Physicians writing on KevinMD about being sued and about making mistakes: the summons, the deposition, and the verdict that does not feel like winning, whether damage caps and safe harbors work, frivolous claims argued from both sides, expert witnesses, nuclear verdicts and premiums, apology laws, and how physicians say errors happen and what it is like to make one. Two maintained records draw on this archive: Medical malpractice: what physicians say, in their own words and Medical errors: what physicians say, in their own words.

Medical malpractice reform in exchange for paying doctors less

KevinMD
November 11, 2010

The bipartisan debt commission appointed by President Obama recently released its recommendations on how to pare the country’s debt.

Of interest to doctors is the suggestion to change the way doctors are paid.  Physician lobbies have been advocating for removal of the Sustainable Growth Rate formula — the flawed method by which Medicare, and subsequently private insurers, pays doctors.

According to this method, physicians are due for a pay cut of …

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Medical malpractice reform in exchange for paying doctors less

Reduce medical malpractice and create a culture of patient safety

Physician
October 19, 2010

When I was a resident in internal medicine many years ago,  I saw an elderly woman who came to the ER complaining of chest pain and shortness of breath.  She had a history of heart disease.  When I listened to her chest, the crackles I heard emanating from her wet lungs told me she had congestive heart failure.  I treated her chest pain and gave her diuretics to help her get rid of the water that was making …

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Reduce medical malpractice and create a culture of patient safety

Medical malpractice and how legal waste increases overall costs

Physician
October 7, 2010

Dr. Kirsch at MD Whistleblower has written about his recent unpleasant experience with malpractice litigation. Despite having full access to the patient’s chart and medical records, the plaintiffs attorney chose to include Dr. Kirsch in the suit … apparently … just because … he had seen the patient.

In Ohio – where this case was filed – a plaintiff in a medical malpractice case is required to obtain …

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Medical malpractice and how legal waste increases overall costs

Physicians must be aware of what they know they don’t know

Physician
September 15, 2010

St. Augustine: “Fallor ergo sum”

When I was in charge of the medical residency programs in Grand Rapids, Michigan, David Leach introduced me to the expanded Dreyfus Model of how physicians can progress from beginners to masters.

I was always struck by how master physicians freely admitted their mistakes and used them as a teaching tool.  As a young surgical and cytopathologist, my sanity was saved more than once by University of …

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Physicians must be aware of what they know they don’t know

How physicians can endure the trauma of a malpractice lawsuit

Physician
September 11, 2010

Several clients have endured the trauma of malpractice law suits, Medicare audits and stinging accusations or criticisms from patients or colleagues that leave them reeling.

These clients have shared feelings of:

  • shame
  • despair
  • depression
  • loss of self-worth
  • disillusionment
  • confusion
  • hurt
  • defeat

Oddly enough, one of the least common feelings they’re able to get in touch with is anger.

Maybe it’s because my clients are self-selected, and many tend to be goal-oriented strivers with a perfectionistic streak. They were, as was I, …

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How physicians can endure the trauma of a malpractice lawsuit

Defensive medicine costs less money than physicians think

Physician
September 7, 2010

Nothing polarizes the heath care debate more than defensive medicine. A recent study from Health Affairs will only add more fuel to the fire.

Here’s what I wrote a couple of years ago in USA Today: “When you consider that rampant testing is a major driver of escalating health care dollars, addressing defensive medicine should be a primary goal of cost containment.”

Is that still true?

Well, yes and no.

MedPage Today summarizes …

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Defensive medicine costs less money than physicians think

Doctors need to become whistleblowers after medical error

Physician
August 17, 2010

Perhaps the most important principle in practicing medicine, drummed into medical students and junior doctors time and time again, is to do no harm.  Our medical interventions and treatments can be given either too early, too late, or inappropriately, with sometimes terrible and tragic results.

Unfortunately, when doctors have harmed patients, the guidelines of what to do thereafter are not as clear, raising the question, “What should doctors do in these …

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Doctors need to become whistleblowers after medical error

Commercial CME funding and the rise of medical errors

Medical Education
August 5, 2010

While the percentage of commercial support for continuing medical education (CME) has continued to drastically drop over the past few years (29% decrease from 2007 to 2009), recent data, which show an epidemic of medication errors in hospitals, make this decrease even more troublesome.

At a time when 30 million more patients will flood our hospitals, do we really need to …

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Commercial CME funding and the rise of medical errors

Unread echocardiogram fallout at Harlem Hospital Center

Conditions and Diseases
August 3, 2010

Recently, the New York Times reported that Harlem Hospital Center had finally completed its investigation into thousands of echocardiograms that after receiving an initial reading by a technician had never been read by a physician.

It turns out that out of 7,000 tests that went unread, only 14 patients “might have been misdiagnosed because their tests had not been handled properly,” according to the hospital spokeswoman quoted in the story. …

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Unread echocardiogram fallout at Harlem Hospital Center

The difficulty of regulating x-ray radiation in the ER

Conditions and Diseases
August 2, 2010

A recent article in the New England Journal of Medicine touched off another salvo about how non-clinicians have no problems judging the abilities of clinicians in the world of medicine.

The article begins by presenting the case of a woman who awoke with facial paralysis and then went to the emergency department. On arrival, she received CT scans and MRI scans of her brain. When those were normal, she was diagnosed …

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The difficulty of regulating x-ray radiation in the ER

Defensive medicine forces residents to use test oriented care

Conditions and Diseases
July 26, 2010

A recent article in US News and World Report, Most U.S. Physicians Practicing Defensive Medicine, claims that physicians are ordering more tests and escalating the work-up of sick patients, all in the name of defensive medicine.

Is it true? Absolutely.

It is especially true in the emergency department, where we have one shot to get things right, or else. Ironically, by practicing defensive medicine we are not practicing …

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Defensive medicine forces residents to use test oriented care

Data and transparency is needed to reduce medical mistakes

Physician
July 21, 2010

An excerpt from On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry.

by John Toussaint, MD, and Roger Gerard, PhD

Admitting Error

In a lean environment, doctors and nurses must allow mistakes to be visible in order to perform root-cause analysis and fix the process. But showing mistakes hits most medical providers in a vulnerable place—right in the collective fear of lawsuits and a highly conditioned need to be …

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Data and transparency is needed to reduce medical mistakes

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Unnecessary testing needs more than tort reform to cure

Conditions and Diseases
July 17, 2010

Recently, while covering for one of my partners on a weekend, I was consulted by a physician to do a procedure.

The doctor wanted his patient to undergo an EGD, which is a scope test that examines the esophagus, stomach and first portion of the small intestine called the duodenum. We gastroenterologists do this test routinely to search for an explanation for a patient’s symptoms, or to determine if these organs …

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Unnecessary testing needs more than tort reform to cure

Fire in the OR and how hospitals should report medical mistakes

Physician
July 14, 2010

Did you know that if there is a fire in the OR during surgery hospitals in some states don’t have to report the event to anyone?

When I read a recent story in the Cleveland Plain Dealer headlined, “Reporting Surgical Fires Could Improve Patient Safety in Ohio, Experts Say,” I was stunned.

The piece begins:

When fire breaks out and burns a patient during surgery in Pennsylvania, the hospital is required by law …

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Fire in the OR and how hospitals should report medical mistakes

Cancer in a transplant kidney, is it the doctor’s fault?

Physician
July 13, 2010

May you never be an interesting case.

That’s a cautionary proverb familiar to medical professionals. While it’s bad to get sick, it’s much worse to get sick with something uncommon or unusual. The more fascinating a case is for doctors, the more difficult it is for patients. Difficult to diagnose, difficult to treat, and often difficult to survive.

Kenneth Liew was doubly unfortunate. He was an interesting medical case and an interesting …

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Cancer in a transplant kidney, is it the doctor’s fault?

Mark Midei and the failure of peer review

Conditions and Diseases
July 8, 2010

A couple of months ago, a Baltimore reporter called to get my take on a scandal at St. Joseph’s Hospital in Towson, an upscale suburb.

A rainmaker cardiologist there, Dr. Mark Midei, had been accused of placing more than 500 stents in patients who didn’t need them, justifying the procedures by purposely misreading cath films. In several of the cases, Midei allegedly read a 90 percent coronary stenosis when the actual …

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Mark Midei and the failure of peer review

Florida EMTs may go bankrupt because of a malpractice lawsuit

Physician
July 2, 2010

An ambulance service was recently held liable for failing to “do what was necessary” before accepting emergency transport of pregnant patient.

A child was born at 25 weeks gestation — 15 weeks premature — and was not breathing. Babies born at this age have a viability of 50-70%. In other words, up to half of children born at this age of gestation die. The family called 911. The paramedics arrived, performed …

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Florida EMTs may go bankrupt because of a malpractice lawsuit

Medication errors spike when new residents start in July

Medical Education
June 30, 2010

by Kristina Fiore

Deaths from medication mistakes appear to spike in July, when medical residencies begin, researchers say.

Over nearly a 30-year period, fatal medication errors appear to jump 10% solely in that summer month in U.S. counties with teaching hospitals, David P. Phillips, PhD, of the University of California San Diego and Gwendolyn E.C. Barker, BA, of the University of California Los Angeles, reported online in the Journal of General Internal …

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Medication errors spike when new residents start in July

How transparency reduces malpractice and defensive medicine

Physician
June 22, 2010

Physician errors have been the subject of discussions about both health care costs and health care quality.

We are told that if we reform the malpractice system — capping damages — that physicians will practice medicine less defensively and costs will go down as a result. We are also told that the quality of care delivered by our health care providers is less than optimal — there are estimates that nearly …

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How transparency reduces malpractice and defensive medicine

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