Tuesday, March 24, 2009

Malpractice III

If you suffer as a Christian, do not be ashamed, but praise God that you bear that name.
I Pe 4:16

I first met Mark during my residency in internal medicine. He was a young, aggressive and well trained emergency room physician practicing in a medium-sized rural town. He was married, had two young children, and had earned a respected place in his community by working nearly five years in the ER of the town’s major private hospital. Mark painted in oils better than most commercial artists. I still have a small painting he gave me of two geese in flight hanging in my office.

One busy night, the town’s popular sheriff came into the ER with burning chest pain. Mark examined him: his lab work was normal, but Mark missed a small “wiggle” on the EKG that suggested cardiac problems. By 3:00 a.m., after observation and testing, the sheriff was sent back to his squad car with a bottle of Maalox and reassurances. An hour later while on patrol, the sheriff crashed into a light pole, dead from a massive heart attack.

In the suit that followed, Mark was treated to the worst of the judicial system. He was publicly humiliated, cast in the light of an uncaring, grossly negligent and greedy physician. Abandoned by his social and church friends, unable to talk to anyone about how he felt, he began drinking. The eventual decision against him was for $2 million, twice his malpractice insurance.

His wife, in an effort to save her children, filed for divorce. On the day of the divorce hearing, rather than suffer another loss, Mark killed himself with his pistol. I am embarrassed to admit I only heard about Mark’s death months afterward.
–Curt Harris, M.D.

It never should end this way, and rarely does. But those of us who have made mistakes in our practices are caught in a dilemma between the harm suffered by a patient for whom we care and a legal system that seems hungry to devour. What should we do as Christian doctors caught between these two important considerations to limit the damage? Dr. Curt Harris, a lawyer and physician offers this advice:

1. When one of your patients has an unexpected complication of his or her treatment or disease, as soon as possible, discuss with the patient and any and all family members what you know, but do not speculate about anything and do not try to blame another physician or caretaker. Be honest, be transparent and be available, including after hours and off call. When you know more about what happened, and especially when you know more about what can be done to make things better, tell the patient and the family. Keep them informed as the care progresses.

2. If you are sued for malpractice, do not read the summons you receive beyond your name on the header. It will contain a lot of legally-required language that will make you angry and depressed, since most of the allegations in a summons have only a thin relationship to the truth. Inform your malpractice carrier; carefully secure and protect every scrap of paper relating to the care of the patient; and, print out a hard copy of any information stored on your computer, including billing and appointment information. Never, never, never add to or modify a record after you have been sued, since it will put every part of your records in question at trial. If you want to make notes separate from the chart, do so with your attorney, so what you do will be protected by the attorney-client privilege.

3. Talk to your spouse about how you feel; be completely honest–trust that your relationship will survive. (Your conversations will be protected from discovery later by the spousal privilege.) Too often, physicians (both men and women) feel that their spouse will think less of them if they made a mistake, and try to hide behind a series of half-truths. Silence can destroy a marriage.

If you are not married, talk to your pastor, a counselor or someone close to you about how you feel. If you are talking to someone other than your spouse, avoid discussing anything but the public facts of the case, and focus on your emotions. These conversations will be of no value to the plaintiff’s attorney, if he decides to discover them later.

4. Finally, a separate word for the spouse of a physician who has been sued: your spouse will be moody, angry, sometimes withdrawn and occasionally inappropriately elated. He or she may feel that you cannot understand what is happening . . . and at one level, this is likely true, if you are not a physician or nurse–a person who has dedicated their life from an early age to being directly responsible for another’s health. Therefore, it may be hard to understand the degree to which a malpractice suit threatens the very being of your loved one. However, you are the most important person in your spouse’s world in every way.

Understand that it is very unlikely that you will lose your home, job, or position in the community because your husband or wife has been sued. If you start obsessing on that possibility, look at your own values, and ask yourself if you are living too much for “things.” Keep your own mental and spiritual health sound, and get good counseling for yourself, if you need to.

Any problem you had in your marriage before the lawsuit was filed will probably be exaggerated, at least at first. Look at the lawsuit as an opportunity to show your spouse how much you really love him or her–this is a moment of “worse” in the “for better or worse” part of your vows.

Perhaps most importantly, realize that virtually every mood change, angry word or insensitive act is not about you, but is about the malpractice suit and how it is hurting your spouse. One simple question can save a marriage: “Honey, are you upset with me or is it something else?”

5. If you need more help, call CMDA and ask for the Medical Malpractice Ministry

Dear God,
This is not about me. This is about my patients whom you love, about my family whom you love, about your plan to redeem this world. Help me to rely on your love living through me and your power to complete your purpose through this struggle. Amen

1 comment:

  1. If your medical malpractice attorney decides that you have a case and you can proceed to trial, he can determine what legal avenues to follow and what damages you can expect to receive.