I really should address litigation. It isn't "illness" what I think the blog is about. But it is definitely about trying to practice medicine. It is about the "illness of the health care system". Something is very wrong with our health care system. We spend over $7,000 per capita on our health care to be ranked 54th in the world in quality. That's not right. We have far too many people without insurance. And one of the economic factors is definitely the litigation. So here is my story:
A neurosurgeon sent a patient to me with a weakness in his leg which he said was "definitely not coming from his spine." I though that he had a small stroke. It didn't show up on his MRI, but that doesn't 100% exclude a stroke. He didn't get better with physical therapy, which he should have. He came in and got upset with me. My biggest mistake at that time was horrible notes. They were about two or three lines. I told them at that time that he might not have a stroke. That was probably something I should have figured out before. But he developed a new complaint. His illness had progressed from weakness to weakness + pain. I said I thought he needed a spine MRI. But he refused it. He then went home. He had always been very conscientous about contacting doctors with all of his symptoms. He went to his cardiologist. The cardiologist's note said "patient didn't like Dr.___. Wants new neurologist. ? MRI spine." He then developed weakness in the other leg and incontinence. He never called me. After two more days, he couldn't walk. He got an MRI of the Spine (the one I had recommended) and had surgery on the problem. He got worse after surgery. He ended up in a wheelchair. I was sued for failure to diagnose. The lawsuit alleged that if the diagnosis had been earlier, he would have never had any problems. He would have been fine. There is no literature to support that. After his surgery, the tumor wasn't completely removed. Those tumors usually can't ever be totally removed. But my notes were terrible. My deposition was awful. My insurance company offered a settlement. It was $1,000,000. That was for an 87 year old man. The plaintiffs demanded 5.2 Million. The trial was a nightmare of torture. The family was all there. They were laughing and partying in the hallways while my wife and I would walk by quielty. The number one cause of "monoparesis" (weakness in one leg) is a stroke. That accounts for most of those. Spinal cord processes are a very rare cause of monoparesis. The expert for them said that strokes never cause monoparesis. He is known lawyer who spends most of his time testifyinig for plaintiffs. My lawyer called him a "plaintiff's whore". So did my brother (a lawyer). The trial ended with me being "not guilty". According to the jury, I did nothing wrong. About two and half years after that, all of the appeals were dropped. That family was very angry. I appologized to them at the mandatory mediation. I don't think it helped.
Now, I have very good notes. I refer many patients for a second opinion. I write down that they don't want to go. I recommend many tests. I write down that they refuse them.
After the lawsuit (seven years ago), I order about $1,000,000 or more in tests that I wouldn't have before the lawsuit. I don't live a day without it. I don't see a patient without it. It is in every single one of my notes. Their anger will cost our system at least $20,000,000. My insurance rates nearly doubled. We all pay that. Their anger has forever change me.
It's not that I don't forgive them their anger. It's just that I gained wisdom. I have an obligation to treat my patients, to protect myself, to my family. I want to continue in practice. Here in this state, if you have three judgements against you that prevail, you lose your license. We really have to be cautious. I am cautious. I understand that these are the "rules of the game". I have to either follow them or pay the price. I accept that. I accept it with no anger. But I do have some sadness that our culture doesn't have the insight to see that the consequences of our system are unacceptable. I think the 20million could be better spent.
8 comments:
I agree with everything that you stated. I believe that the sense of entitlement in this country is causing great harm to us and preventing us from helping others. Wouldn't that 20 mil be better spent in a place like Darfur? They are in a situation that no one should accept and they have no power to change it. They are simply to weak, physically and mentally. This sense of entitlement does not just stop with your industry. How about those teachers who cannot hug their kids anymore because they will lose their jobs, just as you have been threatend. The question here is what grassroot effort should be taken to teach the illness you speak of?
Brooke:
I don't know if "sense of entitlement" is the disease or not. That is certainly a serious disease. I think the litigation disease is a combination of greed and absence of compassion (or forgiveness?).
As far as where the money should go, I'm not sure that I know. The developing world is in great trouble. If everyone person over the age of 18 in an industrialized nation would donate 1% of what they earn that would be enough to end starvation in the world. I'm not sure that would solve genocide. I suppose if we were committed enough as a nation would could end the genocide in Darfur easier than whatever we're doing in Iraq. You can donate to a gropu called Save Darfur (something like savedarfur.org).
There isn't any grass roots group that is interested in stopping medical tort; the AMA is trying to set limits on jugements, but they don't help very much. I haven't spent much time looking into anti-tort groups.
The teacher problem is from fear of sexual predators and sexually inappropriate teacher-student relationships. People are too afraid to be reasonable and draw the line at an intelligent place. That illness is fear. Americans are afraid. I don't even think the teachers themselves are fighting against the prohibitions on touching a student. They seem to be too busy fighting teaching only for a passing grade on a standardized test.
I love charity. It is one of our greatest things. I have many favorite groups ("grassroots efforts"). But I am always open to any suggestions from anyone who has any group that they feel is creating positive change in our world. So let me know who you like.
Thank you for your response. In regard to what you wrote, I am not speaking of a grassroots effort to change a particular industry or one particular cause. I am talking about a grassroots effort that can contribute to our thought process. Isn't that the actual starting place. Many americans have this sense of entitlement. Look at those on welfare or medicare. We are so privledged to live in a country that offers these things and they should not be taken for granted or advantage of but as with everything this will happen. But I wonder if this sense of entitlement is contagious? Do those who take advantage persuade others that may not have because enough people said to them "you deserve it?" It is that thought process that I find concerning. Medicare receipients have the best insurance I can imagine. However, they know that the system is failing and there may be none available for their children. I wonder if the words, "I deserve it" keeps them from doing something that could contribute to the cause. What would have kept this 87 year old man from suing you? You separated a sense of entitlement from the litigation disease that you described as "a combination of greed and absence of compassion." But, I ask you, what exactly do you think was his thought process when he decided to sue you? My guess he thought he deserved it.
I'm not sure what he was thinking. I suppose he thought that he deserved it. I think you may like simple living network: simpleliving.net. That group's focus is on using less, wanting less, and being happy without consuming. It's kind of like "not entitled". The environmental movement is somewhat like this also; "Let's not use whatever we want (especially gas) if it's going to harm the world. We don't have the right." That's kind of anti-entitlement. Still, I think the best approach is to look at all the charity organizations. Those people aren't about entitelment they're about helping others.
An aside: Because I am retired, it occured to me that I might have something to share with one of our younger generaion. I was thinking, perhaps, "Mentor".
Because of the POSSIBILITY of the one I MIGHT mentor having a "bad-hair-day" and accusing me of something I wouldn't think of doing, I have never gone beyond the Thinking Stage. I won't.
Does this make me a contributor to the "system" you were discussing, or a [possible]chicken victum?
Everyone contributes to "the system". Just being alive is an act. There are those who attempt to leave the system in an intentional community, or another country, or "off the grid" or wherever they go. But they are also part of the system because they contribute through the action of trying to be separate. They remain part of humankind. We all act. Non-action is also a contribution. There are specific "non-actions" written into the constitution. The president may choose to not sign and not veto a bill. But there are laws as to the outcome: it doesn't just go into limbo land. The supreme court can decide not to do anything - they don't listen to a case. That means the lower court ruling stands. We only get to choose our actions and try to create our lives. We have to guess about the outcome of our actions but we can understand our intentions and motivations. Our actions should be guided by what we believe is good. Sometimes we believe that non-action is good. I try hard to avoid non-action or action which is based on fears. That allows fear to create our lives. "It is better to have tried and failed than never tried at all."
Quote Collector: After I read what you wrote, I was wondering why you do not mentor someone that you respect so when they have a "bad hair day" you can accept their imperfections. I for one, am always looking for a mentor. Life is a struggle, so why would I not want to learn from someone who may have insight? I would also hope that my mentor would be open to learning from me.
"The life unexamined is the life unlived.".. in a book by:
John D. MacDonald
And; "Too much self analysis is bad."..unknown
Thanks for your in-put.
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