nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Thursday, September 2, 2010

A Doctor Talks About What It Feels Like To Be Sued

Most patients could care less about standing in their doctor's shoes, but sometimes it helps.  Other things go on in your doctor's mind that have nothing to do with diagnosis and treatment.

The Washington Post Health blog (Aug 31) has a great post from an infectious disease specialist who is handed a letter that says he's being sued.  The subsequent panic, review of his treatment, and relief that follows (when he realizes that although the patient in question died, his medical care was unreproachable), is very accurate.  I've never been sued in 35 years, but I know that cold sweat that comes from the internal dialogue, "Please, God, tell me I did everything I should have." 

Studies show that only 17% of malpractice lawsuits correspond to actual medical negligence.  I'm happy the real instances were pursued, but I'm bothered by the 83% of suits that don't involve any negligence.

The really interesting part in this doctor's story comes later when he talks about the impact of going through this process. 
The next day, I was considering whether to order a CT scan for a hospital patient experiencing abdominal pain. On the one hand, I did not think the scan would reveal anything significant, and I try to avoid ordering unnecessary tests. But then I thought about a potential lawsuit. What if I missed a cancer or an abscess by not ordering a CT? How would I defend myself? It was easy enough to pen "CT abdomen to rule out abscess" -- something that could be identified and treated if found through this extra test.

The fear of a lawsuit trumped all other thinking: I ordered the scan; it was negative.
Good luck with changing that very human reaction by using policy or regulatory dis-incentives.  Yes, if we all stood firm in our convictions every time false accusations arise, then maybe the number of these would go down.  But, maybe not; money drives the tort system. 

And, for me and most doctors, it's very personal...not just a policy phenomenon.

Doc D

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