While I believe that medical malpractice is endemic in the United States, I urge readers also to understand the burden under which every doctor has to practice. This burden can be expressed as a simple question: Can anyone be expected to be right 100% of the time?
All physicians practice with the fear that one day we may be sued, and sued for more than their malpractice insurance covers. Would anyone wish to work under these conditions? W hat most people don't realize is that poor outcomes do not necessarily mean malpractice. All procedures have risks. All medications have risks. Yet, some malpractice attorneys, in carefully thought out business decisions, seek out cases with huge potential pay-offs even if no malpractice is involved. They then try to spin these cases to make it seem that there was malpractice involved because if they convince the jury, there is a huge payday awaiting them.
I was sued over a case once and I will never forget it. The case dragged on for years which meant that I had to reveal in every reappointment to every hospital and insurance plan that I had been named in a law suit. I was told by my attorneys that I needed to ready for the case; that it might go to court at any time (even as I was preparing for my honeymoon) and that I would have to arrange my schedule to ensure that I was available. As a matter of policy, my insurance company told me that I should be in court every day, even if the case dragged on for weeks, and even if it meant I would not be able to see my patients; they do this because they feel that the jury will perceive the defendant as uncaring if he does not show up each day.
It seemed to me that none of the lawyers, either the malpractice attorney or my defense team, seemed to care about the patient or the doctor. What most of the businessmen involved seemed really to care about was the money.
What was really hurtful was the fact that I was even sued. The patient had first seen another cardiologist who had missed the fact that she had suffered a heart attack. She only learned of the heart attack after coming to see me for an opinion. I repeated an echocardiogram, at no cost to her, and told her that the previous doctor had incorrectly read her study – and that while he had said that she had not had a heart attack, it was quite clear to me that she had. I placed her on medications that possibly saved her life and sent her for a coronary angiogram.
During this angiogram the patient suffered a stroke that resulted, in what she claimed, was some type of periodic visual disturbance. The doctor who performed the angiogram was sued as well, though the complication was not an uncommon one . Much of the suit, however, centered on why I had sent the patient for the angiogram. Again, no party ever expressed concern about the doctor who got the diagnosis wrong --- the angiogram confirmed everything I said --- even though he had clearly missed identifying the MI in this patient.
The case dragged on for years, possibly because the malpractice attorney did not have a case, and could not find a credible expert witness. But the case seemed to center on two things.
1. The patient admitted that she was told she could die from the test , but not that she might suffer a stroke.
2. That I acted inappropriately in ordering a coronary angiogram and not a nuclear stress test. I believe the plaintiff’s attorney also tried to insinuate that I asked for the angiogram because coronary angiograms pay more.
The truth is is that the patient signed not one but two informed consents with the possibility of stroke mentioned on each of them – the duplication occurred because her initial date was canceled after she arrived to the hospital with flu-like symptoms, and after she reviewed and signed the consent. She returned a week later and repeated the process.
The angiogram was done not because of any financial reward ( I am actually paid over two times as much by insurers to perform a nuclear stress test vs. an angiogram) but because it is the procedure recommended in the guidelines published by the American College of Cardiology.
As the years went by I was asked over and over again to review the case with my attorney, who felt I was not part of the team because I was reluctant to waste another day dealing with this dreadful case instead of caring for my patients. I remember telling him, "You tell me I am not a team player. I guess I cannot be part of the team when you are earning thousands of dollars for this case, getting paid for every minute you spend with me, and asking me to neglect my patients and come visit you to review your case. When I get paid, like you do , then perhaps I will be more motivated to be part of your team."
In the end, perhaps seeing that his case was going nowhere, the plaintiff’s lawyer asked the hospital to offer him a settlement. On the condition that he agreed that none of the doctors were at fault the plaintiff’s attorney accepted an offer of $25,000: about $8,000 for him for his ten years of work, and the rest to the plaintiff and her family.
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Comments
It's hard to decide who the real loser was here. You out time, expenses, revenue and having to answer yes to all the "have you ever been suied" questions, or the person the lawyer made promises to about financial rewards to cover the future.
I once sued a doctor for malpractice. My mother died in surgery...bled out during a partial hepatectomy 17 years ago when she was just 44. The doctor was a general surgeon and the case rested (as I recall) on whether or not he should have had a vascular surgeon on-hand for a surgery where there was a high probability of vascular/bleeding issues. I may not have all the details correct. I was very young and not in the know about the case. The lawyer received one third of the settlement.
I can't tell you at this point whether or not it was fair that I received this award, but during one of the hearings, the doctor broke down in tears. According to what I was told, he felt very badly about what had transpired in his OR that day. We knew of the risks with major surgery, but her prognosis was supposedly good.
Despite my experience. I think malpractice litigation is out of control. It's much too easy to get a payday at a doctor's expense. In our case we truly believed she was ill-served, and would never have sued otherwise. But for every just case, there are countless frivolous cases. No wonder heathcare costs continue to rise.
I appreciate your comment and will answer your question as succinctly as possible. If a patient has almost a 100 percent chance of having disease an you perform a test that will wrongly show a normal test in one of every ten patients that has disease then , in a population of these types of patients it remains that those with a negative test will still likely have disease. A positive or negative stress test in this population of patients will not help you determine if the patient has , or does not have, coronary disease.
I appreciate your comment and will answer your question as succinctly as possible. If a patient has almost a 100 percent chance of having disease and you perform a test, that will wrongly show a normal test in one of every ten patients, that has disease, then , in a population of these types of patients, it remains that those with a negative test will still likely have disease. A positive or negative stress test in this population of patients will not help you determine if the patient has , or does not have, coronary disease
Thank you for sharing your knowledge and experience, Dr. Evan. Another 'thumbs up' for you! ;)
So here we have a case where a doctor actually did something wrong and was not taken to task for it -- either by us or the insurance company. You, on the other hand, suffered for caring too much and paid a high price emotionally and financially.
Don't you just love lawyers and insurance companies?
R
Our constitution starts with the words, "We, the people..." I am afraid that we have distorted it to read "Me, the person...."