Grinding to a Halt

I’ve been in a foul mood of late at work, and it’s because I see the beginning of the end of the health care system I know and respect.

I am not involved in health care policy, or planning, just the trench-line delivery of modern, ‘high-tech / low touch’ American medicine. I realize it’s terrifically inefficient and at the same time realize I am individually powerless to change it. However, I’ve been thinking more and more about our future, and it’s not at all good.

I’ve recently had several interactions just like this one from Australia:

Sometime during the night they were moved out into a corridor to make room for the incoming. I saw them again the next morning. There was no longer any room to sit beside her, so he stood at the foot of her bed. He was angry. “This is disgraceful” he shouted. “I’ve had top private health cover for as long as I can remember….and now I need it, I can’t even get a bloody bed for my wife!”

He sat, red faced and embarrassed at his outburst. It was all beyond him.

Since November, with few exceptions, we’ve been ‘holding’ admitted patients in the ED. Yesterday we had about 1/3 of our physical rooms occupied with patients ‘admitted to the hospital’ who were going to be cared for in the ED. No windows, no TV, no phone, just a real hospital bed, real hospital food and their medications. It’s the biggest shock to people who haven’t been to an acute care hospital for a while, and just assumed there would be space in the hospital for their loved one. This is, by the way, after we’ve been putting admitted patients in the hallways of the upstairs wards to try to relieve the ED overcrowding.

So, 1/3 of our space is now dedicated to inpatients, therefore the hallways were lined with gurneys of the actual ED patients. Four years ago this was an occasional, ‘surge’ thing and now it’s everyday and around the clock there are patients being cared for in the halls. (Mental exercise: describe how much fun it is to give a history in a busy hallway with people and other patients / families constantly walking by, and I’ll leave the thrill of the physical examination to your imagination).

There’s no incentive for hospitals to add beds, unless you happen to have one of those really-well-billing cardiac diagnoses, and there’s money for that, so hospitals are building cardiac units that are closed, meaning if you don’t have a cardiac diagnosis and a cardiologist on the case you lie in the hall. We have, simultaneously, the best and worst healthcare has to offer.

I’m of the opinion many of the problems of modern healthcare do stem from a complete absence of a market in medicine. I wouldn’t take my car to the shop and just say “fix it” without at least discussing the costs (unless I had the insurance / medicare system for my car, then I’d drive it like a nut and sue if it wasn’t perfect when it came out of the shop). I’m 100% for posting signs in the waiting room, patient rooms (and, regrettably hallways) outlining what these tests they’re getting charge. It’d be eye-opening, and it might just cause a few people to think about need vs. want, and would make my job a little harder. I’m okay with that. I’d like to discuss the pros and cons of ‘do you really need me to CT you from stem-to-stern’ with an alert patient who’s able to make informed decisions.

People ask me what I think the future of medicine is when we’re staring at the overcrowding, and ask what I think will happen. I don’t think it’s going to be anything cataclysmic, we’re just going to grind to a halt at this rate. Money continues to be poured down expensive therapies of marginal benefit, there’s no barrier to asking for more healthcare, “now!”, and have a quick peek at nursing demographics if you’re in doubt about the short and long term problems we face.

The Wall Street Journal (may require subscription, sorry) has an editorial about healthcare today, and here’s the money:

[Shifting to a market system] won’t be easy, especially given the ideological stake that so many politicians have in a government-run system. They like the leverage of determining payment rates to hospitals and doctors, not to mention being able to take credit with voters for providing more benefits. But there is no free lunch in health care, any more than there is in any other part of the U.S. economy.

Health care is either going to be allocated by prices or by government, which in the latter case means price controls and waiting lines. Though it represents one-sixth of the U.S. economy, health care is the one industry in which the purchasers actually have no idea what anything costs. An individual market for health insurance would allow more freedom of choice while making consumers more cost conscious.

If we don’t do something, soon, there not only won’t be a medicare system, there won’t be anyone in the hospitals left to take care of us. If we can get out of the hallway, that is.


  1. TheNewGuy says:

    I thought I smelled CJD.

    I would also gladly take a pay cut if it meant some meaningful tort reform. I paid approx 40K this year for my modest malpractice coverage, but I’d pay more to be totally indemnified. What does your legal malpractice insurance cost you a year, CJD?

    Playing the public-resentment-of-rich-doctors game seems to be your favorite rhetorical gambit. As for telling our “sob story” to “real people” (implying, of course, that we’re not real people, just faceless, bottomless deep pockets, waiting to be fleeced), plenty of my patients appreciate how long I went to school, and how well I treat them.

    But that’s OK. We’ll see what kind of “whiner” you are when you have your next kidney stone. Pain is pain, buddy… but I’ll gladly hold back on that morphine so you can show off to your colleagues how you don’t whine. You say the word, and I’ll let you scream/writhe/puke so you can tell them you “took it like a man.”

    Just out of curiousity… do you say the same thing about the clients who attempt to retain your services? All that “whining” about pain and suffering after all… how do you stand it?

  2. New Guy, you didn’t really read my posts, did you? I’m glad you make a lot of money – I think you deserve it. Not once have I said that you didn’t work hard for it or earn it. Read what I wrote, not what you want me to say.

    Do you object to someone arguing that you’re just a rich souless person after another dollar? That you don’t care about those you work for or on? Welcome to the club. Do you object to it when physicians say the same about others? Do you object when one of your colleagues uses terms like “sodomite”? I’m sure you do, because you wouldn’t want to be considered a hypocrite, would you?

    As for the whining, what’s sad about it is that you all feel so totally ineffectual, so whining appears to be all you do. Most of you don’t appear to have the slightest clue what to do about your declining reimbursement rates. Don’t you wonder where your AMA “crisis map” is on this issue? Do you not have talking points unless an insurer supplies them to you?

    We just had a Republican administration pass, almost without objection, the largest entitlement program since the Johnson era. And we’ve got big business screaming for health care relief. Universal health care is about to be a foregone conclusion, and all you guys appear to have the ability to do is curse lawyers. Your malpractice premiums will be a drop in the bucket compared to the income lost, not to mention the wholesale changes in your practice, when that happens.

    But what are you doing about it? What is one of the potentially most well funded groups of people in the United States, who have more at stake if universal health care becomes a reality than anyone else, doing to stop this? Or do you want it? What’s the AMA doing on this front? Where are the vitriolic letters to the editor? Where are the crisis maps, the empty claims of physicians leaving and people going untreated as a result, the marches on the state capitol? What do you think is going to have more of an impact on your bottom line – keeping a few people who have been hurt really bad from getting fully compensated or Washington completely running your billing?

    Is it too complex an issue? Is there no easy party to demonize? What’s the deal? This is the real issue. The baby boomers are going to hit and the strain on US health care is going to be enormous. Do you really think any politician is going to let GM go under because of healthcare costs? They have 1 million workers whose health care they are providing for. And that’s just GM.

    Incidentally, I paid about 4% of my income in malpractice premiums last year – about what the average physician pays. If I handled complex and costly cases like med mal on a regular basis, it would have been significantly higher. If you want to be “totally indemnified”, buy more insurance and do just a little bit of asset protection planning. While no one is totally and completely indemnified, you can come damn close. I warn you, though, you will have to speak with an attorney to do so. If you’re smart, you’ll talk to a plaintiff’s malpractice attorney to get a better idea of exactly what your exposure is.

    Like I said, I believe you’ll get your wish of complete indemnification. But I bet you won’t like the price you pay for it.

  3. will quit soon says:

    Regarding physicians being the best paid profession in the world, has anyone looked at the hours dedicated by physicians? Would any other profession get out of bed at 3 in the morning to go to the ED in a winter’s storm to evaluate a patient with belly pain who has no insurance and will probably not pay the physician and then probably sue the physician if the outcome is less than perfect? Granted the average plastic surgeon is living a very comfortable lifestyle, but not the average physician. This will become more evident as the numbers of physicians decrease in the future. I am only in my 50’s and had planned to practice medicine well into my 70’s like my father before me. However, I will close my practice next year and join a corporation selling medical devices. No, it won’t be satisfying, but at least I won’t have the fear of losing my house and my wife’s and children’s financial security. I’ll probably join a few medical missionaries abroad to keep a hand in clinical medicine. And will my patients lose out? You bet, but that’s the world we have all created.

  4. Matt (CJD)

    Healthcare is failing for many reasons. The legal system is just one aspect. You consider yourself far too important. I would look silly trying to lecture a bunch of attorneys bout their practice and their profession. You look perpetually silly trying to do the reverse. If you don’t like listening to whining then don’t, but I think you enjoy the attention you get. We have heard all your talking points. Go lecture your dog, or your kid, or help someone with estate planning.

    “How many med mal cases do you think there are with no actual damages? You’re illustrating physicians’ ignorance of the law. Considering the cost of bringing a med mal case, why would anyone file the case?”

    I don’t know. For me personally, it has been 5/5 cases that were frivolous, without merit, and without liability. I understand that verdicts are filed for the defense majority of the time. You probably have some up to date statistics. If you trust the court system then the majority must have been frivolous and without merit. Bad outcomes yes, negligence NO. I think it would be much harder to figure out for cases not going to trial since there is not a jury decision. Clear cut negligence cases are likely settled as a higher percentage, but a very large number are also settled just to get rid of the nuisance. Maybe because you are more practical, or more ethical, you have only done three cases of med mal that had clear liability and settled. You don’t have the money and resources to take those frivolous cases to try and hit the jackpot. Is that because you are more practical, ethical, realistic, than the bigger sharks? Maybe you should try and “educate” them if you are so concerned about the impact of the legal system on the healthcare delivery.

  5. “No, it won’t be satisfying, but at least I won’t have the fear of losing my house and my wife’s and children’s financial security”

    If you have this fear it is because you have failed to adequately insure yourself and have failed to sit down and consult with either a lawyer or financial planner who can explain very basic asset protection strategies. There is not a state in the union that allows your home to be taken by anyone but the primary mortgage lender, unless you have a ridiculously expensive home. The fact that you don’t know this indicates that you need to do some investigation. You may be quitting a job you love for the complete wrong reasons.

    The world you believe has been created is not in fact the world that exists.

  6. Jerry,

    I do not consider myself important at all, and I am not lecturing you on anything. Really, it makes me sad to see a group of people feel so helpless, and if you can look past your irrational hatred of lawyers, you might see that your lobbying organizations are failing you.

    I have no doubt many of you have been named and dropped in lawsuits, and have probably wondered why. It’s because one, there are some attorneys who just scattershot name everyone when they shouldn’t. No doubt about it. But a lot of times its because you can’t tell who to eliminate until you’ve done some discovery. And I doubt any of you are willing to go under oath about a patient before suit is filed. If a lawyer could request medical records and clear up their case and focus it prior to filing, either through pre-suit depositions or receiving detailed affidavits from the physicians who saw the patient, many would. Since the plaintiff’s lawyer isn’t paid by the hour, it’s a waste of their time and their money to have multiple defense lawyers for multiple doctors on the case and sending them discovery requests, correspondence, etc. But I don’t think many of you will talk to a lawyer about a patient pre-suit, will you?

    The other problem is the incredibly short statute of limitations for medical malpractice, which by the time the patient comes to the lawyer, often leaves no time to do in depth discovery. But I doubt you want to lengthen the limitations period, either.

    “You don’t have the money and resources to take those frivolous cases to try and hit the jackpot.”

    Why do you refer to those victories as “jackpots”? Has the lawyer not worked for his fee? Has the victim not suffered? Would you trade places with many recipients of a $1 million med mal verdict? These jackpot winners? Would you put tens of thousands of your own money at risk and months of your time on the bet you could win a med mal case like their lawyers? Knowing how often you will lose? I get that it’s a cute turn of phrase to make is look like every plaintiff is getting undeserved money, but do you really believe that?

    ” Maybe you should try and “educate” them if you are so concerned about the impact of the legal system on the healthcare delivery.”

    What you don’t understand is that in the great scheme of things the impact of the legal system on healthcare delivery is minimal. The price of healthcare to the consumer goes up regardless of tort reform. Heck, the best you can hope to do on premiums even is to “slow the rate of growth”.

    Lawyers can’t make you do a better job. If you want to change the legal system, here’s a suggestion: Start putting out guidelines for the standard of care. Why are physicians not reviewing malpractice cases looking for trends and then establishing standards of care that they will live by and which courts can rely on? I realize every case is unique, but there have to be common themes.

    You’re right though, my pleas are probably falling on deaf ears. But one doesn’t have to be a physician to understand what’s going on in healthcare and to recognize the political realities of the situation. I for one do not want universal health care. I do not think it is a good solution to any of the problems. It’s just frustrating that those in the best position to do the most about it are pissing away their time on something that is really only a benefit for insurers and really only a negative for the people who are injured the worst by legitimate malpractice. It doesn’t harm lawyers and doesn’t really help doctors.

    Maybe you just don’t care, though.

  7. “This comment illustrates just how well paid you are. If you would trade away 40% of your salary, that’s a hell of a salary. Your insurance premiums certainly don’t constitute 40% of your salary”

    Again CJD, you’re changing the subject. Whether I make $20,000 a year or a million, the fact that I (and most doctors) would be willing to give up a portion so that we can do what we loved before lawyers ruined it shows how good medicine could be if we could just get this legal monkey off our backs. Your profession has made physicians afraid of the very patients we are supposed to be caring for. So we hide, try to avoid “high risk” patients, and lawyers have created a “cold war” between physicians and patients. I’m afraid to go to work every day, lest a patient has a bad outcome and I get sued. If 40% would allow me to want to see patients again, I’m all for it.

  8. Goodness, everyone of you Drs., speak of patients, as though we are all waiting for you to make a mistake so that we can hire Matt to sue you.

    In reality, how many of your patients have filed lawsuits against you? Do you think lawyers are going to take on a lawsuit that they believe has no merit? How many hrs. do you imagine they spend preparing for a trial? How much money do they spend on investigators? How many witnesses do they have to speak with? You pretend as though you believe someone walks into their office and says “I’m pissed at my Dr. and I want to sue him.” The lawyer then says “OK, lets go for it, I will file the papers and see you at trial.” Give me a break! You are turning pts. against you with your defensive medicine attitude. You order tests and procedures that you know we don’t need, then you get angry if we don’t pay, or our ins. doesn’t pay you for all this BS. Why not just try honesty with your pts.? Tell us if there is a test that “could” be done but your expertise and education tells you that it probably won’t show anything, then leave the decision to us as to if we want that test or not. For the most part, we come to you because we trust you and we believe in you. You are taking away all that trust!

  9. Again ds, your comments illustrate that you really have no idea of the risk entailed in what you do. If I were you I’d want to know someone other than the AMA and my insurer, but you seem content to unquestioningly rely on whatever they tell you.

    If you could happily afford to give up 40% of your salary, why don’t you just use some of that to buy a $10 million malpractice policy? The chances of you having a verdict in excess of that are infinitesimal. And you can make them even smaller with just a little bit of money spent on asset protection.

    If you really want to put your mind at ease, speak with a good tax/corporate attorney, and then talk to a malpractice lawyer on both the plaintiff’s and defense side. Only a fool would rely solely on an insurance company and lobbyists to tell him what is in his best interest.

    I mean this in all sincerity, you do need some help because you are scared way out of proportion to your exposure. And I don’t think you should be so willing to give up your hard earned money.

  10. “Would you trade places with many recipients of a $1 million med mal verdict?”

    Lots of people suffer. I have a cousin who is 19 years old and cannot function because of intractable seizures due to Neurocysticercosis. I have had to tell parents their 2 year old was dead. But to reward a few (and their lawyers) and destroy an entire profession in the balance (ie OB-GYN) to reward a minority of “victims” is insanity. In the ER, we get sued most often for errors of ommision, so we test, test, test, to the point that we cannot handle the volume of patients we see(and their defensive test workload). And we still miss the “needle in the haystack” and get sued anyway. I am not going to pick up every single disease that walks into my ER, and I test more then almost every doctor I know. But I will miss something and get sued. Why do these tragedies have to be equated with monetary reward in this country?

  11. “Goodness, everyone of you Drs., speak of patients, as though we are all waiting for you to make a mistake so that we can hire Matt to sue you”

    We have to think that way. I put my name on approximately 5000 charts a year. I will get sued for approximately 1/25,000 patients I see. (once every 5 years) So it’s unfortunate, but I have to treat all 25,000 patients defensively to save my butt one that one who sues me. I can’t predict who that one will be, so I treat all 25,000 like they will be the future plaintiff. Every ER doc (and OB-GYN, Orthopod, general surgeon) I know practices this way.

    As to offering tests and letting the patient decide, we do this every day. We then are forced to tell them “If you don’t do this test you are at risk of dying” , If you refuse I need you to sign out AMA, which is antagonistic, but I never lie to a patient, I tell patients “in emergency medicine we often look for needles in a haystack”. Unfortunately alot of patients don’t understand what I am telling them, and they agree to the defensive test that I would never agree to myself (ie Lumbar Puncture for headache, “just in case” it’s a subarachnoid)

  12. This goes deeper than your mistrust of lawyer’s, and your fear of that 1 out of every 25,000 patients. You are making broad statements pertaining to the entire judicial system. Aren’t you allowed to hire your own qualified attroney’s if you are being sued? Aren’t you granted the right of a jury trial and your attorney allowed to question each potential juror before he/she is excepted? Why aren’t you allowed to present your defense in front of the jury and prove your innocence? If I was being sued and hundreds of thousands or millions of dollars were at stake, I would hire the best defense attorney available to me. If I had done nothing wrong I would not be intimidated by a lawsuit, I would fight my ass off to clear my name.

    The fact that patients and their attorney’s are granted millions of dollars at these trials is way over board, but is that the norm in a malpractice trial? I doubt that it is. We only hear about the few that do receive that type award.

    I once had a Dr. (surgeon) that was being sued by another patient. This Dr. informed myself and my husband 2 weeks before my surgery of this lawsuit. He explained it in some detail to us, because he wanted me to be aware of it before I agreed to to have surgery. It didn’t matter to me in the least. We had a good Dr./Pt. relationship and I willingly wanted him to operate on me. I gained much respect for him that day for making sure I knew about this lawsuit. I thought it was probably very hard for him to inform his Pts. about it. We never spoke of it again and I never knew what the outcome was. I continued treatment with him for 5 years. His office was always packed . He was an oncology surgeon so this was a long term raltionship. He saved my life. Millions of dollars couldn’t have compensated him for what he gave back to me.

    I can plainly see your side of this, but, something has to be done
    before your fear of lawsuits destroys your profession.

  13. Ds,

    You’ve moved away from the risk question, and I hope you take my advice, because it would do you a lot of good. But you do bring up another issue, although you’re still a bit overwrought, when you say this:

    “But to reward a few (and their lawyers) and destroy an entire profession in the balance (ie OB-GYN) to reward a minority of “victims” is insanity.”

    Why should these people get any money? Why should the victim of a car wreck get any money? Or the victim of a faulty product? I think it’s because we as a society believe these things have value. And the only way we can compensate those losses is money, the one thing that we all agree does have some value. It’s not perfect by any means, and no one disputes that. But we are simply not willing to say that it lacks value.

    The next thing is personal responsibility. If you harm me, and cause me damage, why shouldn’t you have to take responsibility for that? Why shouldn’t my medical bills as a result of your actions, be they driving a car or performing surgery, that fall below the standard of care? I didn’t cause the injury.

    The third thing is related to the second – allocation of resources. You see a $1 million verdict and think that person just got a million dollars, less attorney fees. But they didn’t. Their health insurer got some, their future medical providers get some, their mortgage holder likely gets some, the lender on their car gets it. The award, by requiring the person responsible to pay, keeps all those other people solvent, and keeps the injured person off the welfare rolls in the case of catastrophic injuries.

    You’re right though, we could not award any money for anything. But then why would we need insurers?

    Now, in the case of your examples, we can’t collect on God. You’re right, sometimes crappy things happen, and Americans know it. In fact, the number of tort claims has declined over the last decade.

    As to your claims that you MUST do defensive medicine, they are, like your risk assessment, faulty. Or at least uninformed. Do you have any ideas which missed tests are most likely sued upon? Do you know what the likelihood of success in those cases are? I’m betting you don’t. So you’re just performing these tests willy nilly, with literally no comprehension of whether they are actually doing you any good.

    And really, if you buy that $10 million policy and do your asset protection, why are you afraid to tell the jury exactly how your actions met the standard of care? You’ve got a pretty good shot of winning as it is.

    With regard to your examples, was their suffering the result of another person’s negligence? Your

  14. “As to your claims that you MUST do defensive medicine, they are, like your risk assessment, faulty. Or at least uninformed”

    It really shows how little you know about what goes on in Emergency Medicine. It’s my full time job. Defensive medicine is what we do. We practice risk assessment 24/7. I’m not just some outlier, obsessed with lawsuits. I’m just one of the few with the kahunas to say it. We see a ton of patients with complaints, more then the system can handle, our job is to decide who is “at risk” of a bad outcome, and deserves that test today. Most of us admit the majority of patients with chest pain, not because they have a high likelihood of disease, but because missing an MI is so “high risk”. If most ER docs knew that abdominal pain in the elderly was even higher risk, they would be more defensive about those patients too.

    “Do you have any ideas which missed tests are most likely sued upon ”

    It depends on the patient population. The most likely lawsuit from a missed test in all comers is a missed fracture from a misread xray.

    In Kids you don’t want to miss Meningitis or appendicitis. So the missed tests that get you sued in kids is Lumbar Puncture (for meningitis) and whatever test your hospital does for appy in kids (Ultrasound, Ct Scan). A new source of income for lawyers is the delayed diagnosis of meningitis, ie you do the lumbar puncture, but it causes delay in giving antibiotics.

    In adults the big misses are Missed MI and Missed Subarachnoid hemorrhage. Failing to admit a patient with chest pain is a big error of ommision. Failing to do a CT scan (and LP) on a headache is another big winner for the lawyers. Most ER docs are being very defensive about doing these tests, though LP continues to be a problem due to the time it takes to do.

    Omitting treatments is another big source of income for lawyers, especially since so many treatments, ie TPA for stroke, is so controversial. Delays in treatment are creating further wins, as the system gets more and more overwhelmed, for example USC lost a huge lawsuit after a guy with DKA got fed up of sitting in the waiting room, went home and died at home. He never saw a doc but the lawyer dinged the hospital for the wait.

  15. What I’m asking is if there are any studies that you know of that indicate which tests, when not given, have been determined by a jury or a court to be part of the standard of care for the particular complaint?

    You say you practice risk assessment 24/7, but you do it without any baseline. You can’t tell me a single thing based on anything other than anecdotes about what act or omission leads to a lawsuit.

    You’re making all these claims about this or that being big moneymakers for the lawyers (as always, forgetting that someone was actually hurt by the negligence), but they all appear to be based on one, maybe two cases you read about in a newspaper. What is the source for your claims? So and so told you about this case? A friend of a friend?

    If I were as stressed as you, I’d want some hard statistical evidence on how to lower my risk. For some reason, it does not appear any effort by physicians has been made to review the cases out there and determine where care is being found to have fallen short consistently, or to create some firmer guidelines for the standard of care that all physicians can count on. If nothing else, you’ll be able to tell where expert witnesses are giving false testimony. All this stuff appears to be done on an ad hoc basis now, leaving you with nothing more than anecdotes.

    The anesthesiologists did just that, took a hard look at where the verdicts and settlements were coming from, and improved the quality of their services. I realize they are not ER docs, but surely you’re not saying there is NO room for improvement, and NO need for some firm guidelines on what constitutes the proper care.

    The information is out there – the insurers have all the medical records from every case. Granted, it won’t work for all cases, but no one appears to have even tried. Has it occurred to anyone that instead of just demonizing lawyers, actually trying to improve quality might yield some results? Who in your industry is studying these sorts of things? What is the AMA for? Just lobbying on behalf of med mal insurers?

  16. TheNewGuy says:

    There is statistical data on exactly what DS mentioned, CJD… you know it as well as I do. I’ve seen it, and I know you have too. Most risk-management folks in the hospital (or your insurer) have those numbers. I don’t have them at my fingertips, but the last time I went over them, they dovetailed exactly with what DS just wrote.

    There is good data for what particular diagnoses bring in the big cash for med-mal cases (missed MI is always at the top of that list). The tests for those diagnoses are pretty standard, and it’s those tests (like LP for SAH) that DS is talking about.

    I loved your suggestion to just buy more insurance, BTW. My group could only find 2 companies that would even talk with us (many companies are NOT interested in carrying ER docs under their umbrella… we’re too high-risk).

    That 40K per year that I’m paying? (which is a hell of a lot more than 4% of my income) Yeah… that’s for 250/750 coverage, with no pending suits, and nothing in the last five years. I strongly doubt that 10 million in coverage would even be economically feasible for me. And how is that 10 million coverage going to indemnify me when the insurer is likely to drop me (or double my already-astronomical rates) after a single payout?

    There is a double-edged sword with carrying more insurance, and I’m quite certain you’re not ignorant of it. The first question every plaintiff’s attorney asks is “what are their policy limits?” It’s common to aim as high as you can (sometimes for the policy limit in particularly bad outcomes) to maximize payout, and so that any subsequent settlement offer appears more reasonable. Also, simply settling out of court, whether to make a frivolous suit go away, or to avoid a big payout, can get you labeled as somebody who won’t fight. It’s very, very bad to get a reputation as a “payer;” nothing attracts sharks like blood in the water.

    I could simply protect my assets and go bare, but my hospital won’t allow it… they don’t want to be the only “deep pocket” when the local PI attorney comes calling.

  17. “The anesthesiologists did just that, took a hard look at where the verdicts and settlements were coming from, and improved the quality of their services.”

    I just love this one. What does an anesthesiologist do when he has a difficult intubation in the OR? He cancels the case. Patients are NPO and prepped for surgery. Patients I see who need to be intubated are near death, have a full stomach, and usually just had a liter of vodka. But of course CJD’s world is like the anesthesiologist’s: The controlled, aseptic environment of the courtroom, where the only subjective thing is the emotions of the jury.

    Regarding proof of which cases you lawyers make big money on, are you f-ing kidding me? Why do you think lawyers go after OB-GYN’s so often as compared to psychiatrists? Because all the stupid, fumbling docs went into OB-GYN? Why are there 500 lawyers out there who specialize in “birth injury”, and none who specialize in “missed cases of depression”. Cause that’s where the money is. I can point to at least 10 studies which will show you that Missed MI is the biggest breadwinner for the lawyers in emergency medicine. As for a single specific “test”, it would be impossible to study. Having now seen over 50,000 patients, I think I can say in my professional opinion the most “missed test” is the CT Scan for appendicitis, since there is no specific test for MI. I don’t use “the newspaper” or a “friend of a friend’ for my medical education or information. As I said, there are many studies which show the payout rates based on the missed diagnosis, but I certainly am not going to list my references when I’m arguing with CJD. If you really want to learn this stuff get out of the gutter and go to medical school. Or you can look it up yourself.

  18. Jeremy,

    Are you still listening to this? See what ignorance you are up against? Have you scrambled out of your match choices? CJD’s ignorance of medical risk assessment is almost as funny as his trolling of medical weblog sites changing his pseudonym. He apparently is not aware that the majority of clinical medical school and residency is a continuous study of pre and post test probabilities of disease based on results of established and evolving technologies, the risk assessment of missed diagnoses, cost effective analysis of diagnostic tests based on prevalence of disease and on and on and on and on. A large portion of continuous medical education is dedicated to medicolegal risk asssessment, statistics, and avoidance. He wouldn’t know that, I wouldn’t expect him to, but what a baffoon to presume to know. While you work in the real world and take care of real people (meat cutters and truck drivers), uninsured, illegal aliens he will be stuck in his alternative universe. You will sweat bullets in the middle of the night doing your best to take care of everyone with limited resources, backup won’t be there, and CJD and his crazy ass kind will be waiting for the kill. Ever watch the Jackals on Animal planet?

  19. Exactly what I wanted to say Jerry, well put. If you’re interested in evidence based studies that show rates of malpractice based on diagnosis several such studies have been published in Annals of Emergency Medicine.

  20. “Ever watch the Jackals on Animal planet?” -ds

    Come on, that is an absurd comment. I’m a physicist and a complete outsider to this debate, and from my point of view there is merit on both sides of the issue. If a doctor commits harm to a patient through gross incompetence, I think most reasonable people would agree that the patient deserves some monetary compensation. That’s the way our legal system works – the world is obviously not fair, but the legal system tries to create a more just outcome when possible. The lawyer who helps the injured patient receive reimbursement is not morally equivalent to a jackal.

    “For some reason, it does not appear any effort by physicians has been made to review the cases out there and determine where care is being found to have fallen short consistently…” -Matt

    This comment also does not make sense to me. As I understand it, the point of much medical research is to improve care, especially in cases that consistently fall short. ED doctors should not be responsible for economic analysis of malpractice litigation, and neither should the AMA. It’s not clear that the most common misdiagnoses (or omitted tests) would even coincide with the highest-settlement misdiagnoses (or omitted tests).

    Anyway, on the whole I’m satisfied with the system at the moment, doomed as it may be. There will always be occasional miscarriages of justice leading to excessive compensation, but there are certainly numerous patients unaware of or uninterested in their right to sue, and possibly even unaware of damage caused by incompetent medical practitioners.

    The threat of malpractice suits helps to focus doctors on the most commonly misdiagnosed problems, and may also help by forcing doctors who can’t handle high stress levels out of certain practices. The drawbacks seem to be extra costs to the system, possibly more impersonal and “defensive” medical care, and a less pleasant work environment for the doctors.

  21. Danny,

    I’m not sure many non-physicians appreciate the true costs of our current malpractice system, and the attendent defensive medicine costs. They’re huge… billions of dollars if they’re a dime. We order MANY tests, and admit MANY patients to the hospital in attempts to exclude unlikely-but-potentially-ruinous diagnoses, all in an attempt to stay out of the courtroom.

    Malpractice cases are decided in favor of the physician somewhere around 80% of the time at trial… and that doesn’t count the ones that are dropped, or settled to make them go away. If one assumes that the courts/juries generally get it right, then the vast majority of malpractice cases are without merit. Those cases suck billions and billions of dollars out of the healthcare system in attorney’s fees, expert witness fees, malpractice premiums…

    Also, those cases that are actually filed are only a tiny fraction of the medical errors that are committed every year. Is it because all doctors are incompetent quacks? No… it’s because we’re human, and medicine is mind-bogglingly complex. I’ve met some of society’s finest minds in some of my colleagues, and even the BEST don’t get it right 100% of the time.

    CJD takes a lot of abuse on forums like these (and some of it he brings on himself), but it’s not really all his fault; his existance, while repugnant to many physicians, is only an expression of a deeper problem. CJD exists because we have unrealistic expectations as a society.

    We expect that people will live out their whole lives without pain, injury, or suffering. We expect that our wealthy society will/should be able to care for everyone, regardless of their behavior or pathologies… and if we don’t? Then By God, somebody’s going to pay. That lust for vengeance is a defect in our national character, and it’s in all of us, whether we like to admit it or not.

    CJD believes that he restores what was lost, and that he dispenses justice to the wronged… and he can be pretty self-righteous about it (as can physicians), but that justice is selective. I don’t know too many PI attorneys who’d take a case where the party was legitimately wronged, but is an abrasive, raving lunatic on the stand. If, like an ER doc, CJD took every case that walked in the door, he’d probably get a lot more respect here (“but I can’t afford that!!” he cries… ah, yes…). However, like most, he is out to make a profit, so he cherry-picks. But what about the others? Are their cases any less deserving? Even with as many cases as our current system files, it allows meritless cases to stay in the pipeline, while leaving other wronged parties out in the cold. Should we compensate all of them? Can we even afford that?

    As our current system is painfully adversarial, wasteful, incredibly expensive, and has badly corroded doctor/patient relations, What we need to ask ourselves is this: How can we, as a society, reform this system to take care of this issue? Multimillion dollar verdicts for everyone are NOT the answer.

    The involved physicians are not objective, and the hired guns sure as hell aren’t either.

    I think we need a malpractice court. It might leave a lot of PI attorneys unemployed, but if all they’re doing is filing meritless cases…

  22. New Guy,

    Nicely said.


    Nicely said. We well understand the issues of the other side. It is easy to get vehement from your own viewpoint in an internet weblog. In my reletively short career 5/5 lawsuits filed against me were completely meritless. I couple were easily dismissed. In the others I literally did every conceivable thing possible under austere conditions for the patient. Having been through the court proceedings “jackels on Animal Planet” is not such an absurd metaphor. I have been there. They took some flesh from my hyde, but I will survive.

  23. LibraryGryffon says:

    Three years ago, even though I am a medical librarian, I was chosen to sit on a malpractice jury. When we got down to deliberations after 4 1/2 days, it turned out that 4 of the 6 of us had realized that it was a defense verdict before the first plaintiff’s witness had finished.

    Note to lawyers:

    If your two expert witnesses can’t agree on the cause of the malpractice, you might have trouble convincing a jury.

    If you sue the GI, but not the surgeon to whom the GI refered your client, who saw him/her in between his/her last GI visit and the unfortunate event, and who agreed with the GI’s diagnosis and treatment, you might have trouble convincing a jury.

    If your 72 year old client has a permanent colostomy, but is otherwise in good health (except for an understandable depression), don’t ask us to give him/her over $125K per year for the rest of his/her expected life span. Asking for medicals will win points with the jury (assuming we believe there is malpractice), but trying to drastically improve the client’s lifestyle will have a negative effect on our decision, because then it just looks like an extortion attempt.

    Given that this blatantly frivolous case made it to trial, I really don’t want to see the quality of the cases that get dismissed.

  24. ” As I said, there are many studies which show the payout rates based on the missed diagnosis, but I certainly am not going to list my references when I’m arguing with CJD.”

    I love this line. It’s like that girlfriend you met at camp who lives too far away to actually come see you right now. Is she doing some modeling, Napoleon?

    “I think we need a malpractice court. It might leave a lot of PI attorneys unemployed, but if all they’re doing is filing meritless cases…”

    How exactly will a malpractice court eliminate lawyers? Are laymen, who maybe can’t even speak as a result of your negligence, going to present the case to a panel of physicians or judges by themselves? Think critically for a moment about what you’re saying.

    What’s funny is that you think that good med mal attorneys will go broke. They won’t, they’ll just not be working for you because the defenes will hire them. Or are you a superhero who can never be injured.

    “Multimillion dollar verdicts for everyone are NOT the answer.”

    What percentage of verdicts and settlements are multimillions? Do any of the mysterious studies tell you this? Again, think before you type.

    “If, like an ER doc, CJD took every case that walked in the door, he’d probably get a lot more respect here (“but I can’t afford that!!” he cries… ah, yes…). ”

    You only illustrate your ignorance with posts like this. The ER doc fronts none of his own money to represent the party. He still makes a salary or gets paid through medicaid regardless of the quality of his care in a good percentage of his cases. Your comparison is so inept as to be laughable.

    But you’re right, we should get more people’s injuries taken care of. So what’s your proposal? And have you run it by the insurers? Because so far the only proposals out there in the legislatures don’t involve getting more people paid – they just involve insurers paying less.

    “They’re huge… billions of dollars if they’re a dime. We order MANY tests, and admit MANY patients to the hospital in attempts to exclude unlikely-but-potentially-ruinous diagnoses, all in an attempt to stay out of the courtroom.”

    This claim, like many of your claims, is simply unquantifiable. Why? Because few, if any physicians, will dare take out a bill and say under oath that X,Y, or Z act (that they billed for) was unnecessary. Why? Because it’s insurance fraud. So all we get is their vague assurances of the costs. The actual measurable costs of malpractice against the total health care dollar are around 1-2%. That number IS verifiable.

    “and that doesn’t count the ones that are dropped, or settled to make them go away. If one assumes that the courts/juries generally get it right, then the vast majority of malpractice cases are without merit. Those cases suck billions and billions of dollars out of the healthcare system in attorney’s fees, expert witness fees, malpractice premiums…”

    You should retake your statistics course, because you are lacking vital ones that would be needed to reach these conclusions. Since you don’t know the number of cases filed (or even claims made without suit) v. how many are tried, you have no idea what the vast majority of cases are. You may be right about the billions, but that’s still a tiny percentage of the cost of healthcare. What’s more, you make another wrong assumption when you say that the attorneys’ fees, expert fees, premiums, would actually go back into healthcare. That’s largely false. They would go into the physicians’, the insurance exec, and the hospital administrator’s pockets.

    What’s sad about most physicians in this situation is that while they are chock full of criticisms – about the legal system, healthcare, etc., few have any solutions. The best most can come up with are caps on damages. They aren’t sure what this does other than, if their insurer’s want to, potentially lower premiums and (they hope) make it harder on lawyers.

    They also like health courts, but they really don’t know why or how they’d work, or how it would save anyone money or improve healthcare.

    What you will never hear is that a study of how to improve the quality of their own services is necessary. It’s never their fault – by and large they are the biggest group of victims you’ll ever meet.

  25. I HOPE the system breaks. Lets see what America is like without doctors. Let’s see how many Matt’s out there will be able to continue their parasitism off of the few that can continue to practice medicine.

    I have deep loathing for those who would victimize individuals who went into a profession just to help others. I once was one of them.

    Now, all I want to do is discourage others from entering into Medicine. It would be in keeping with my hippocratic oath–and preventing suffering–by preventing those poor slobs from going to medical school.

  26. I just hope the frustration and unbelievability of the situation doesn’t die. We have a house supervisor (the one who assigns beds) who is so burnt out she treats this situation as “normal” or “that’s just the way it is.”
    If too many give up like that, then we’re lost.

  27. And we love YOU, CuriousJD… without you, we’d forget what PI attorneys are really like.

    Your backhanded insults are why nobody is willing to debate you seriously. You make a lot of mendacious comments about how doctors are unwilling to improve the quality of their care, how they’re in a conspiracy of silence, how they don’t really care about people, and how they’re all greedy, etc, etc.

    How much of your care is delivered pro-bono, CJD? Give me a percentage, and I’ll give you mine. Do you really want to have an “I care more” measuring contest? I give away plenty of my own services, fully knowing in advance that I won’t get paid… and they get my best effort like any other patient. Do you take pro-bono cases, knowing there is NO CHANCE you’ll get paid? How many times a day do you advocate for a client for free?

    You have this funny tendency to claim that unquantifiable expenditures can’t possibly exist. Do you also think that all those unreported rapes we discover by survey data are bullsh*t? I’m telling you we do all kinds of things to avoid your ilk, and I’m the one in a position to know. I don’t expect you to grant the point… it would undermine your position that med-mal is not that big a deal.

    Attorney’s fees, expert witness fees, judgements, defensive medicine costs… those sure as hell come OUT of the healthcare dollar… You think all those costs, if erased, would go right back into MY pocket? Yeah… as if that would fly in our current class-envy political climate. Legal costs may not all come out my pocket, but some of it does; thousands per year. Most of it comes out as increased cost for everything else in healthcare. It sounds hollow when you try to make this debate about physician greed, while you conveniently gloss over your own huge financial interest, which I might add, is MUCH larger than mine.

    My solution? We’ve gone over it many times on this forum; in a nutshell, a medical court to vet these things for merit before trial. I don’t expect you to support it… too much lost income potential for you.

    I love you, man… I really do.

  28. I might add that after facing the jackals it makes me much less fearful to face them and that every physician that is practicing good clinical medicine has little to fear. Even though the cases were frivolous they can’t even choose the best angle of attack because they lack basic understanding of medicine and of cause and effect. Like Matt (CJD), they rant and pontificate but in the end look like fools, but are too blissfully ignorant to realize it, or to see how they have distorted the big picture. So I accept them for what they are, it is just irksome that my costs, my personal time, my time away from other patients, my emotional distress is not worth a nickel, but somehow for a plaintiff client the same things are worth millions.

    And as a side point where do they find these so called “expert witnesses”? Where does a washed out doctor with poor interpersonal skills who can’t hack a living anymore in clinical practice send his resume to?

    Enough ranting, time to go to work. There are 15 holding admits, 15 in the waiting room. Three nurses “called off” and replacements available. Im glad for my partners that continue to hack it with me.

  29. You guys keep telling yourselves whatever you need to. I personally think we’ll have universal health care within a decade, so all of this will be moot.

    And I would almost guarantee that you’ll be longing for these bad old days within a few years of that happening.

  30. Anonymous says:

    Jerry, you are priceless! 15 holding admits, 15 patients waiting in the waiting room, who haven’t even been seen yet, and 3 nurses that called off. Sounds about right that your priority, at this time, would be to jump on the computer for yet one more pissing contest with Matt. Those patients waiting in the “EMERGENCY” waiting room probably appreciate your concern and compassion!


  31. Cathy,

    You are right. As written it appears pricelessly silly. Failed to mention that I am not scheduled to work today. I happened to be in the hospital for administrative duties and noted what was going on and stepped in to make a dent in the waiting room. And yes, pissing with Matt (CJD) is not particularly constructive, just an occasional 2 minute diversion. I should swear it off and not clutter up Gruntdoc’s weblog whose prose (and others) is much more thoughtful than mine.

    The nurses hate it when they are short handed and an extra doc jumps in to make things move, but you might feel better that the waiting room now looks much better. The patients in the corridors waiting for admission beds still languish. Nothing I can do about that. Cheers!

  32. TheNewGuy says:

    *laughing* Don’t worry, Cathy. I can pretty much guarantee that Jerry is not sitting on his ass, spending his whole shift arguing with CJD while patients are waiting to be seen. That level of neglect on his part would cause his group/partners to invoke his contract’s 60-day-out clause in a heartbeat (I would if I had to carry his slacking/blogging carcass the whole shift.. no offense, Jerry). First things first… and patient care trumps all. Most ER docs have elevated the prioritization of tasks by importance to an art form; you can’t survive in the ER without that ability.

    That said, if there are no ER rooms in which to put those patients, no staff to assist him in their care (ER docs are only one small cog in the ER machine), and no beds upstairs to take all those ER holds, there’s not much a doc can do but field patient complaints, and beat his head against the wall. That’s the very situation that started this whole thread (before we all took a detour into malpractice land).

  33. To the other ER docs: Call me crazy, but isn’t arguing with the lawyer sodomites on these sites like a good bottle of Go-Lytely? You come to work, the patients you admitted yesterday are still sitting in the hall, there’s no beds, you’re taking 5 patient expects an hour to put in beds you don’t have, the boss wants to yell at you about that State Senator’s Aunt who didn’t get a bed, you see the mail courier headed at you and pray he’s bringing you that “video” you ordered and not another lawsuit, the drunk in bay 6 just yakked a pint of blood (all over the drunk in bay 5 next to him), the next patient you’re going to see has tombstones on his EKG (And just got brought in from the waiting room after a 4 hour wait). You leave work through the back door, afraid to face the waiting room you’ve left behind. Then you get home and read a lawyer writing about how he’s saving the world by preventing you from committing “murder and negligence” on your patients, and how if it wasn’t for his actions patients would be unsafe in hospitals. I feel like a kid finally getting out to recess by unloading on these CJD’s after what I deal with at work.

  34. TheNewGuy says:

    I hear you, DS. I suppose it’s my default to assume the best of people until proven otherwise, even for consistent provocateurs like CJD. I’ll learn one of these days…

    Anyway, I’ve met docs with what I suspected were marginal skills, and so have you. We really owe it to our patients to police ourselves. The decidedly unsavory alternative is to let the court system (and guys like CJD) do it for us. Not a good idea; they’re not very good at it. Their profit-fueled dragnet nabs far too many competent physicians who did their level best, but simply had a bad outcome.

    I like the medical court idea to vet claims… but in addition to the ability to award money, I’d also give that court some additional teeth. I’d include the power to sanction and pull licenses for physicians who exhibit a pattern of egregious incompetence, incompetence with malice, substance abuse, sexual improprieties with patients… whatever. Not everyone will probably agree on that last point, and there would certainly have to be some due process involved, but I think it would be a feasible alternative to the current mess.

  35. New Guy,

    From a couple of posts above. You are absolutely right. My group tracks every single thing that can be tracked. pts./hr, acuity/patient, door to doc time, time to disposition, patient satisfaction scores, nurse satisfaction scores, resource utility, procedures/hr., unscheduled returns, %asa given with chest paint, door to cath lab time, antibiotics for pneumonia, etcetera……….. Of course CJD thinks we do none of that.

    If you can’t move the patients fast, efficiently, with the correct diagnosis, and with a smile on your face you are out of the group.

    In addition, since we are self insured for medical liability we track and moniter and address risk outliers and trends. Of course CJD says we do none of that.

    We collect 36% on the dollar. Twenty – twenty five percent are no pay or illegal aliens, which we pay 15-20 dollars per visit for the priviledge of seeing them and taking their risk, for which there is no paymaster in the sky for. Of course CJD says we do none of that.

    It is a survive or die existence, Of course CJD says it is not. Your right there are some physicians that don’t measure up. These are usually the ones that don’t know what they don’t know (like CJD). I have seen a couple of these types from my med school class disciplined by the state board over the years.

    And yes DS, sometimes it is cathartic to vent. Too bad physcians have run around like stray cats for too long and do share some blame for current state of affairs. I’ll give CJD that.

  36. I have another solution, one I’ve gotten alot of flak for on Kevin’s site: I think we, as physicians, need a militant Political Action Committee (PAC). Do you really think Arlen Spector always votes Pro-Lawyer because he believes their side on everything? No, it’s because the ATLA (American Trial Lawyers Association) sponsors his campaign. Same is true for half the politicians in D.C. The AMA is a paralyzed joke. If we could have a strong PAC, that pays off politicians the way the lawyers do, Tort reform could pass on a national level. The hell with “red states” and “blue states” Money talks. They are all “Green states”

  37. TheNewGuy says:


    You’re right… money talks and always has. Everything else walks.

    The problem, as I see it, is that many physicians are simply too busy to do politics, and it doesn’t naturally lend itself to our profession.

    Where do lawyers hang out? The courthouse, where they rub elbows with all the other lawyers we elect to public office. I’m not saying lawyers don’t make fine legislators… some do. In fact, they are better at it than physicians; our existance doesn’t really revolve around creating and wielding the law.

    Also, (and I’ve said it here before) I don’t belong to ANY of our professional societies, or the AMA. They all have their problems, and I don’t see any of them (with the possible exception of AAEM) that adovcates well for the in-the-trenches average doc.

    My other beef is the groups who posture and triangulate on all sorts of only quasi-medical issues: gun control, no-nukes, land-mine bans (I’m an ex-military doc, and ex-LEO, so some of those really stick in my craw.) Those things have nothing, N-O-T-H-I-N-G to do with nuts-and-bolts EM practice, and only serve to create schisms in what could be a much larger membership.

    How I long for the day when they’d say “We have no position on that issue, and we don’t plan to take one. We consider those distractions from our primary mission. Thank you.” That’s all they’d have to say, but nooooo….

  38. I know dissenting viewpoints aren’t you guys’ thing, but thought you might want to know what that liberal and trial lawyer backing CATO Institute recently concluded:

    There is a great deal of public debate about potential reforms of the malpractice system. A closer look at available data suggests that some of the rhetoric surrounding this debate may be misleading. First, increases in malpractice payments do not seem to be the driving force behind increases in premiums.

    Second, increases in malpractice costs do not seem to affect the overall size of the physician workforce, although they may affect some subsets of the physician population more severely. Furthermore, no research has linked the decline in physician supply to worse health outcomes or reduced patient satisfaction.

    Third, we find evidence that the strongest effect of greater malpractice pressure is in increased use of imaging services, with somewhat smaller effects on the use of other discretionary, generally low-risk services such as physician visits and consultations, use of diagnostic tests, and minor procedures. We find little evidence of increased utilization of major surgical procedures.

    While our study does not speak directly to the effect of malpractice reforms, it does provide insight into the mechanisms through which those reforms are likely (and unlikely) to operate. Our analysis suggests that state-level tort reform is unlikely to affect the practice of medicine by averting local physician shortages. We also find no relationship between the level of malpractice premiums and the presence of traditional tort reform measures such as damage caps. This evidence does not imply that traditional tort reform measures are ineffective, for they may have reduced the growth of (perhaps unusually high) premiums in the states where they were enacted. However, our results do call into question the view that states with traditional tort reforms have lower levels of premiums or defensive medicine than states that have not implemented such reforms. Last, while increasing malpractice liability pressures do seem to substantially increase
    expenditures on diagnostic procedures, we find little evidence that malpractice payments are driving the dramatic increase in overall health care expenditures.

  39. “That’s the very situation that started this whole thread (before we all took a detour into malpractice land).”

    You’re right. So the question is – what are you doing about it? And don’t give me the “impotent AMA” line. The AMA got tort reform passed in a number of states, with help from the insurers. So what is it doing for you guys? And if the AMA isn’t doing it, what are you doing for yourselves?

    If you don’t have time to do it for yourselves, why aren’t you hiring someone to do it for you? Heck, lobbyists have no loyalty – if you think ATLA’s lobbyists are good, hire them. Physicians have as much disposable income as anyone to donate to political causes.

    Oh, and by the way Jerry, speaking of pontificating and ranting about something you know little about, can you tell me what plaintiff has ever won millions on a claim for nothing more than “emotional distress”, as you claim: “my emotional distress is not worth a nickel, but somehow for a plaintiff client the same things are worth millions.”

  40. I would just like to say from a “consumer” point of view that one of the problems with lawsuits is ignorance. My husband and I are currently considering suing the hospital that treated my son. Without going to a lawyer, I dont know how Im supposed to know if his injury is a “bad outcome” versus neglect.
    His IV infiltrated. The result was a third-degree chemical burn that was approximately 2″x2″x.5″ – a sizable burn on a 3 pound infant. We were told it was “Common.”
    The burn took weeks to heal and left him with thick scars on his hand and wrist. It’s possible that the burn affected some of his muscular function but he’s too little to be completely sure.
    Is this a regrettable result? Or is this negligence?
    The doctors wouldn’t say, and all their answers had a certain quality of carefully-picked words.
    If it is a result of negligence, I dont want some extraordinary monetary compensation (or any at all). What I would like is my son’s hand fixed.
    The only way I will be able to find out the answer (apparently) is by suing. Once I sue, I really have no choice but to ask for monetary compensation. And a lawyer will get paid.
    If there was a medical court it would be so much easier.
    My point is that in a sensible world the hospital could say (if it was negligence) that they would repair the damage and use their own staff (who would presumably provide the service at a discount to them)to fix the problem.
    My point is – I have no way to tell if this is a mistake or negligence. Reading my son’s chart wouldn’t help me, as I dont know what the reasonable procedures are for preventing IV infiltration and if they were followed.
    As far as tests go, I come at it the other way. I get strep throat about 4 times a year (for the past 20 years). I know strep like I know my job and in most cases I get a white-coated throat before I even start to feel the other effects (sore throat, fever). I dont need a strep test. I need antibiotics.
    Yet, the one time I went to an ER for strep the doc gave me the antibiotics perscription and insisted on sending out a strep-test, the results of which would not be back before I left the ER.

  41. “My point is that in a sensible world the hospital could say (if it was negligence) that they would repair the damage and use their own staff (who would presumably provide the service at a discount to them)to fix the problem.”

    They could do that right now in this world. Settlement offers are not admissable as evidence. They choose the wall of silence.

  42. That girl: write a letter to your doctor and to the hospital President. Outline what happened when, and lay out what you want done. (You may not know, then a request for a paid referral to a pediatric hand specialist would be a good place to start).

    I wouldn’t bother with any threatening language, just a formal letter will be enough to get them sweating.

    If that oesn’t get your child cared for, then there’s always the CJD option. I’m sorry you haven’t been dealt with in a more straightforward manner, and andmire your restraint for not jumping directly to the ‘sue ’em’ answer.

  43. Please, let us know how it turns out.

    Of course, as GruntDoc may not know, most lawyer do send a demand letter before filing, unless they are running up on a statute of limitations. If a case can be settled prior to filing, it’s obviously more beneficial for the patient and the attorney.

  44. I just wanted to point out to you that not all patients are money-hungry and sue-happy. Im sure you only see that aspect because there’s no reason for you to talk to patients who might have had a legitimate reason to question the care and chose not to sue/pursue it.
    I could tell you stories about er docs that would make you cry. My favorite was one doc who told me (on a Friday night) to just not eat anything until I saw my doctor on Monday. I made him write it on the discharge instructions. That was the sum total of his treatment for which I was expected to pay $350.
    I think really good doctors often forget that any population has a percentage of morons for which everyone pays.
    But please know that the majority of us understand the work you do is thankless, time-consuming, deals with a very high percentage of patients who got there by doing something moronic(of which I have been one). We very much appreciate the long time you spent in school and how hard you work.
    So since we obviously dont say it enough…

  45. “Yet, the one time I went to an ER for strep the doc gave me the antibiotics perscription and insisted on sending out a strep-test, the results of which would not be back before I left the ER.

    Theoretically, If he does it that way they should have a “follow-up nurse” who calls you the next day if the strep culture is negative, and tells you to stop taking the antibiotics. Saves you from the problem with resistance. I’m so fed up and burnt out I don’t bother, I just give most patients who want the antibiotics the ABX they want. I’m sure I’m treating alot of viruses with antibiotics, but I’m seeing 5-6 pts an hour these days, I don’t have time to explain why viruses don’t need abx.

  46. Oh, and by the way, if you are going to sue anybody for an IV infiltrating, shouldn’t it be the nurses, who are probably the ones who put in the IV in the first place?

  47. That Girl,

    Thanks for the thanks. I do hope your son has no lasting damage from IV infiltration. What medication infused caused the burn?

    Matt (CJD) her point was that she did not want to have to go see a lawyer and therefore there would be no demand letter before filing. And you may not know, but we are told by our insurers and lawyers NOT to correspond with the plaintiff or the plaintiff attorney but instead just give details of the case to our lawyer representative. I didn’t invent the system, that is the way it is, and something that I agree is fundamentaly wrong. Some type of medical legal review board would save a lot of time and frustration in many cases like That Girl. You always ask what is our profession going to do about it. The legal system sets the playing rules so what is your profession going to do about it? Trial lawyers have too much invested interest in keeping things the way they are.

    In the demand letters that I have recieved before filing they are so bogus without liability, so on one level why should I respond to demand letter and give some money? My insurer forcefully tells me not to have any correspondence anyway. On another level, perhaps things are just a misunderstanding and the plaintiff would be satisfied if there could be a sit down chat and have a chance to ask questions and have them answered. However, once an attorney is involved on the other side that can’t happen. At least not with my insurer, and that is the only perspective that I can speak from.

    And yes, there have been millions awarded for “emotional distress” in court cases. Pain and suffering is limited to 250K in my state in medical malpractice. The other side can still “claim” millions however in the accusations. I never said they would be awarded that.

  48. That Girl, I agree with what Gruntdoc said. Letters go a long way if they are sent to the right people. My family took that route after my grandfather was sent home from an ER with three hip fractures, no pain medication, and unable to walk. My family met with the hospital administrators and also sent letters. The administrators, to their credit, (after some prompting from my mom) went to the nursing home where my grandfather was recovering from surgery and apologized to him. It would have been nice if the doctor had apologized, but I guess you can’t have everything.

  49. “And yes, there have been millions awarded for “emotional distress” in court cases.”

    Name one where millions were awarded for “emotional distress” without physical injury.

    “The legal system sets the playing rules so what is your profession going to do about it? Trial lawyers have too much invested interest in keeping things the way they are.”

    Yes, it’s all the lawyer’s fault that physicians won’t take the time to sit down with the patients and explain what happen. Is there nothing wrong with the way physicians go about their business? Is there no room for improvement? You guys are almost Bushian in your willingness to blame literally everything wrong on others, and claim that you haven’t made a single mistake.

    Didn’t you read her post? She can’t get an answer NOW, and she hasn’t hired a lawyer. And its your insurer who is telling you not to talk to the patient, not their lawyer. Again, settlement offers are not admissable. If you don’t talk to your patient because your insurer tells you not to, that’s no one else’s fault.

  50. CJD, are you really a graduate of an accredited law school? I can poke holes in every line of your last statement, but I’m not even going to bother. Just for example line 2 you added your own unattached claim to disprove line 1. Physical Injury? I know we’re Doctors, but we understand logic. You need some work dude.