It really spoils your day when a patient launches a medical malpractice suit against you because the patient ignored your advice.
posted 02.08.06
THUNDERING CLOUDS IN JANUARY
A wounded dog will put on a brave face in the company of others. He will hold his head high. He may wag his tail to signify that everything's okay, or he might snarl fiercely to show his bravery and willingness to engage an opportunist. But when the dog is alone, under cover of moonlight, he will lick his wounds and sadly lower his head.
A thick letter
I was sitting at my desk. There were charts piled high and I was dutifully making my way down the stacks, calling patients with their test results and following up on their many ills, when I caught sight of a thick letter addressed to me. It was from the risk management department of the hospital at which I completed my residency. It stated that I was being sued.
My throat tightened. A chill grew within my spine, as normally quiet neurons exploded in trillions of communications with my gut, my lungs, and my heart—fear, shame, danger! I read through the complaint filed against me with incredulity. I did not even remember the patient, but she and her lawyer did not forget me, my hospital, and a host of other doctors.
It is known that it takes eleven compliments to make up for one insult. As I read through the craftily constructed allegations of the trial lawyer, the hurtful accusations about my competence, and the decimation of a woman's health, I sensed that these words might take a lifetime to heal inside me.
"Dr. Charles, your next patient is ready," said the medical assistant.
I stared into the ugly yellow stationary a moment longer before finally mustering the will to reply: "Okay, I'll be right there."
The medical assistant raised her eyebrows. "Is everything all right?"
I smiled a cracked smile. I wagged my tail.
I read the complaint again. Among the sensational claims, the trial lawyer had inserted one sentence that gave me pause. I had ordered a test, and the patient did not get it, and therefore her diagnosis had been "missed." The trial lawyer made sure to abdicate any and all personal responsibility on the part of the patient to follow through with my recommendation. All he had to contribute were horrendous allegations, one-sided conjectures, and adversarial batteries. No objective medical records were included.
The phantom
Slowly my limbs lifted me into a standing position and I walked out to see the next patient. I held my head high. "Hello, how are you doing today?" I began. I collapsed into a chair and exhaustedly tried to listen. The man had metastatic cancer, dizziness, falls, and severe back pain. It was awful.
But instead of hearing his words I only saw them twisted and misrepresented by a phantom lawyer poring over my notes, even as I presently jotted them down in the chart. The lawyer was fat, sweaty, and angry as he sat his corpulence upon my shoulder to see what I was writing. I recognized him from daytime television commercials on channel 7. I couldn't stop myself from ordering CT scans of the brain, chest, abdomen and pelvis, in addition to MRIs of the hip and back, plus a complete metabolic panel, complete blood cell count, thyroid function tests, folate and B-12 levels, and a goddamned magnesium level. The man nodded okay, and limped out of the examining room.
I didn't smile the rest of the day. I just wanted to go to the hospital and review my notes to figure out who this unknown attacker was. Had I truly done something wrong? I wished she had called me to let me know what was happening to her. I wished I could call her, offer my sympathies, and sit down with her to figure out where things went wrong, and why she never got the test I had apparently ordered. But I knew that I could only speak through lawyers now, and even if they were defending me that my message would go unheard amid the din of hostile rhetoric and multimillion-dollar lottery dreams.
At home that night I displayed my wounds to the one I love, and she tended to them graciously. She felt warm in my arms, and in that moment of extreme self-doubt I knew that she understood.
"It's part of being a doctor," she said. "You know that it's only a matter of time before you are sued, righteously or not. You are expected to be perfect, all the time, even when you can't be. Bad things happen to people...."
"No one takes any personal responsibility for themselves," I interrupted her. "How am I supposed to make sure every patient follows every bit of advice I give them, and how is it my fault if they don't? And even if I discover that I made a mistake when I finally read through the records, how am I supposed to be perfect every minute of every day of every f*cking year?"
A little better
She brushed the hair from my eyes. "You're a doctor because you want to help people, and you do your best, and if there's no heaven and no hell, if there's only this, then you'll die knowing that you tried to leave your world a little better than how you found it."
The moon was behind the thundering clouds of January that night. Instead of snow there was a lightning storm; the clapping thunderbolts and brilliant flashes that bounced off the walls and streaked through the windows were troubling signs of the times. Somewhere in the night I heard a stray dog howling. There shouldn't be summer storms in the dead of winter. [Add your comment]
Reprinted by permission of the author from The Examining Room of Dr. Charles, where it was originally published (in January). Dr. Charles is a family doctor who likes to write. A collection of his reflections, Legends of the Examining Room, is available through his site.
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