Yes, we do live in a very litigious society, and i think that is the crux of this problem. It’s such a subjective topic because, as someone said earlier, you never know just how a person presented. The 46 year-old woman who comes in to your ER with unrenlenting nausea turns out to be in the middle of a non-stemi that you only happened to catch because you ordered enzymes goes up to the cath lab and suffers a reperfusion arrythmia. Luckily for her she has an illustrious tech on the tele floor who just happened to read an ACLS book tell her that it never would have happened had she not waited 3 hours to see a doc in the er and Viola! instant lawsuit. Meanwhile she waited 3 hours because she walked in and told the triage nurse she “had butterflies in my stomach” so she took a backseat to the 2 traumas and 3 respiratory distress pts that came in at the same time.

I dont think it is so much that people are afraid of getting dragged into lawsuits that keeps up the code of silence (which, by the way, is absolutely real). In my observation it is the fear of being human that keeps us quiet. Everyone makes mistakes, some more serious than others. Mistakes, however, do not make people bad providers. Unfortunately, once you hold that title you are no longer viewed as human and capable of error by the general public. You are expected to be perfect. Now, knowing that everyone misses something at some point, why would we casually point these errors out to patients. Karma is a (insert expletive here). You could be the best doctor in the world, have one off day, and because you made a habit of selling out your collegues for the last 5 years they will be looking for a reason to throw you under the bus. As much as i hate to be negative, time has taught me that the days of singing kumbaya around the campfire are long gone.

Does this mean i advocate keeping patients in the dark, or becoming selectively mute whenever a potential malpractice situation arises, absolutely not. There is a line to be drawn between simple errors and bad medicine, and those practicing bad medicine should not be permitted to continue, which brings me full circle back to Amy’s post and the subsequent “what is substandard” post. The question my friends, is actually what is STANDARD, and by whose definition?

On the other side of the coin, from the patient perspective i know how frustrating it can be to not get answers. I suffered an anaphylactic reaction which began while standing in the ER of the hospital i work for, and a series of “errors” resulted in respiratory arrest, atelectasis, 2 weeks in MICU on a vent, and 2 vocal cord surgeries to date along with a good case of retrograde amnesia (thanks to versed and diprovan), and it took me almost a month to find a doctor that would even level with me as to what happened.

The other issue is that the “appropriate” treatment for any given illness or ailment changes depending on what literature is en vogue at that particular moment in time, and whether all parties involved have received the latest updates.

Point is, it’s a very complex issue that has an unlimited amount of variables on both ends, and each side has either the inability or the unwillingness to look at it from the perspective of the other.

Before anyone retaliates to this i would like to offer up a little disclaimer: I am not, nor have i ever claimed to be, a doctor. I don’t pretend to have the knowledge or experience that those of you who are have. Please take what i say at face value, as these are just opinions and observations. Thanks for putting up with the crap that you do and being there to help all the whiney self-empowered people who have to large of an ego to thank you themselves

We constantly talk, talk, talk about changing the culture, we have meetings about near misses but we wont use names or cases..we play the as if game.

The culture needs to change and patients need to catch a clue.
Medical providers aren’t robots with no needs..so patients need to start taking some responsibilty for their care to take up the slack. Patients don’t need to get a medical education but how about they know why they are taking the pills they are taking?
I cannot tell you how often I have asked and had patients say “oh I take the little blue one with the the big red one and I have no idea why” Or they can’t remember there own medical history..any surgeries? oh no..then you lift their shirt and see a huge sternotomy scar…and then you get “oh yeah I had a new valve last year but I don’t know why..”
Then with a crappy history and a bunch of unidentifiable meds we are expected to use ESP to determine what the hell is going on.
Then when you can’t figure it out or take the most easily solvable problem and get that under control they go see their family doc with his complete history who is all “why how could they have missed that?…

I admit my mistakes because I have learned it makes my patients trust me..anyone who is up front with everything is going to have better luck because we all know SOMEONE is going to yap..it better be you.

Amy- I agree with you whole-heartedly. There is BAD medicine being practiced. I often wonder about how nonphysician-patients get through the system. This is just a reality in an overly complex outdated medical structure.

8 years in the ED has given me multiple opportunities to render 2nd and 3rd opinions and discover “missed” (using the term loosely) diagnoses. However, I am happy to report that I make a concerted effort NOT to critize to previous MDs. I just tell the patient I wasn’t there for your previous visits and the other docs didn’t have the luxury of all of these tests results that you’ve accumulated in your doctor shopping. I also hear from other patients that my effort not to badmouth is seldom shared by my collegues in the community. I hear not infrequently about the poor care given in the ED. We need to face the fact that feeling important/authorotative is the main reason lots of folks go to medical school. (I guess my childhood must have been a lot happier that other docs.)

I am an obstetrician and I know more about being sued than I ever wanted to know, but I’ve also been a patient and it is horrifying.

We aren’t doing ourselves any favors by obsessing about lawsuits while at the same time refusing to weed out bad doctors. There is no way for people to assure themselves that the doctor they choose is a good doctor, since no one will warn them if he isn’t.

I don’t know if it is a result of more time pressure or less training, but I have seen doctors commit mistakes that would never have been tolerated where I trained. What’s worse, they look the patient in the eye and lie about it.

It’s happened to me, it’s happened to my relatives and friends, and if you ever have the misfortune to be hospitalized with a serious medical problem, it will likely happen to you, too.

You are actively contributing to the hysteria. Why?

That girl: There are other things you could do besides suing. Please consider reporting this misbehavior to your state board of dentistry.

However, consider that there’s a good reason why physicians are not forthcoming with information when the “potential lawsuit” balloon goes up. With a potential malpractice claim in the air, they will tell you not to talk to the patient, your colleagues, your nurses, or anyone else. If you talk about it with people, they can be dragged into the case, since they now have knowledge of it.

Anyone who has ever had contact with the criminal justice system (either as a principal or in the course of working) knows that most people hang themselves in court. How/Why? Because they don’t avail themselves of their right to remain silent. Get in any kind of legal hot water, and shutting up is the very FIRST thing your criminal defense lawyer will tell you to do.

People love to talk, whether to get things off their chest, or to justify their own actions… but it can get them into trouble. It’s very tough to keep quiet, particularly when there’s a bad outcome and your professional reputation is at stake… who wouldn’t what their side of the story told?

There’s a reason nobody talks when people start making malpractice noises; it’s nothing personal, and it’s not an evil conspiracy. You might not sue, but plenty of others have.

When my dentist’s hand slipped and he cut up my mouth (16 stitches) and then forgot to give me antibiotics (do I have to tell you what my face looked like 3 days later?). I didnt sue. I even paid for the office visit. I figured, everyone makes mistakes, I didnt die. I got sick (lack of nutrition) and Im deathly afraid of dentists, but really, mistakes happen.

Then 2 years later I see him in my bar every day, at lunch, 2 bourbons and right back to work.

And I have to wonder if by NOT suing him I helped him hurt other people.

I know plenty of people with similar stories about health-care professionals, but you (naturally) are really only gonna meet the ones who sue. You may want to consider that it skews your view somewhat.