Saturday, July 27, 2013

The Malpractice Report

I read this report on the other day.
It was a report of data obtained from a survey of physicians in the USA. And some of the numbers and the responses, frankly, were just depressing, scary and discouraging. Maybe I'm too idealistic- deep in my heart I think that most doctors put their patients' best interest as a priority, and that no one hopes for any bad outcomes. And perhaps mistakes happen, and when they do, perhaps a lawsuit is just.
However, seems that many more, are not.
Some of the findings: 40% of those surveyed have been named in a lawsuit. And contrary to my impression, the specialities most frequently sued were not the procedurally-inclined, but internal medicine and family medicine (perhaps also because there are more primary care docs...). And this is where it starts to get sticky:
Nature of the suits include "failure to diagnose" or "failure to treat". I will humbly admit to all my patients that doctors are not Gods. We are not know-alls. And sometimes, perhaps limited by normal test results, there are some things we might not be able to pick up. And within this, repondents gave examples like: "There was a fetal demise at 19 weeks. Prior to trial, it became apparent that the mother (patient) was using cocaine." or "The patient had a complication after a laparoscopy. She then sued, saying that she no longer could eat big meals and enjoy steaks. She neglected to reveal that between the time of my laparoscopy and the suit, she had a gastric bypass and stomach stapling."
In addition, some lawsuits occured not because that doctor made a mistake- but merely because he/she was involved in a patient's hospitalization. Having seen the patient as a consult or something of that nature, but enough to have their name associated with the patient file. Pan-suing every doctor associated to a patient, to maximize money, seems to be a strategy some take.
Some lawsuits were also directly the patient's fault- failure to show up for follow-up and then being lost through the cracks. I see this as a problem with my practice too; if you no-show your follow up with me, I'm not going to call you and ask you to come back to see me to see how you are doing. But the lawyers say this isn't a good approach, it seems.
Almost a quarter stated that being sued was the most horrible experience of their life, many spending over 40 hours preparing and being in the trial, with some legal proceedings lasting over 5 years. After the lawsuit, almost a third of physicians stated that they no longer saw patients the same, that they no longer trusted them and began to see them as adversaries. That is a shame, because as much as a patient-doctor relationship is a formal one, many of us enjoy visiting with our patients, many of whom we may see as almost friends.
And some advice the respondents gave: "It is perfectly legitimate to order every test that you feel is acceptable to prevent another suit." and "Don't assume ANYTHING!! If it hurts, CAT scan it. If it hurts between the nose and the toes, consider it a heart attack and stress-test everyone from 9 to 90!". And people wonder why the cost of healthcare is so high.
It's sad to read that report. And it's scary to think it's only going to be a matter of time before it's my turn, whether or not it was medically justified. After all, I've been asked by several patients to help be their 'expert witness' in suing someone else- even those very frivilous ones. Like that guy with a BMI of 55 who eats at McDonalds every day who wants me to claim that his diabetes is related to a pill his GP prescribed, which he took only for a week- I gently refused and suggested it was related to his weight- and he never came back to see me. Every night, I see TV ads talking about lawsuits and trying to recruit plaintiffs. Every day, the ads play on the radio as well.
Medicine is getting too complicated these days. Perhaps the legal system here should adopt what a friend told me they do in his home country: if a lawsuit is thrown out or judged to be in the accused's favor, then the plaintiff has to pay for his legal fees as well. Right now, it seems that one has nothing to lose suing another, and only money to gain. This system has to change.