February 27th, 2013
Knowledgeable and honest. Yeah, that’s me. Study shows that doctors wearing white coats were most likely to be judged by patients as being the “best” physicians. Doctors wearing scrubs were also more likely to be highly rated. Of course my widespread appeal could also come from my stunning good looks or my debonaire personality …
Interesting dilemma. A patient in Washington DC called an ambulance at 1:26 AM when he was having trouble breathing. Just so happens that it was New Years Eve and about 25% of the entire DC firefighting force had called off sick that day. An ambulance arrived 30 minutes later and the patient arrived at the hospital exactly one hour after the initial call for help. Unfortunately, the patient’s condition was poor and he later died.
There is now a news article about how the family thinks the $780 bill for the ambulance is “appalling and hurtful.” A petition was posted on Change.org to get the DC Fire and EMS Department to drop the bill and 166,000 people have signed it, many stating that the family should sue the Department for damages.
Yet the bill went to the patient’s insurance company and a copy of the bill was sent to the patient’s family – clearly stating that insurance was being billed, so the family isn’t paying for the transport.
Should we not pay for less than desired outcomes? If so, should the lack of payment extend to all aspects of payments? Job performance? Government benefits?
Heads at the Joint Commission are about to explode. Hand sanitizer which increases patient safety by preventing the spread of germs is allegedly to blame for burns to a cancer patient’s body after static electricity supposedly ignited the alcohol in the sanitizer and set the girl’s shirt on fire.
Joint Commission news release: “Hand sanitizer is dangerous. No, it’s good. No, it’s dangerous. No it’s good. Well it’s sometimes dangerous and usually good and if any of your patients are injured by it, you’re going to have to come up with an action plan to show us why we shouldn’t decredential you for using it … or not using it. Now buy our new manual on hand sanitizer usage for $149.95 or we’ll do a surprise inspection on you.”
One doctor is keeping his office open late to help care for people who would otherwise have to go to the emergency department. Unfortunately, not many patients are utilizing the convenience. But emergency departments in the area are experiencing growing patient volumes. Wonder why the disconnect?
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Posted in Healthcare Update | 13 Comments »
February 22nd, 2013
So I had a problem with a patient and family recently and I’m looking for solutions from everyone who reads this blog.
An elderly patient who lives at home with his wife, his son, and his son’s family was brought by the ambulance to the emergency department for “not feeling well.”
As I attempted to get more of a history about the patient’s symptoms, the discussions angered the family.
“When you say that you don’t feel well, what do you mean?”
“I’m sick! That’s why I came here so you could tell me what’s wrong.”
“But I don’t understand what you mean when you say that you’re ‘sick.’ Do you mean that you’re nauseous or you’re having pain or you’re feeling weak?”
“No, none of that.”
The daughter in law then stood up next to the bed and firmly said that he “just doesn’t look right.”
That didn’t help me much, so I said “I’ve never seen him before, so I don’t know where to begin in finding out what is wrong. What about him doesn’t look right to you?”
She threw her arms up in the air and rolled her eyes. “What do you want me to say? He doesn’t look right.”
No, I didn’t grab his head, turn it to the right and say “There … problem solved.” I just stopped asking about his symptoms.
“OK, well how long has he not been looking right for?”
“Oh, it’s been a while now ….”
After about 15 minutes, I was able to determine that the patient was sleeping more than usual for anywhere between 3 days and a week, depending on who was answering my questions.
After I left the room, the nurse told me that the whole family was upset with me because I was being “difficult.”
So the questions I have for you all are the following:
1. If you’re in the medical field, and a patient/family provide you with a vague history, do you try to find out more information? If so, what approach do you use?
2. If you’re not in the medical field, how would you suggest that a health care provider respond to you if the information that you are giving them isn’t helping them figure out what may be wrong with you?
I think that these are questions that a lot of people would like to know, so please chime in below.
Thanks
Posted in Random Thoughts | 51 Comments »
February 20th, 2013
I hate the movie Pitch Perfect. Actually I like the movie itself, but my kids won’t stop singing the frigging songs. I have heard the songs from that movie in my sleep for months now. The latest thing that my kids have taken to doing is re-enacting the “cup” scene where Anna Kendrick sings You’re Gonna Miss Me When I’m Gone using a cup. Before school in the morning, “you’re gonna miss me when I’m gone.” At night after dinner, it’s a chorus of “you’re gonna miss me when I’m gone.” Without a doubt I am NOT going to miss that damn song when it’s gone. I can’t take it any more. Ditto for Don’t You Forget About Me. My head hurts just thinking about the words.
When I try to go to sleep, then it’s the dogs’ turn. About half of the nights of the week our boxer snores … loudly. Most of the time Mrs. WhiteCoat will call her name and wake her up to stop the snoring. Sometimes, Mrs. WhiteCoat has to throw a slipper at her to wake her up. When that doesn’t work, she’s actually had to tip over the bed a couple of times to get the dog to wake up. Even that didn’t work last night. After being dumped out of bed, the dog woke up, climbed back into bed, and promptly started snoring again. By that time, I was awake and I was tired. So I sat up in bed and yelled like a dog … I barked at the top of my lungs for about five seconds. I think it roughly translated into “wake up and be quiet or I’m going to tie your ears in knots.” Our older dog sat bolt upright in his bed and was looking at me with his head cocked to the side. The boxer was doing a John Belushi imitation (forward to 0:30) spinning back and forth trying to see where the attack was coming from. One of the girls let out a scream from down the hall. I laid back down and then I couldn’t sleep because I was giggling to myself. But the snoring stopped.
Once Mrs. WhiteCoat went to sleep, she had bizarre dreams. In one dream she was trying to get into our oldest daughter’s room, but she couldn’t get the door open. So she broke the door in. It was freezing in the room. Our daughter was sitting on the bed and she could see her breath. “Come on, let’s go,” Mrs. WhiteCoat said. “I can’t move,” our daughter replied. So Mrs. WhiteCoat ran into the room and grabbed her, then headed for the door. The door closed and she opened it. While doing so, she bumped something behind her. She turned around. It was her carrying a laundry basket. Her mirror image dropped the laundry basket, pointed at our daughter, and said … “check her potassium level.” Then she woke up. And no, we didn’t check her potassium level. What are we going to put for the reason … vision in a whacked out dream told me to?
Almost back to normal after surgery. There’s still a bulge there and yes, it is the hernia. Just some postoperative swelling. Have to wait another week before I get back into normal activity. It’s strange not feeling the area pressing up against my pant leg like it used to. And after about six days I no longer feel like I have a weight tied to one of my “boys” … if you know what I mean. Still a little sore walking around, but I’ll get over it soon enough.
I was going to try some walking this week and slowly get back to running on the treadmill, but I can’t do that because Junior WhiteCoat and his friends had to watch some dumb YouTube clips where people were trying to launch themselves off of treadmills. Then they had to try it for themselves and busted the damn treadmill. They bent a roller and they bent the platform and the manufacturer doesn’t make either any longer. Fortunately, I anticipated someone in the house being a victim of dumbassery (Junior was the odds-on favorite) which is why I bought a cheap used treadmill instead of a fancy expensive new one. So said treadmill goes out to the curb this week and I have to look for another used model. Doubt I’ll be able to beat the $150 I paid for the last one, but we’ll see.
So back to the wall thing. I was trying to videotape what I was seeing as I pushed through the insulation. So I had a camera in one hand and a MagLite in the other hand. I used the MagLite to push away the insulation and something flittered in front of the light. I jumped back thinking “Holy second cousin, Batman.” But how could bats be in a wall? Don’t they like to hang? I pushed through the insulation again and a loose piece of insulation pulled off the edge. I found a crawl space behind our closet that I never knew existed. Like 6 or so feet deep, 4-5 feet tall and about 20 feet wide. Damn. It was like a varmint party room in there. On the floor between two rafters were a bunch of chewed up sunflower seeds. Then I stuck my camera in the area and recorded to see if anything was around. Nothing when I reviewed the movie. I put on some protective eyewear and stuck my head inside to look around. Up in the corner of one wall, something had chewed its way through the wall leading to the outside. I stuck a straightened coat hanger in there and went outside to see where the end came out. Couldn’t find it. Then I realized that our house has a brick exterior. More secret passages inside to be discovered.
We called the exterminator, but apparently no one deals with varmints. Only bugs and mice. That’s when hernia surgery stopped me from climbing around further.
The good news is that since I stuck the hanger in the hole, the scratching hasn’t been back, either. So either whatever it is either became pregnant and is hatching spawn to create a habitrail through the walls of our house or it got scared and moved on to another house. I’ve already decided that I’m going to open up the wall and put flypaper and mouse traps all over the place. So I don’t think that the mysterious scratch is of a flying variety. My guess is on a squirrel. We’ll find out next week, I suppose. Maybe I’ll even post a couple of pictures.
Posted in Random Thoughts | 2 Comments »
February 19th, 2013
When you work in an urban hospital, sometimes it’s difficult not to become jaded.
There are certain neighborhoods that generate a disproportionate number of patients for some emergency departments. Meth is rampant. Marriage pretty much nonexistent. More bars than there are restaurants. Domestic abuse frequent, but prosecutions rare. Police know people more by their street names than by their real names.
South Heights was one of those neighborhoods.
The emergency department frequently treats South Heights kids who are neglected by their parents. I’ve seen young South Heights kids with seizures from cocaine. Now seizing kids get drug screened as part of their workup. I’ve seen more than one young South Heights kid with a lighter burn. I’ve given a lollipop to a 2 year old South Heights kid and watched the mother take the lollipop out of the kid’s mouth when she thought no one was looking, chew on the lollipop until there was nothing left, then slap the kid for crying. Many parents from South Heights can recite the names of the family court judges from memory and quite a few have had their children taken away. Social service workers know many South Heights kids personally. Based on the history of the area, many people tend to look at the kids from South Heights with pity and look at parents from South Heights with contempt.
The next patient on the board was “finger laceration.” As I walked toward the room, the nurse mentioned “they’re from South Heights.” I was already thinking about whether I’d get attacked if I had to call Child Protective Services.
The patient was a cute little girl about 5 years old. Thin stature, great smile, polite. She was holding her arm out on the table and a gauze pad with a slowly enlarging spot of blood covered her hand. Her mom was weathered. Most of her teeth were missing. Her clothes looked like they hadn’t been washed in a while. A reusable shopping bag with newspapers, empty beer cans, and a pair of headphones sat on the chair next to her.
“So what happened to your finger?” I asked the little girl.
“I cut it with a scissor.”
The mom explained that the patient was told to wait to open a bag of cookies, but didn’t do so. Instead, she grabbed a pair of scissors from the drawer and forgot to take her finger out of the way when she cut. The result was a fairly deep laceration to the outer part of the index finger.
I went through the described mechanism in my head for a second. Scissors in one hand, holding a bag with other hand, cut to opposite index finger. OK. Injuries seem to fit the explanation.
Then I went about describing what I was going to do next.
“I’m going to put some medicine into your finger to make it stop hurting. Then we have to clean it out to get rid of all the germs. Then I’ll fix it up for you. The medicine to make it stop hurting burns a little bit. Once the burn is gone, it won’t hurt any more. OK?”
The little girl looked from me to her mother and her eyes began to tear up.
She cried and whimpered, but she held completely still while I injected lidocaine into her finger. Her mom leaned over next to her, gently cupped her head and wiped away her tears.
After the wound was clean, I got everything ready to fix the wound. But the patient was a little hesitant because the lidocaine injection had hurt. Despite me showing her how her finger was numb, she cried and didn’t want me to touch her hand.
Then mom came up with an idea.
She ruffled through her shopping bag and pulled out an old iPod. She started playing a country song on the iPod.
“Do you know what this song is?” mom asked.
“My ‘I love you’ song,” the little girl said back.
While I worked fixing the little girl’s finger, I watched as her mom caressed her daughter’s face and as they softly sang the words of the “I love you” song back and forth to each other.
I finished the last suture about 15 seconds before the song ended. The little girl didn’t move a bit until the end of the song. Then she used her uninjured arm to hug her mom around the neck and tell her one more time “I love you, mommy.”
As I wrapped up the little girl’s finger, I thought how difficult it can sometimes be not to form premature impressions about people.
And as the young patient blew me a kiss with her bandaged hand while being carried out the door by her mother, I thought how desperately South Heights needs a few more moms like this one.
———————–
This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.
Posted in Patient Encounters | 5 Comments »
February 18th, 2013
Some hospital CEOs just don’t like being questioned. When one hospital chief of staff led some other physicians in questioning the manner in which a hospital was being run, hospital CEO Bruce Mogel allegedly had black gloves and a gun planted in the doctor’s car. Then someone called 911 and reported that someone was driving down the street waving a firearm. The doctor was arrested in the hospital parking lot and was strip searched at the jail.
The doctor sued. During depositions, a witness alleged that the CEO claimed “People do not know how powerful I am.”
Now a jury has found the hospital liable for $5.2 million.
It appears that former CEO Bruce Mogel got away scot-free … and is now a “consultant” at the Nelson Financial Group in Arizona.
As a follow up to the article about wait times in upstate New York emergency departments, the CEO of one hospital provides a great response … and reiterates that health care insurance doesn’t equal health care access.
“With a severe primary care shortage and some practices without after hours and/or weekend care, people are forced to seek care that is available … [j]ust around the corner, millions of Americans are about to have health coverage. Where will they seek care if we have not expanded access to primary care? In the emergency room.”
Government regulations never seem to get less onerous, do they? HIPAA regulations change again. Now doctors can be held liable if their business associates cause patient privacy breaches, penalties increase, and privacy notices have to be modified.
For some reason, I seem to read about events like this on a regular basis. Another car crashes into hospital emergency department. This schmoe wasn’t seeking medical care, he was intoxicated and trying to get away from police.
What would happen if Press Ganey ratings were superimposed on the Wong-Baker pain scale (i.e. the “smiley faces”)? GruntDoc shows you.
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Posted in Healthcare Update | 2 Comments »
February 17th, 2013
By Birdstrike M.D.
My first night shift in a stretch of 7 was almost over. It was 6:15 a.m. and I had to keep moving otherwise the minute I would stop, my eyelids would drop like two ton shades and I’d fall asleep. That never makes for a good drive home after a night shift.
“Got time to see one more?” asked Jenny the nurse.
“Do I have choice? The door-to-doctor time storm-troopers would have it no other way,” I grunted back, eye lids drifting closed.
“Febrile seizure,” it said.
Good, this should be quick and easy, I think to myself. We’ll give some Tylenol, reassess in 30 minutes and this baby will be happy, smiling and bouncing off the walls. That way I can get out of here at 7 a.m. and be home in bed with my eye blinders on drifting towards sweet REM sleep at 7:20 a.m. My sanity depends on it. 15 feet away, I head towards the room. Looking into room 4, I expect to see the usual post-febrile seizure toddler, sitting up in bed, recovered, awake and well appearing. First I see the child’s mother, well put together, attractive, smiling and relaxed. I cross the threshold to the room, look down on the hospital stretcher and I see a child, about 1-year-old, still seizing. Still seizing? I think to myself. This isn’t right.
“Jenny, get in here! We’ve got a seizing baby,” I say. I look down at the child, who is pale, head turned to the right, with the left arm twitching violently. “Call respiratory! Jenny, you get the IV, I’m going to start bagging. Someone get the Broselow tape and some Ativan. Let’s stop this seizure. Get some diastat, too. We may need it. As I bag the child, Jenny quickly gets an IV in. We give a dose of Ativan and the baby stops seizing quickly. The O2 sat is 97%, the baby is breathing spontaneously and I stop bagging. I put an O2 mask on the baby. I feel the brachial and femoral pulses. They are bounding.
Considering the baby has normal vitals, I turn to Mom hoping to get some history while hoping the baby will quickly awaken from the post-ictal slumber. “Mom, hi, I’m Doctor Bird, tell me what happened please.”
She looks at me and smiles. Her lips spread apart and reveal a soul-sucking brown smile. Why is she smiling? Her baby just got done seizing? Why isn’t she panicked? I look towards Jenny the nurse whose face is beet red and stressed like mine, after a 12 hour night. I shoot a glance at the clock and it’s well after shift change now. I’m fried. I haven’t slept in over 24 hours. I look back at Mom and I realize she’s the calmest one in the room. There’s something really, really wrong here. In the corner of the room is a man sitting on a chair that I hadn’t noticed before. He’s smiling. I look at him. “Hey doc! How’s it goin’? Havin’ a good night?” he asks with a smile and a laugh as he slaps his knee. Having a good night? I’m having a horrible night, I think to myself, and I’ve got a seizing baby on the stretcher in front of me. It doesn’t seem to be cramping his style too much, however. I feel the energy drain right out of my chest. At that moment I know exactly what the diagnosis is, and I feel like I might puke my guts out.
“Charge nurse? Please escort them to the family consult room. Thank you. Suzy, call the chopper, now. Jenny, let’s get this baby tubed. Tell CT to clear the table, we’ll need a scan in 2 minutes. Call PICU at —– —— Medical Center. We’re flying this one out! Call Social Services and the Police, too.”
Once intubated, stabilized and after another dose of Ativan we shoot over to CT. I watch the image slices appear on the computer monitor one by one. My stomach turns over. I see just what I feared: massive bilateral subdural hematomas (bleeding around the brain.) There are skull fractures. There is a brain that looks obliterated.
The helicopter crew arrives and prepares the toddler for transport. As they wheel out the door with our tiny toddler in tow, Jenny the nurse, the respiratory therapist, Suzy the unit clerk, Bob the charge nurse and I all just look at each other. Nobody says a word. What is there to say? We all know as much as we need to know. Off we go, out the ED doors headed home, exhausted as the sun comes up after a very long night shift.
A few days went by. We all tried to work through the next few shifts pretending like nothing big had happened. It’s “just a job,” right? A few muttered comments here or there but most everyone tried to work past it. In a case like this, despite knowing you did all you could do, it’s hard not to feel like somehow you failed, since at the end of it, a child remains brain-damaged or worse. I tried to forget about the case and move on, but I had to get some follow-up. In a rare slow moment, during a shift a few days later I asked, “Suzy, why don’t you call down to the PICU at —– —— Medical Center. Let’s see how the baby from the other night is doing. I’m sure we could all use some good news right now.” I was hoping that my worst suspicions would be proven wrong, and my cynicism would lose out to wishful thinking. I sat down to check the internet for the weather while I waited. Already up on the screen, was the local news site. The headline said:
“Shaken Baby Dies: Mom and Boyfriend Charged with Murder”
“You know what Suzy? Hang up the phone. We don’t need to call. I’m sure everything turned out just fine. You all did a great job with that baby,” I said. I headed to see the next patient, chief complaint: “Itchy nose.”
“Hello, Mrs. Jones, I’m Dr. Bird, how can I help you today?”
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This author does not divulge protected patient information or information from real life court cases. Any post that appears to resemble a real patient or trial can only be by coincidence. This author does not post, has not posted and will not post factual identifying information about real patients. To the extent that any post is based on the real life experiences of the author, names, dates, ages, sexes, locations, diagnoses, and all other factual information are routinely changed to the extent that it should be considered fictional. Any opinions expressed here are of the author alone and not those of epmontly, WhiteCoat, my employer or any of the hospitals with which I am affiliated.
Posted in Uncategorized | 15 Comments »
February 16th, 2013
By Birdstrike M.D.
My kid and I are outside in the front yard blowing bubbles, enjoying the blue skies and 70 degree weather when she says, “Cool Daddy! Look, there’s a police car coming down the street. Oh, cool! I think he’s coming to see us!”
Uh, oh, I think to myself. Despite my kid’s excitement, I know that rarely does anything good come delivered by a policeman. My wife is inside, my one kid is with me and my other is inside, so they’re not coming to give me some tragic news. Or are they? My parents….my siblings….is everyone okay? Why is a sheriff pulling into my driveway?
I exhale for a minute. Maybe it’s Jim, the officer that lives in the neighborhood, I think to myself. He’s probably just stopping by to chat or say, “Hi.” As the car rolls closer, squinting to look beyond the window glare I see that it’s not Jim. It’s an officer I’ve never seen before. Clearly none of us has done anything to get arrested….
“Daddy! I wanna go see inside the police car! Daddy, will he give us a ride? Ooh, ooh, can I see his gun? Cool!” says my kid, jumping up and down with excitement.
“Let’s see what he wants,” I answer.
The driver door opens. A huge officer gets out, in grey uniform, bulletproof vest bulging underneath, with black wrap-around sunglasses, and a toothpick in his mouth.
“Are you Dr. Bird?” he asks, as serious as a heart attack.
“Yes, sir,” I answer.
“I got a present for ya,” he says, as he pulls a thick rolled up stack of paper from under his arm and hands it to me. “Here’s your subpoena,” he says.
“My what?” I stammer. “What’s this all about?”
“You’re getting….” he starts before,
“Daddy! Daddy! I wanna ride in the police car. I wanna see the lights go on! Yay!” says my little one.
“…sued,” I finish the sentence for him.
“Yes, sir. You and every other doctor in this county it seems like. I’ve got about a dozen more to go serve. These lawyers are unbelievable. (laugh) I happen to know this one will sue you for breathin’ and win, too. You know, the one on the back of the yellow pages? You ever run into any trouble, though, you call him. Trust me, he got me out of a jam one time,” he says with another grunt-laugh.
“Wow. Thanks for that wonderful advice. You’ve really brightened my day,” I snark back at this guy, who apparently thinks it’s hilarious to be part-time process server and part-time comedian.
“Oh, don’t take it personally. It’s just business,” he says chuckling, as he spits out the same old lie and cliché I’ve heard a thousand times from doctors who’ve been sued.
“That’s great. Thanks. Anything else I can do for you today, officer?” I ask, dejected.
“Oh, yeah, I’m gonna have to give you a ticket for parking your car on the street overnight….Just kidding!” he says, and give’s a snort-laugh.
This guy’s unbelievable, I think to myself as I turn to walk away.
“Don’t worry, Doc. You’ll win that case. That lawyer will sue a dead dog if he could get it to settle for a bone and a biscuit,” he says.
“Uh, thanks for your…uh, support,” I say, shaking my head in disbelief.
Yep, it happened. After about 30,000 lawsuit-free patient encounters I finally got hit with a lawsuit. I guess 29,999 out of 30,000 isn’t bad, I think to myself. What’s that, 99.99% accurate? Well, it’s still not perfect; still not 100%.
I walked inside and ripped through the pages and start reading about the case of which I have zero recollection. What? This? This is nothing. This is ridiculous, I think to myself. Where’s the malpractice? Where the h—l did I not do everything as I was taught, as I should have and as I would do again?
I can’t find the malpractice, because it’s not there.
Almost every day in my training, it was either implied to me, or I was explicitly told that someday, no matter how perfectly I practiced, no matter whether I met or exceeded the standard of care, that I would be falsely accused of malpractice someday and be sued. In each of those teaching moments, I was told how to practice so as to decrease the chances of such a false accusation and how to document, so as to be able to fight the inevitable false accusation in court. Never once was I told, or was it implied that it wouldn’t happen.
Though these words were never spoken, the unspoken lesson was: You are getting excellent training. You are going to be an excellent doctor. You will be prepared to handle any situation thrown at you. You will go out into the real world and do your best with every patient you see, and one day you will be sued for it, and possibly put on trial. I trained at a top notch institution. My teachers were right.
Over the next week, I obsessed about the case. Over and over and over again, it ran through my head, what would I have done different? I can think of all kinds of things I could have done differently, but none of them seemed better, or even equally as appropriate as what I did. In my head I kept hearing the mantras of physicians that have walked the plank of false medical malpractice allegations before me, “It’s the cost of doing business,” “It’s not about you, it’s about money,” “It’s not personal,” “Every doctor gets sued.” Yeah, bulls—t, I thought to myself. The more I thought about it the more it infuriated me.
Also, reading through the record, I couldn’t help but think, of all the patients I’ve seen, why this one? There’s nothing here, nothing at all. Not only did I not commit malpractice, I cannot see where any of the other providers even might have or possibly committed malpractice.
As the months went on, I went through the “process.” I met with my lawyer. I reviewed the record ad nauseum. I read every bit of literature about this case I could find. The more I read, the more I was certain I did nothing wrong. The more I thought about it, the more I realized that didn’t matter. Also, the more I was told and the more I told myself it “wasn’t personal” and “was just the cost of doing business” the more I took it personally. It is personal. When you dedicate your life to helping people, often times without payment, often times at 3 a.m. dog tired, on your kids birthday or your third holiday in a row, and it’s routine business that you’ll be extorted for money just for doing your job and doing it well, you’re damn right it’s personal.
Along came the depositions. The plaintiff deposed their “expert” who plainly put, was not an expert. He was a hired gun, paid thousands of easy dollars, to testify that everything I and my co-defendants did was absolutely wrong. Also, he was of a completely different specialty than my own. His testimony was laughable. His answers seemed to indicate he hadn’t even read the evidence closely or at all. Regardless of how bogus his testimony was, my attorney tells me, he made enough (false) accusations to get the case to trial.
One by one, our experts line up drooling to testify that their expert was absolutely wrong. They had the truth on their side and they were actual experts. But would the jury understand? Whose “experts” would they believe? As strong as my case was, I resigned myself to the fact that that’s what the case would come down to. Not what was right, or what was wrong, but whom the jury chose to believe, for whatever reason they chose to believe him. As difficult as it can be to judge another physician in a different specialty I can only imagine how difficult of a task it is for a jury with no medical background to judge the decision making process of a physician, in a complex medical case. How many times have you gone to an M&M conference and a dozen experts argue over a case with a bad outcome and even those highly trained experts couldn’t agree on what the “standard of care is” let alone whether or not it was met?
Over months, the trial draws closer. My tension waxes and wanes, fades and returns with each deposition, each email from my attorney and with any patient encounter that reminds me of the case. Ultimately as the trial closes in on me, the tension builds. All the while, I know I met…No, I exceeded the standard of care. As the trial date gets closer, the more I realize how little that may matter. How would I come across to a jury? I’ve never been on trial. I know I’ll be very nervous on the stand. Will that be seen as appearing “guilty” or will the jury understand and see my side of things?
I get an email from my lawyer. “Just to let you know, the trial is set for –/–/—-. There will be a routine mediation meeting tomorrow. You do not need to attend. We are taking this to trial. You did nothing wrong. We will fight this every step of the way.” Deep breathe, exhale.
The next day, breaking the silence comes a “ding.” It’s an email on my phone. I open the inbox, and I see two words that shock me:
“CASE OVER! “
“The charges against you have been dropped. No money will be paid on your behalf. There will be no trial. Congratulations. You are dismissed with prejudice”
I could hear and feel the air start to leak out of the balloon of pressure hanging over my head: “Dismissed with prejudice.” I ask my lawyer to translate: that means “Over. Permanently. Done. You are innocent. You won.”
Well, it didn’t feel like a “win,” but it was over. I was relieved not to have to roll the dice. Even though I was vindicated, there was no “win” in being falsely accused of committing malpractice considering all the time spent reviewing charts, attending legal meetings and depositions, and all the mental stress and sleepless nights. Others have said that although a dropped lawsuit is a win in a literal sense, it is a great loss for patients and doctors because it drives a harmful and dangerous wedge in the physician/patient relationship. As I progressed forward from this point on, I truly understood how true this is. I couldn’t help but feel that from then on, memories of this lawsuit and the process would be irreversibly intertwined with each patient interaction, each handshake, each differential diagnosis and treatment plan, as much if not more than the science, pathophysiology and the text books I read.
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This author does not divulge protected patient information or information from real life court cases. Any post that appears to resemble a real patient or trial can only be by coincidence. This author does not post, has not posted and will not post factual identifying information about real patients. To the extent that any post is based on the real life experiences of the author, names, dates, ages, sexes, locations, diagnoses, and all other factual information are routinely changed to the extent that it should be considered fictional. Any opinions expressed here are of the author alone and not those of epmontly, WhiteCoat, my employer or any of the hospitals with which I am affiliated.
Posted in Guest Posts, Medical-Legal | 74 Comments »
February 15th, 2013
Fascinating study about missing obvious findings on CT studies, based on another study about selective attention. In the cited study, 83% of radiologists missed the abnormal findings on the first CT image.
Don’t ruin it for anyone else, but how many of you caught all the abnormalities on the CT scan below? For those who aren’t used to looking at chest CT scans, I included a fairly “normal” CT chest cross section (except for the small nodule) at approximately the same level on the bottom for comparison (credit here).
 Abnormal CT 
Posted in Medical Studies | 5 Comments »
February 14th, 2013
Surgery went uneventfully, I think. Don’t remember much of it because of the dang Versed.
While walking back to the outpatient surgery room, I never thought what big business surgeries are for hospitals. The outpatient surgery floor had a long curving hallway of identical rooms, one after another, all with freshly-made beds, blankets folded neatly on top of the beds, and patient belonging bags draped over the blankets. Walking by the rooms, it was almost like having the same picture flashed in front of my face over and over again.
After I got settled in the room and started watching the news on the flat screen TV in the room, a rapid-fire succession of people came in and out of the room … nurse, nurse anesthetist, anesthesiologist, OR nurse, then surgeon. I could hear them going from room to room and could hear them repeating similar information with other patients. Most common question was whether my pain was being controlled. Thanks, Press Ganey.
I didn’t even have time to flip through the news stations before I was being wheeled off to the operating room. Traveling down the hall I could see little vignettes of other patients waiting for surgery through the doorways to the patient rooms. An older lady with a priest standing at the head of the bed talking to family. Little girl watching TV with her parents. An older businessman with reading glasses flipping through pages of the Wall Street Journal.
I felt a tug on my IV line. The nurse anesthetist was walking beside the bed and had a syringe that she was twisting onto my IV line.
“I’m just going to give you a little Versed.”
Great.
I felt the rush of cold IV fluid running up the veins in my arm, but was still wide awake as we waited in line for the doors of the OR to swing open.
I thought to myself “I wonder how cold the OR will be this time.”
Then I heard my youngest daughter’s voice.
“Wait a minute,” I thought, “she’s supposed to be in school.”
Someone was rubbing my hand.
I opened my eyes and my beautiful wife was sitting next to me with a smirk on her face. Apparently I was being an unconscious smart ass and don’t remember a bit of it.
Damn Versed.
I asked her several times what the surgeon said. She told me several times but I didn’t remember. I do remember her telling me that she was going to text it to me so she’d stop having to tell me.
The surgeon apparently told my wife that the hernia was fairly large and I apparently kept remarking that wasn’t the hernia.
The nurse asked me if I would rather have some water or some juice after surgery and I asked for a double shot of tequila.
I’m sure my wife couldn’t wait to get me out of there.
So I’m back home and relaxing. Groin is sore. Kids are feeding me their unwanted Valentine’s candy. Hope to be up jogging tomorrow.
Thanks to my excellent surgeon for his expertise and to the hospital staff for their prompt and courteous care … and for putting up with all of the other wisecracks that my wife probably didn’t tell me about.
Posted in Random Thoughts | 2 Comments »
February 13th, 2013
 California doesn’t have enough doctors to provide healthcare to newly “insured” patients under the UnAffordable Care Act.
California state senator Ed Hernandez asks “”What good is it if they [state citizens] are going to have a health insurance card but no access to doctors?”
Wait. Health care insurance doesn’t mean that patients will have access to health care? Where have I heard that being said for more than 3 years?
The government is going to give patients their medical “insurance,” but access to physicians is limited by government policies, payment cuts, and administrative red tape — which are driving many doctors from the primary care business and are, in effect, rationing care to patients.
California’s grand plan is to allow physician assistants, nurse practitioners, optometrists, and pharmacists to provide primary care services. I liked one of the commenters who said that he went to see the doctor, but was referred to the janitor who gave him a bag of medications for $5. These other health professionals and their organizations seem to naively think that the patients they will treat only require management of simple medical problems. In reality, most patients have multiple interrelated chronic medical problems that must be managed together.
Take diabetes, for example. Will it really be cost effective to have an optometrist manage a patient’s diabetes and perhaps monitor the patient’s diabetic retinopathy while the patient still has to be assessed and monitored for diabetic nephropathy, diabetic wounds and wound care, diabetic neuropathy, the increased risk of heart disease, oh and the impotence that often accompanies diabetes? Should the optometrist prescribe Viagra for a diabetic patient with heart disease or not?
If the optometrist refers the patient to a bunch of physicians to make those decisions, then the government has just created an additional layer of bureaucracy which will cost more money.
If the optometrist just blissfully monitors the patient’s glucose levels, prescribes insulin and doesn’t regularly evaluate the patient for diabetic complications, then the patients are receiving government-sanctioned poor medical care. That should make the trial lawyers happy … if the optometrists have insurance for the millions of dollars in damages when bad outcomes occur.
These health care providers are begging to get in over their heads and we need to let them do so. The medical establishment should really stop fighting this idea.
Allowing governments to implement a system that reduces access to doctors, increases complexity in medical care, and that will likely increase bad outcomes will eventually create patient outrage with government officials who adopt the idea.
We all should be part of a team, but not everyone is able to play quarterback.
I predict that these types of policies, if implemented, will ultimately increase the demand for physicians.
Unfortunately, the underlying problem is that most of us will be expected to pay more in “taxes”, insurance premiums, and other fees … for less medical care.
But remember that everyone will be insured, so things will be OK.
In anticipation of hate mail from nurse practitioners, physician assistants, optometrists, pharmacists, and possibly even Lucy VanPelt expressing outrage at my unprofessional stance because there aren’t any studies showing worse outcomes in medical care provided by those with less medical training, I’ll quote a comment that I posted on KevinMD’s site a couple of months ago in response to a nurse practitioner who asserted that he had “the same ability to provide patient care [as physicians] based on the evidence.”
You’re right about all the studies, I’m sure. In fact, I bet there aren’t any studies showing that treatment rendered by grade schoolers is any worse than that rendered by nurse practitioners, so next down the line to help patients save money will be gifted grade school student phone advice and then Shaman Skype toddlers with their magical rattles of health. Goo goo ga ga.
I don’t care how good you think you are, if you can’t pass a doctor’s board exam, you shouldn’t be [independently] treating patients, so lose the ego. Actually, the law says that you can treat patients, but you damn well better tell the patients that you aren’t a doctor and then let the patients decide whether they trust you with their lives. But lose the ego, anyway. It’s a team sport and you don’t get to be the captain just because you think you’re better than everyone else. When there’s an emergency in the hospital, no one goes running to find the nurse practitioner.
Posted in Access to Care, Policy | 22 Comments »
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