability and 26% resulted in death). The reviewers judged that 63% of the injuries were due to error. The remaining 37% lacked evidence of error, although some were close calls.".
But again, the word frivolous doesn't just mean a losing case, it means a case that you cannot win, aka bogus. Frivolous has a very specific meaning in law, and lawyers can be sanctioned financially for bringing frivolous suits. The 37% described here were not frivolous. Certainly a close call is not. The other 10% were, apparently. So society should find a way force the legal system to eliminate that 10%. And doctors need to find a way to reduce that 63%. Clearly the doctors have the bigger job here, according to the Harvard study.
 

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The title of this thread is one of those meaningless, pointless attempts at profundity. Saying, "the problem is that doctors make mistakes" is like saying, "the problem is that people get sick." What a waste of time.
 

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newguy357 said:
The title of this thread is one of those meaningless, pointless attempts at profundity. Saying, "the problem is that doctors make mistakes" is like saying, "the problem is that people get sick." What a waste of time.
All online banter is a waste of time. But there are very real studies going on in various specialties keyed to limiting mistakes and lowering negligence rates. I think Gawande's book complications has a discussion of this with respect to anesthesiology. (If I'm remembering the right source). And the whole point of M&M meetings is to try and do this. So a lot of people in this profession waste their time on this.
 
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Law2Doc said:
According to the link attached to that Harvard Study reference, "More than 90% involved a physical injury, which was generally severe (80% resulted in significant or major disability and 26% resulted in death). The reviewers judged that 63% of the injuries were due to error. The remaining 37% lacked evidence of error, although some were close calls.".
But again, the word frivolous doesn't just mean a losing case, it means a case that you cannot win, aka bogus. Frivolous has a very specific meaning in law, and lawyers can be sanctioned financially for bringing frivolous suits. The 37% described here were not frivolous. Certainly a close call is not. The other 10% were, apparently. So society should find a way force the legal system to eliminate that 10%. And doctors need to find a way to reduce that 63%. Clearly the doctors have the bigger job here, according to the Harvard study.
This post pretty much sums up my feelings on the issue. However, if you read the actual study it comes out much closer than that, they gloss over cases settled out of court, threats of litigation that required a lawyer but were dropped before filing, the cost of defensive medicine etc. This issue is impossibly complex to grasp in a single study. I think to say we should address one side of the issue to the exclusion of the other (in general, I know you're not saying this) is idiotic.
 

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Law2Doc said:
Again, only 10% were bogus. 40% were not bogus, but the physician was not determined to be liable for wrongdoing. That doesn't mean that there wasn't a real injury, a frivolous suit, nor does it mean that someone other than the physician was not ultimately culpable. Suing someone and losing does not make the suit frivolous. Suing someone with no legitimate claim or cause of action makes it frivolous. That was not what Harvard found here.
So based on that math roughly half of all suits involve no culpability on the fault of the physician.... that seems like a substantial proportion still.
 

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I agree that doctors make mistakes, but let's remember that doctors are just regular schmucks like us. Oh wait...that's right...I'm a regular s---- and I'll be a doc in 3 years time.

Sadly, the doctors who make mistakes aren't the ones who get sued and the ones who get sued aren't the ones making the big mistakes.
 

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Law2Doc said:
According to the link attached to that Harvard Study reference, "More than 90% involved a physical injury, which was generally severe (80% resulted in significant or major disability and 26% resulted in death). The reviewers judged that 63% of the injuries were due to error. The remaining 37% lacked evidence of error, although some were close calls.".
But again, the word frivolous doesn't just mean a losing case, it means a case that you cannot win, aka bogus. Frivolous has a very specific meaning in law, and lawyers can be sanctioned financially for bringing frivolous suits. The 37% described here were not frivolous. Certainly a close call is not. The other 10% were, apparently. So society should find a way force the legal system to eliminate that 10%. And doctors need to find a way to reduce that 63%. Clearly the doctors have the bigger job here, according to the Harvard study.
I don't think this is a fair comparisson. Please correct me if i'm wrong but are you saying that 10% of all lawsuits (in the medical arena) are frivolous. I highly dought that 10% of all pt encounters result in some sort of medical error. Who again has the bigger job here?
 

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Law2Doc said:
According to the link attached to that Harvard Study reference, "More than 90% involved a physical injury, which was generally severe (80% resulted in significant or major disability and 26% resulted in death). The reviewers judged that 63% of the injuries were due to error. The remaining 37% lacked evidence of error, although some were close calls.".
But again, the word frivolous doesn't just mean a losing case, it means a case that you cannot win, aka bogus. Frivolous has a very specific meaning in law, and lawyers can be sanctioned financially for bringing frivolous suits. The 37% described here were not frivolous. Certainly a close call is not. The other 10% were, apparently. So society should find a way force the legal system to eliminate that 10%. And doctors need to find a way to reduce that 63%. Clearly the doctors have the bigger job here, according to the Harvard study.
I never used the word frivolous. I said "bogus". when 40% lack evidence of error for injury, and 10% never had injury to begin with, that's half of the cases wasting time and money in the medical/judicial field. There are also tons of cases settled out of court which are hard to categorize.

My point is, is that there's tons of fault on both sides. That's the way of the world I guess...
 

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ESzczesniak said:
A pediatrician I know had done a simple sports physical for a young boy who wanted to play basketball. He found a heart defect and signed the form stating that the boy was not in appropriate physical condition to play basketball. The physician was subsequently sued for the psychological trauma this boy went through for not playing basketball. The case was eventually settled out of court for a couple hundred thousand. Now come on, was he supposed to coddle the kid's feelings or let him die of a heart attack on a basketball court?


a COUPLE HUNDRED THOUSAND??
he let the bastards take more than his yearly salary. That's like grand theft and extortion man.



So, are doctors this easy to take advantage of?
Are doctors so afraid of smudging their record that they'll always settle out of court?
.... because if that's the case, I'm about to make a lot of appointments with random doctors and sue them for whatever stupid reason I can think of. 99% chance they'll settle right? :thumbup:
 

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No, the problem is that the fear of litigation leads physicians to practice defensive medicine, often throwing common sense out the window and relying on expensive tests and imaging when a good history and physical exam would suffice.

This jacks up the cost in ways you wouldn't believe.

Not to mention all the time we spend on CYA paperwork so we can prove that we told the patient not to use a barbeque indoors or to run with a sharp stick.
 

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Law2Doc said:
Um no, the Harvard med study concluded "They found that more than 90 percent of the claims showed evidence of medical injury, which means they weren't frivolous.". So only 10% were bogus. It's just that the physician was liable in 60%.
"Medical Injury" and "bogus" are very relative here. I've been to various malpractice cases within the courtroom and read about others/spoke with physicians about others (I'm not claiming to be an expert here by any means). I would just like to say that one thing all cases had in common was a "Standard of Care." As long as a physician abides by the standard of care with regards to the procedure at hand, he/she stands a good chance of winning the case. The problem with "standard of care" is that it too is a relative term. The Standard of care is constantly changing and is primarily based on the opinions of the "experts." Mistakes are obviously going to happen in any profession...it's just very unfortunate that the mistakes in medicine have such terrible consequences.

On another note: even if the ruling is for the plaintiff, the claim can still be a bogus one. So the stats can be swayed in either direction.
 

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No, the problem is that the fear of litigation leads physicians to practice defensive medicine, often throwing common sense out the window and relying on expensive tests and imaging when a good history and physical exam would suffice.

This jacks up the cost in ways you wouldn't believe.

Not to mention all the time we spend on CYA paperwork so we can prove that we told the patient not to use a barbeque indoors or to run with a sharp stick.
Excellent point.
 

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Let me preface this by saying that I am a lawyer and practiced in NY for three years. In addition, there are a number of legitimate malpractice cases brought against negligent physicians every year (for example, the physicians who removed the wrong limb). These cases make the papers and we know that they are out there. However, we cannot dispute that there are a number of frivolous cases brought each year as well and many judges are loathe to dismiss them or order sanctions against attorneys for bringing such suits because many of these cases turn on a review of facts (and facts are the purview of a jury). Many of these are settled because the cost of trying them often amount to 50K (if you think this number is wrong consider many witnesses make more than $500+/hr for their testimony and many of these cases involve the battle between expert witnesses).

Also, injury is very broad. There are many negative outcomes that occur through no fault of the doctor. Lawsuits must prove causation. The problem is that juries are human. They look at the plaintiff who is all too frequently the common man and then they look at the defendant-- a physician and an insurance company. Next to pharmaceutical companies, there is no bigger whipping boy than the insurance companies. Deep pockets. Dollar signs. It is only human to want to help the downtrodden-- the construction worker who can't lift the heavy cement packs to keep his job or the waitress who can;t work on her feet for 10 hours any more. That is the dilemma.

Unfortunately, the fear of litigation likely costs society more in terms of defensive medicine than medical error and there is not a really good way to measure such costs.

Consider also that traditional forums (i.e., M&M and autopsies) for discussing errors and preventing their future commission by other practitioners have been severely curtailed by malpractice litigation. Has anyone considered why thirty years ago 95% of patients who died following surgery had an autopsy performed and today the numbers are closer to 5%? No one wants to know if an error was made because it can ensure a high pay day. This is dangerous for our profession and the future of medicine.
 
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vtucci said:
Has anyone considered why thirty years ago 95% of patients who died following surgery had an autopsy performed and today the numbers are closer to 5%? No one wants to know if an error was made because it can ensure a high pay day. This is dangerous for our profession and the future of medicine.
This cuts two ways -- either there is a fear of litigation for the unknown or the fear of litigation due to the known. i.e. You wouldn't do an autopsy so as to not learn of unknown mistakes but you also might not if you didn't want to uncover mistakes that you know must have occurred. The answer is not to shut down the litigation part of the checks and balances system here, it is to get more M&M type privileges to discuss and unearth errors so they are hopefully not repeated, or so ways can be found to minimize them. But if negligence (actions below the reasonable standard of care) occurred and someone was seriously injured as a result, he should get a remedy. You can't have it both ways.
 

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Background info: My mom is a malpractice defense attorney. She was a nurse for 10 years before becoming an attorney to defend doctors and hospitals. I've been working at the firm for my year off between undergrad and med school.

I've got to say that we get a ton of pointless lawsuits. Most of the time, the doctor feels he was providing the "standard of care" and feels confident that he would win at trial, but settles to save time, money, and stress. It costs so much more to actually go through the entire prep and trial to salvage your good name than it does to just settle. It's sad, but an economic truth.

And it's interesting to see who is named in the suit and who is subsequently dropped. A lot of times the healthcare providers with the large insurance policies are kept and the ones with little insurance are dropped. Agency nurses are a huge target because they often carry million dollar policies.

While I can completely understand the need to assign blame for negative experiences in the hospital (it only seems natural to want someone to pay when your baby is born with a birth defect, or you are sent home from the ER without your real problem being diagnoses/treated), I think our society just hasn't come to terms with the fact that doctors are people, not magicians. Sometimes the doctor just makes a human mistake, sometimes the patient's anatomy is different from the norm and the procedure is instantly more difficult and riskier (and this is just an observation, not a judgment call, but it seems that most of the patients that end up suing are obese), sometimes patients will not present with signs and symptoms that can lead a competent physician to the correct diagnosis. I'm all for doctors paying for mistakes that another reasonable physician in his shoes wouldn't have made, and certaintly yank those licenses from a negligent or malicious doctor, but there really is a litigation problem here.

I should say though, that since Proposition 12 passed in TX a few years ago, there has been a significant decrease in the number of cases, but the ones that go through tend to me severe neurological things and end up with much larger pay outs.

Just my thoughts.
 

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maybe someone has already mentioned this, but it has been shown that patients that "perceive" that their doctor really "cares" about them, end up sueing WAY less.

has anyone here ever been to a doctor that acted like he/she just didn't give a sh!t? come on you guys...think about it. how did it make you feel? mad, right? (to an extent) now imagine how pissed you'd be if the doc screwed something up...even if minor. wouldn't it make you REAL mad?


the bottom line it this (and this is something you can't learn in medschool)....


people want to FEEL like their doctor truly cares and has their best interest at heart--ALWAYS. yes, we get busy...yes, we can't spend an hour with the old lady who wants to tell you her damn life story....yes, we are overworked and cranky sometimes....but let's not forget how far in our professions we can get with an amazing, compassionate, and loving bedside manner.

there is this book called "How to love your patients" written by an ER doc. he basically reiterates what i have just tried to say.

people do not want to go to cold, unfeeling, robotic doctors. they want to go to a human being.....maybe if we stop acting robotic and start displaying a little more personality and warmth, we might just get sued a little less...no?

just food for thought
 

RxnMan

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lil pook said:
maybe someone has already mentioned this, but it has been shown that patients that "perceive" that their doctor really "cares" about them, end up sueing WAY less.

has anyone here ever been to a doctor that acted like he/she just didn't give a sh!t? come on you guys...think about it. how did it make you feel? mad, right? (to an extent) now imagine how pissed you'd be if the doc screwed something up...even if minor. wouldn't it make you REAL mad?


the bottom line it this (and this is something you can't learn in medschool)....


people want to FEEL like their doctor truly cares and has their best interest at heart--ALWAYS. yes, we get busy...yes, we can't spend an hour with the old lady who wants to tell you her damn life story....yes, we are overworked and cranky sometimes....but let's not forget how far in our professions we can get with an amazing, compassionate, and loving bedside manner.

there is this book called "How to love your patients" written by an ER doc. he basically reiterates what i have just tried to say.

people do not want to go to cold, unfeeling, robotic doctors. they want to go to a human being.....maybe if we stop acting robotic and start displaying a little more personality and warmth, we might just get sued a little less...no?

just food for thought
Are you saying it actually pays to be nice?
 

Law2Doc

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RxnMan said:
Are you saying it actually pays to be nice?
I'd rather take my chances with the lawyers (the enemy you know). :laugh:

Actually there are quite a few studies suggesting that those doctors who take the time to befriend their patients and become a confidant, not just caregiver, get sued less by those patients. But they have to spend a lot more time per patient, and so generate a lot less business revenue. It would be curious to see whether on average the cost of litigation offsets the cost of being nice. :)
 

Dr. Weebs

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Law2Doc said:
I'd rather take my chances with the lawyers (the enemy you know). :laugh:

Actually there are quite a few studies suggesting that those doctors who take the time to befriend their patients and become a confidant, not just caregiver, get sued less by those patients. But they have to spend a lot more time per patient, and so generate a lot less business revenue. It would be curious to see whether on average the cost of litigation offsets the cost of being nice. :)
I know you're the law expert... but I really hope that everyone will hear what I'm about to say. I feel like it's so important. I've worked thousands of hours in nursing... and have been spending the entire time trying to improve my bedside manner for when I become a doctor.

I don't really know if it takes that much more time to make somebody feel cared for.

These things will take you a LONG way with patients: A confident and friendly introduction, a positive attitude, active body language (no hands in pockets etc... passive is bad), good eye contact, use of physical contact (handshake, hand on the shoulder, doing a light physical exam even if not necessary), active listening, remembering personal things about the patient (I write down little notes in my charting so that when I enter the room I know a little something about them, like their dog's name, or what their spouse does for a living etc...), a few encouraging words before you leave, and end with a handshake! You can do all of those in a 5 minute visit with a patient, it just takes some thought and some practice.

However, 5 minutes spent doing an exam while hardly speaking to the patient, talking down to them when you do speak, not introducing yourself, not shaking their hand, not looking them in the eye when they speak, not explaining things... You get the point.

If you've only got 5 minutes, you've only got 5 minutes. How you spend it, on the other hand...
 

Law2Doc

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Dr. Weebs said:
I know you're the law expert... but I really hope that everyone will hear what I'm about to say. I feel like it's so important. I've worked thousands of hours in nursing... and have been spending the entire time trying to improve my bedside manner for when I become a doctor.

I don't really know if it takes that much more time to make somebody feel cared for.

These things will take you a LONG way with patients: A confident and friendly introduction, a positive attitude, active body language (no hands in pockets etc... passive is bad), good eye contact, use of physical contact (handshake, hand on the shoulder, doing a light physical exam even if not necessary), active listening, remembering personal things about the patient (I write down little notes in my charting so that when I enter the room I know a little something about them, like their dog's name, or what their spouse does for a living etc...), a few encouraging words before you leave, and end with a handshake! You can do all of those in a 5 minute visit with a patient, it just takes some thought and some practice.

However, 5 minutes spent doing an exam while hardly speaking to the patient, talking down to them when you do speak, not introducing yourself, not shaking their hand, not looking them in the eye when they speak, not explaining things... You get the point.

If you've only got 5 minutes, you've only got 5 minutes. How you spend it, on the other hand...
Totally agree with you. But I suspect that to actually reduce lawsuits you are going to need to go well above and beyond the 5 minutes (however well you use them). There will be patients who will still feel you don't care if you cut them off at 30 minutes of rambling. (we had clients like this in law too, but didn't matter because we billed by the hour). The average time a doctor spends with a patient in an office visit is probably about half the time the patient thinks you should be spending. I'm pretty sure those doctors who avoided lawsuits due to befriending their patients spent substantially longer.
 

lil pook

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i have had many doctors tell me that if you usually just let the patient speak without interrupting them, they will be finished within 5 minutes or so-usually. of course you'll always get the lonely old lady who wants to ramble for hours, and in this instance, then i agree that trying to direct the patient through the conversation is important. however, how many doctors do this?

i'm sure you've all heard that we interrupt patients on the average, every 15 seconds (or something like that). i have experienced this personally with about 70% of the doctors i have ever been to. i had this one doctor (an orthopeodic surgeon) who was so rude and interrupted me so often, that i actually started just writing down my complaints and handing them to him when i saw him!! that's how bad he was!! it got to the point where i just started to hate him for being so rude, and eventually went to someone else. and thats too bad, cuz he lost out on a 20 thousand dollar surgery! :laugh:

this is an extreme example, but i just wanted to show how even something like interrupting people can really piss a person off. i mean, its just common manners and decency not to do so...besides extremely professionally rude if you do.

don't ya think?
 

MacGyver

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Med mal will continue to be a problem as long as doctors get paid 10 times more money for being "expert whores" than they get for treating patients.

Its a tremendous incentive to lie/mislead juries.
 

MacGyver

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VPDcurt said:
"I would just like to say that one thing all cases had in common was a "Standard of Care." As long as a physician abides by the standard of care with regards to the procedure at hand, he/she stands a good chance of winning the case. The problem with "standard of care" is that it too is a relative term. The Standard of care is constantly changing and is primarily based on the opinions of the "experts."
"standard of care" as applied to malpractice law is a myth conjured up by trial lawyers.

lets examine this more closely.

A "standard" cannot be set by one person. A "standard" is set by a community, an organization, such as ACOG or AAP.

So the real question here is do you really need to prove a "standard" was broken to bring a lawsuit or to win at trial?

The answer to this is ABSOLUTELY NOT. All the plaintiff has to do is present an expert who says he disagrees with the defendant. Thats ALL that is required. You dont have to show jack about breaking a "standard" of care.

The few times that organizations have tried to set standards, it has done nothing to curb lawsuits. Take for example ACOG and cerebral palsy lawsuits. ACOG published a set of guidelines for managing fetal distress/asphyxia a few years back, in the hopes that if doctors followed the guidelines, it would reduce their lawsuit risk. ACOG poured over thousands of medical studies and reached a consensus statement of practice. A bona fide true "standard of care" that pertains directly to perinatal distress.

Of course, ob/gyns were encouraged by the guidelines by ACOG. The vast majority started using them as the "standard of practice."

Now, given this trend, you would expect the # of CP lawsuits to fall right? WRONG. IN fact, lawsuits INCREASED after the ACOG established this standard of practice.

So how did lawyers get around this? Isnt med mal supposed to be about breaking a "standard" of care? If an ob/gyn followed the ACOG standard, then surely they cant be guilty of breaking a standard can they?

The lawyers got around this by hiring expert whores who claimed (for ungodly sums of money, up to 10X what they make in clinical practice) that the ACOG standard was in error. Bingo bango, problem solved, allowing the cash cow of CP cases to continue unabated.

"standard of care" is a unicorn that does not exist in the real world
 

Law2Doc

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MacGyver said:
"standard of care" as applied to malpractice law is a myth conjured up by trial lawyers.

lets examine this more closely.

A "standard" cannot be set by one person. A "standard" is set by a community, an organization, such as ACOG or AAP.

So the real question here is do you really need to prove a "standard" was broken to bring a lawsuit or to win at trial?

The answer to this is ABSOLUTELY NOT. All the plaintiff has to do is present an expert who says he disagrees with the defendant. Thats ALL that is required. You dont have to show jack about breaking a "standard" of care.

The few times that organizations have tried to set standards, it has done nothing to curb lawsuits. Take for example ACOG and cerebral palsy lawsuits. ACOG published a set of guidelines for managing fetal distress/asphyxia a few years back, in the hopes that if doctors followed the guidelines, it would reduce their lawsuit risk. ACOG poured over thousands of medical studies and reached a consensus statement of practice. A bona fide true "standard of care" that pertains directly to perinatal distress.

Of course, ob/gyns were encouraged by the guidelines by ACOG. The vast majority started using them as the "standard of practice."

Now, given this trend, you would expect the # of CP lawsuits to fall right? WRONG. IN fact, lawsuits INCREASED after the ACOG established this standard of practice.

So how did lawyers get around this? Isnt med mal supposed to be about breaking a "standard" of care? If an ob/gyn followed the ACOG standard, then surely they cant be guilty of breaking a standard can they?

The lawyers got around this by hiring expert whores who claimed (for ungodly sums of money, up to 10X what they make in clinical practice) that the ACOG standard was in error. Bingo bango, problem solved, allowing the cash cow of CP cases to continue unabated.

"standard of care" is a unicorn that does not exist in the real world
While I sort of agree with you, each side of a lawsuit presents an expert who indicates what the standard of care is. These are all doctors we are talking about -- the lawyers, plaintiffs, judges are not really involved in this debate, they just put their experts up there and let them go at it. Not infrequently the juries believe the defense's expert as opposed to the plaintiff, BTW. So it's less of a unicorn and more of a zebra -- it can be either black with stripes or white with stripes, depending on who puts on a more convincing show.
But when it all comes down to it, the reason doctors tend to be easy targets, is that some of their brethren make truly excellent witnesses against them.
 

obake_at_night

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lil pook said:
i have had many doctors tell me that if you usually just let the patient speak without interrupting them, they will be finished within 5 minutes or so-usually. of course you'll always get the lonely old lady who wants to ramble for hours, and in this instance, then i agree that trying to direct the patient through the conversation is important. however, how many doctors do this?

i'm sure you've all heard that we interrupt patients on the average, every 15 seconds (or something like that). i have experienced this personally with about 70% of the doctors i have ever been to. i had this one doctor (an orthopeodic surgeon) who was so rude and interrupted me so often, that i actually started just writing down my complaints and handing them to him when i saw him!! that's how bad he was!! it got to the point where i just started to hate him for being so rude, and eventually went to someone else. and thats too bad, cuz he lost out on a 20 thousand dollar surgery! :laugh:

this is an extreme example, but i just wanted to show how even something like interrupting people can really piss a person off. i mean, its just common manners and decency not to do so...besides extremely professionally rude if you do.

don't ya think?
You know I had the same thing happen to me. I saw an orthopod for a foot disorder. He interupted my questions and wouldn't listen when I mentioned my symptoms. When he taught me how to do some calf stretches, I had my left foot positioned in the wrong way. To add injury to insult, (usually it is the other way around), he kicked my left foot which happened to be my sore foot to the side. He gave me an off the wall diagnosis. I had absolutely NO symptoms related to the diagnosis that he gave me. Not even one.

Eventually, I went to see more specialists and later attended physical therapy. All of these clinicians disagreed with the ortho doc. The physical therapist mentioned that my complaints about this doc were not isolated. Now, I make sure that people I know avoid this doc like the plague.
 
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