Comments on: Healthcare Update — 01-23-2012

By: Matt

Matt — Thu, 26 Jan 2012 06:11:30 +0000

“What are bad outcomes for which physicians should not be sued?”

Your question is unanswerable for two reasons. One, you or I can “sue” someone for living on the moon. If you pay your filing fee, and take it down to the clerk, they will take your money, stamp it, and you can serve it. You have now sued someone. There is no way to put a prohibition on that without empowering clerks to review all suits filed and make determinations on validity.

The other reason is that you’re asking to say what outcome is never the result of negligence. That is simply impossible, at least for a layman. You’re the doctor – can you think of any outcome where it is simply impossible that negligence can cause it. Can the outcome of death be caused by negligence? Sure. Can the outcome of loss of say, vision, be caused by negligence? Sure. We can go on like this for a long time.

Do YOU know any outcomes that absolutely, positively can’t be the result, under any circumstances, of negligence? You see far more outcomes than I.

“I believe that they are a lot less than what trial lawyers would have us believe.”

How many are trial lawyers trying to make you believe there are? And how many do you believe there actually are? And while we’re at it, how many of those result in a claim? Now your answers to those questions would be quite interesting.

By: WhiteCoat

WhiteCoat — Thu, 26 Jan 2012 03:31:01 +0000

I just wonder what will happen when all of the hospitals in your area adopt a similar policy leaving drug-seeking patients with nowhere to reliably get their medications. Do they then return with a vengeance?
If you’re *required* to check the database on every patient – which is what the recommendation is – it would eat into your time.
You’re lucky that everyone is on board with your plan. Can’t pull that in our ED because the patients will come back with “Yeah, well Dr. So-and-so did it, why won’t you?”

By: ThorMD

ThorMD — Thu, 26 Jan 2012 01:56:07 +0000

You make good points. A couple of comments based on my experiences working with this policy. First, we get VERY FEW drug seekers and chronic pain patients because our policy is well known in the community and they have stopped trying. So if I get one per shift, it’s no skin off my back to check our database.

Second, when I say “no”, it’s nice to say “I’m sorry, I wish I could help you, but we are not allowed to do this because of our policy. They won’t let us”. It takes the argument away from Me vs Patient. We can be caring and compassionate when we say no.

For what it’s worth, our ED’s have PG’s routinely >97%. Occasionally we dip to the mid 90′s, but that’s rare.

By: Hueydoc

Hueydoc — Thu, 26 Jan 2012 01:54:36 +0000

My wife has been sued twice for patients she has never even seen !

By: Hueydoc

Hueydoc — Thu, 26 Jan 2012 01:52:52 +0000

Family practice.
Not only do kids hug me, no one has threatened me yet !

By: WhiteCoat

WhiteCoat — Wed, 25 Jan 2012 22:40:25 +0000

Regardless of how it happened, the outcome sucks. And from what you describe it is a nail.

Some of the cases I’ve been involved with:
- Doctor sued for wrongful death of a patient when the doctor was on vacation in Europe during the patient’s entire admission and did not even know the patient
- Doctor sued for failing to diagnose an MI in the ED when the patient had a normal EKG and no symptoms until 6 hours after reaching the medical floor.
- Doctor sued for failing to diagnose a patient with a stroke when the patient didn’t have a stroke
- Doctor sued for giving a patient the wrong dose of medicine when patient got “anxious” after receiving it but had no other “injuries.”
- Doctor sued for missing mesenteric ischemia on a patient that he saw for 10 minutes before shift change, ordered labs to get the workup started, and signed the patient out to the oncoming physician. Oncoming physician wasn’t named in the lawsuit.
- Doctor successfully sued when patient died of an MI. Patient signed out of the hospital AMA, refused follow up recommendations, refused to get a stress test, and died three weeks later. Multimillion dollar judgment because doctor didn’t call patient to see whether the patient had done the stress test.

Are these nails, too?

Obviously, there are cases of bad outcomes due to misdiagnoses. I believe that they are a lot less than what trial lawyers would have us believe.

Goes back to the question I posed to Matt. What are bad outcomes for which physicians should not be sued?

By: WhiteCoat

WhiteCoat — Wed, 25 Jan 2012 22:24:31 +0000

If you’re seeing a pain specialist and the medications don’t help, I don’t think I’d be too concerned with asking the doctor for stronger medications. Or perhaps nerve blocks may be of some help.
You’re also not going to be questioned about drug seeking behavior if you’re up front with the ED nurse/doc and you’re not there so much that the post office starts forwarding your mail.
Bringing the MRI report probably isn’t a bad idea.
As for what patients in legitimate pain are supposed to do, it puts everyone in a bind. Patients/primary care docs/ED docs. Thank the drug seekers for getting that ball rolling.

By: WhiteCoat

WhiteCoat — Wed, 25 Jan 2012 22:14:43 +0000

Family medicine or acute care clinic?

By: WhiteCoat

WhiteCoat — Wed, 25 Jan 2012 22:12:33 +0000

If your policy works with your ED and the admins can tolerate the satisfaction issues, then there isn’t a problem.
The policy at the Orange County hospitals requires counseling and referral to a family physician – at least according to the article. Perhaps their definition of “chronic pain” doesn’t include cancer patients, but that wasn’t stated in the article.
My example illustrates what happens when legislators start painting with too wide of a paintbrush.
Why not have the database spit out the names of the patients receiving excess prescriptions and go after them instead of harassing physicians.
Did you see what the article says is the next recommendation? Requiring physicians and pharmacists to check Florida’s new drug-monitoring database. Like we don’t have enough to do without spending a few more minutes x 30 patients per shift = 90 minutes per shift tracking down potential drug seekers.

By: midwest woman

midwest woman — Wed, 25 Jan 2012 16:08:48 +0000

Boyfriend’s coworker had GI complaints for one year. Pain nausea. Got blown off. No endo no colonsocopy. Nada nothing. Colon ca mets to liver stage 4. Oh well shit happens right?
He will leave 2 small children and a young wife.
Looks like a nail to me.