Litigation

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.