Wednesday, December 06, 2006

CYA (Cover Your Ass)

At CME conference today, we had an interesting if not perturbing but totally relevant subject. At least to doctors in north America. Medical malpr@ctice. Something that, on average, most doctors face at least once in their careers. Perturbing because the lawyer speaking made us realize how litiginous society has become, and how really, the only way to avoid someone trying to sue you, is to quit working. And even that doen't always work (think neighbour slipping on ice and falling on your sidewalk).
Kinda brings me back to that time when a patient tried to pull a fast one.
I had suggested the patient undergo a diagnostic procedure. The interventionalist explained to him the risks and potential complications, and he consented and wanted to proceed. And unfortunately a complication occurred, not due to negligence or lack of expertise, but sheer dumb luck (no invasive procedure is 100% risk-free. Never believe a doctor who tells you that), necessitating urgent treatment. After a few days' stay, he was dismissed with no side effects other than perhaps psychological.
I should have known something was up when I visited him late at night in the hospital, and the first thing he said was

"Doc, since I owe your hospital a lot of money for previous treatments and this happens now, what say we call it quits and you have them scratch off my debt?"

I told him it wasn't my call, and suggested he talks to admin. Last I heard, he's been harassing the staff and verbally abusing them, threatening to sue. He's left me alone coz he knew I wasn't the one performing the procedure. I doubt though that this will ever surface, because the complication was not due to negligence or error, and he had consented knowing the risks. But it does leave a bad taste in the mouth. Kinda like you've been taken advantage of, your trust of the patient has been breached. Makes you wonder why you bothered worrying if that was cancer, and suggested the evaluation.
Among the CYA advise the speaker gave at the conference was to document everything (which we all do anyways, even the 30 second phone calls we get) in the charts, and to not let patients tape-record your meetings. True, that would raise red flags and an eyebrow, and I'd probably feel that way if this work environment was more hostile, but really, how can you say 'no' to that sweet little old lady who can't remember your explanations of her diverticulitis and wants to record it for her daughter? I haven't said no yet to a patient who asks to record our meetings.
I suppose you could keep patients at arm's length and not let your guard down, but really I can't see practising medicine in that cold, formal, sterile (not microbiologically speaking) manner. I like the other approach; warmth, kindness, a hug here or there, hand holding, tears and laughter, and even a sense of friendship and trust. I hope I won't regret this someday.
Thankfully, the vast majority of our patients know we mean well and that we try our best. That we aren't Gods, and can't always prevent death or bleeding or infections when patients already come in really sick. So they trust us, and in return, we trust them.

14 Comments:

Anonymous Anonymous said...

Chanced upon your blog recently and find it very entertaining. I'm not a medical professional but I can relate to your experiences as a Malaysian living and working abroad (Canada, US, Europe). Great stories - keep them coming!

Kim

9:31 AM  
Anonymous Anonymous said...

On medical malpractice suits: in the book The Tipping Point, Malcolm Gladwell concludes that the biggest predictor of malpractice suits was patient satisfaction (or lack thereof), and that was directly related to the bedside manner, listening skills and doctor-patient interface.

Other survey data also show female physicians being significantly less likely than male physicians to be sued, with research suggesting that female physicians have a more patient-centred communication style - a characteristic positively associated with patient satisfaction.

So, you could conclude that one way to reduce your malpractice risk would be to change your gender! :-) But then again...

Kim

9:33 AM  
Blogger vagus said...

hmm. paying settlement on a lawsuit might be cheaper than a sex change operation :P

10:45 PM  
Anonymous Anonymous said...

Presumably your insurance company would pay out - so, not only cheaper but also less painful than a sex change op too!

But then someone like me would come along and raise your future premiums ... so, can't really win.

12:26 AM  
Anonymous Anonymous said...

It is always nice reading your sharings on your profession. It is very comforting to know that there are doctors like you who are not afraid to inject the human touch when treating patients. Keep it up.

9:27 AM  
Anonymous Anonymous said...

I have always enjoyed reading your sharings on your profession. It is comforting to know that there are doctors like you who try to inject the human touch when treating patients. It makes a lot of difference.

Keep it up.

9:32 AM  
Anonymous Anonymous said...

I have seen too many doctors who are like cold, clueless robots who have no idea how to reach across and show a bit of warmth and empathy esp. in life and death situations where the human touch is so essential.

You sound like someone who is not afraid of showing a human face behind that surgical mask. The medical profession would do well with more like you.

Tinkerbell.

11:07 PM  
Anonymous NIPHS said...

a man collapsed in a shopping mall and a nearby doctor rushed to help. finding him pulseless and not breathing, CPR was administered. an automated external defibrillator was brought by a security guard and it was applied. the AED gave 2 shocks, then advised no further shocks. the man unfortunately died after a long battle to save him.
the family threatened to initiate legal proceedings against the shopping mall and the doctor on the grounds that 1)the mall didn't have a permit to own medical equipment i.e. the defibrillator 2) the dr. who applied the AED wasn't a cardiologist. it was settled out of court - not because of any wrongdoing - but because it was easier than thrashing it out in court.

1:02 AM  
Anonymous nesidioblastosis said...

a man had upper abdominal discomfort and nausea on board a long haul flight. a doctor on the flight was asked by a stewardess to see the man and he agreed. wanting to CHA (cover his ass), the doctor suggested that an atypical MI was a possibility and that the plane should land immediately. a doctor back at the airlines HQ was asked to give a 2nd opinion. this doctor felt it was probably just gastritis. after a brief discussion the airline HQ doctor took all of the responsibility on himself and decided that the plane did not have to land and some antacids should do the trick.
15 minutes later, the doctor on board the plane handed the stewardess a receipt for 400 dollars - "my standard consultation fees". after another brief discussion, the cheeky bugger settled for an upgrade to first class.

1:22 AM  
Blogger vagus said...

thanks for the kind words, everyone.
Kowsai: wah. are those real stories?
dang it, i never did get any free upgrades to first class or anythin. just a crappy pair of Korean Air pajamas that faded.

7:16 AM  
Anonymous NIPHS said...

dunno.

might be true, might not be.

might be "totally fabricated to fool gullible readers"

cheers

8:05 AM  
Anonymous Anonymous said...

love readin ur blog.....

Howz life in the US? have any plans to return to "tanah melayu"? he...he..

one q.... the best country to work as a doc? (in ur opinion)

IMU (sem 6)

11:34 AM  
Blogger vagus said...

plans to return to Msia? yea, for vacations.
longterm, likely not. i think the career options are brighter here. and opportunities as a whole if you're not of a certain race, certainly greater here.
i cannot raise a family in a country where some of its people still think they are superior than others just because their ancestors got there first.

6:05 PM  
Anonymous Anonymous said...

I share your sentiments about returning to Malaysia. Yet it's not a position that I've come to easily, and it is still one that I am ambivalent about.

I used to find it ironic that I can only be defined as Malaysian, period, when abroad - when in Malaysia, I'm clearly Bangsa Cina, Agama Buddha.

Now, I just find it sad.

Nice blog, by the way.

3:54 AM  

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