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.