Doctoring Like A Lawyer


courtesy wikimedia commons

courtesy wikimedia commons

A bunch of good thoughts, stories, and controversy about malpractice this week that are worth a look:

  1. If you’re not reading Trial of a WhiteCoat, you’re missing out. WhiteCoat’s Call Room, probably my favorite EM blog out there, stuck his neck out by deciding to post his account of his malpractice trial. It’s fascinating, nerve-racking, and well-written. It all starts here, and the next installment looks like it’ll reveal who won the case.
  2. KevinMD features Robert Ricketson, a former neurosurgeon involved in a high profile malpractice case in 2003 where Dr. Ricketson gives his side of the story, minus all the sensationalizing from the media. Not surprisingly, it’s not “evil, reckless neurosurgeon puts patient safety at risk.”
  3. And finally, Stuart Swadron talks about Teaching to the Tort, at an up-and-coming EM blog with a bunch of big names, appropriately named, *ahem*, EM Blog. The point is this: should residents be learning about the latest evidence, and how to, as far as we can tell, best care for patients, when the “classic teaching” says otherwise, because of malpractice concerns? Are academic programs freer to practice in ways that community physicians aren’t? Dr. Swadron gives the example of pretreating children with atropine for intubation: while the “available evidence contradicts” its use (and note: the latest version of Ron Wall’s airway bible does not recommend it), is not using it going to be a red flag in a malpractice case for an expert witness?
    I asked a similar question to several colleagues and was told this: “Do what you think is right and best for your patients. Malpractice cases come down to one expert versus another: yours will support you, and the plaintiff’s will support the plaintiff. Your job is to do right by your patients as well as you can; while our books certainly provide expert guidance and management strategies, Tintinalli is not “the standard of care” for the patient in front of you. You are.”
    I don’t know if “medico-legal” was part of the curriculum 10 years ago, but I certainly feel it today. I know to document, how to communicate with families and patients, and how to discuss medical decision-making. I can’t help but feel some level of angst that not only am I going to make a mistake that will harm someone, but I’m also going to make one that may cost me my personal, professional, and financial lives. I think I’m more of a fatalist about it, and perhaps my generation is the same: I’m going to be sued sometime. It’s out there. Be prepared for it, do your best, but don’t spend all your time worrying about it. Document well, work hard, think and care, but it’ll happen, no matter how perfect you are. Am I wrong?

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