Sued If You Do, Sued If You Don't
Being a doctor in the age of litigation, from White Coat's Call Room, a blog from inside the emergency room:
An 87 year old lady who is in excellent health comes into the department because she couldn't move her leg. When she woke up and was fine. Her family helped her get dressed. She read the newspaper at breakfast. Then she went to the bathroom, was in there about 15 minutes, and began yelling for help because her leg hurt and she couldn't get off the toilet. The family thought that she was sitting too long on the toilet, irritating her sciatic nerve, and thought she just needed to let her leg relax for a little while. A couple of hours later, her leg was hurting her more and she still couldn't move it, so they called the ambulance.This was a wonderful little lady who looked like she was 60. She was well-dressed. She carried on a normal conversation and was completely coherent. She joked back and forth with us. Her hair was done up perfectly and she had a fresh manicure. She took a blood pressure pill each day and that was about it. Unfortunately, when you looked at her leg, it was mottled and cold from the mid-thigh to her toes. It was obvious that she had an acute arterial occlusion of her leg. See an example on the right side of the picture above where there is no dye advancing in the femoral artery past the mid-thigh.
I called our vascular surgeon who came immediately and evaluated the patient. He recommended that she be transferred to the tertiary care center in our area where they had "more experience" dealing with these issues and could perhaps do intra-arterial thrombolytics. I called the vascular surgeon at the tertiary care center and he gave a lot of push back. Why were we transferring the patient when we had a vascular surgeon on staff? He demanded to talk to the patient and the family on the phone. While he was talking to the family, the patient had an episode of pulseless ventricular tachycardia.
The patient was a DNR, so we abided by her wishes and did not resuscitate her. About 30 seconds later, she had a pause in her rhythm and spontaneously converted back to normal sinus rhythm. She woke up asking "what happened?"
Upon hearing that the patient had an episode of ventricular tachycardia, the vascular surgeon at the tertiary care center told the family that he would not accept an unstable patient and hung up the phone. The ambulance company refused the transfer.
Our vascular surgeon was faced with a Morton's Fork. If the patient didn't have surgery, she would lose her leg and would likely die from the ensuing complications. However, the patient was also a high risk for having surgery. She just demonstrated an unstable cardiac rhythm and her cardiac enzymes were abnormal. Surgery would likely kill her.
Either way, they all get sued. The rest at the link.
via Overlawyered
It doesn't help that surgeons are competitive and protective of their stats.
My brother (not an MD) works with surgeons, and the last thing they want is a patient dying in the OR. As soon as the patient is fixed, they're in a hurry to sew'em up and get 'em out to the recovery room. As soon as the surgeon hands off the patient to recovery, it's someone else's problem if the patient dies.
Tyler at January 24, 2011 11:10 PM
(sigh ...) She's 87.
Pirate Jo at January 25, 2011 6:10 AM
When somebody figures out how to live forever in perfect health with no complications, remember that Social Security will just go casters up faster.
What's the moral of this story, you're going to die someday? What a surprise. If it were me, I'd choose the surgery. There is the possibility of a good outcome. If I don't make it, I'll just join the 100% of us who are going to die despite anything we do.
MarkD at January 25, 2011 6:35 AM
The patient was a DNR, so we abided by her wishes and did not resuscitate her. About 30 seconds later, she had a pause in her rhythm and spontaneously converted back to normal sinus rhythm.
I'll say this, that's one tough old biddy. Her heart managed to regain a normal rhythm from tachycardia with no intervention? I'm impressed.That kills much younger people than her.
Ltw at January 25, 2011 8:47 AM
I'm not surprised she survived the surgery, it sounds like she was in pretty good shape other than the immediate problem. But it was pretty brave of them to go ahead with the surgery under the circumstances. Good for them.
I have some experience in making those sorts of calls - in a totally different field - where you don't have enough info or time, you're under enormous pressure to make a decision, and you know you could get sued or put in jail if you get it wrong. Pretty much all you can do is make the best call you can. And pick and choose the ones that really need to be made right now and which can be left until you know more - albeit at a cost.
Ltw at January 25, 2011 9:02 AM
Doctors should not have immunity from malpractice, however lawsuits should not hang over their heads like guillotines waiting to drop.
Face facts, these people deal with dying or potentially dying people all day long. Even the best of them is going to make a mistake no matter how well prepared, every mistake is not preventable. I'd like to think the vast majority do everything in their power to avoid such mistakes, but the inevitable will happen.
Not least of all because of their oft times grueling regimens, why does a doc pull 18 hour shifts? Well the next patient needed treatment then and there and no one else was available. Should we see him sued if he makes a mistake, since he should have done nothing due to his weary state?
I'm reminded of an old television show, I think it was Louis & Clark. Superman was sitting down to dinner with his family, and he was agitated as the news was on and it was talking about some trapped miners. "People expect me to be everywhere," he said, "I just can't do it all no matter how much I want to, I try to save as many as I can, but I have to eat, sleep, and live also." "Nobody expects you to do that." His mother answered, "Yes, they do." was his answer, and I forget how the rest went.
Point is that they really are damned if they do and damned if they don't and we're damned when we have a shortage of doctors as a result of our demand that they all be perfect all the time.
Robert at January 25, 2011 10:04 AM
I think Robert is on to something there. Some people seem to think doctors are some sort of supernatural beings who can save them from pretty much anything. They're human like the rest of us. Yeah, they may know more about medicine than we do but they can't be perfect all the time.
Daghain at January 25, 2011 10:26 AM
"Face facts, these people deal with dying or potentially dying people all day long. Even the best of them is going to make a mistake no matter how well prepared, every mistake is not preventable."
I would even argue that this is stretching the definition of the word "mistake", in terms of having made an error: My definition is that if the probability of a bad outcome can only be demonstrated in hindsight, it's not a mistake. The current definition of the word "mistake" is one written by the people who demand a zero-risk society, one where they can feel free to screw around and act irresponsibly and at all times be shielded -- not just from the consequences of their actions, but from all of the challenges of living in the universe we live in. It's the ultimate in spoiled brathood, officially sanctioned and encouraged by (certain segments of) society.
All I can say to those people is, "I hope you never come up on a car accident where a person with a spinal injury is trapped in a burning car, and you are the only person around to help them. Oh, and the victim is the teenage daughter of a famous personal-injury lawyer. Actually, on second thought I hope you do."
Cousin Dave at January 25, 2011 5:50 PM
My family faced something similar a couple of weeks ago.
My father was admitted to the hospital with a small-bowel obstruction caused by scar tissue from bowel surgery he had last year. Nobody truly wanted to do surgery on an 89-year-old man with metastatic cancer, advanced Alzheimer's and multiple other health problems, but it ended up being a quality-of-life issue. The doctor said his death would have been like being shot in the stomach with an arrow if we simply let it rupture. So we did the surgery.
Dad died two days later of system-wide organ failure. His body just wasn't strong enough to handle the surgery. Nobody blames his doctors for this. It was risky to begin with, and it was really just a matter of picking which death he would prefer.
MonicaP at January 26, 2011 6:42 AM
MonicaP, I'm sorry to hear about your father, but I agree, you did what was best for him. The problem is, while your family understood it was risky, but worth trying, there are many people who think doctor = miracle worker and would have sued the pants off the guy if the outcome wasn't favorable.
I think some people really need to get some perspective that's based in reality.
Daghain at January 26, 2011 10:39 PM
Its been my experience that most pepole experince a subjective reality, so no matter how crazy their shitty behavior is it seems perfectly reasonable to them
lujlp at January 27, 2011 11:00 AM
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