John Edwards and his malpractice fortune

[Sessamoid]

John Edwards stood in front of a jury and (New York Times, free reg required, blah blah blah) claimed to be channeling the words of an unborn fetus, winning a $6,500,000 verdict for the plaintiff (of which he kept a huge chunk). If he wins the nomination, I'm going to campaign so hard against this scumbag. I'll go door to door against him.

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[jdr]

Def.
As I read, John Edwards is there to stand up for the common man...as long as there's a million bucks in it for him! What a joke, his 'have vs. the have nots' is the only original campaign slogan he could muster up; the war was already taken.

 

[jwin]

i am particularly fond of his constantly saying: "i am one of you!!"

(and he is one of them plus about $60 million)

 

[rustybruce]

Having met John Edwards and knowing a bit about his law practices, I am in a rough situation. With Bush as president, I am ashamed of my country. If Edwards was president, I might leave my country.

 

[jdr]

Listen to this story during his ?sue the pants off anything that moves? days:

Edwards told one doctor that if he was unwilling to settle the malpractice suit, he (Edwards) would go after the physician?s personal assets for every penny above what his malpractice insurance covered! The Dr. settled (as I sure would!). As physicians/future physicians I don?t think we want this guy anywhere near the Whitehouse.

 

[juddson]

You people are idiots.

The types of lawyers and lawsuits you hate are the frequent 30-100k nuisance suits filed in response to every bad outcome, regardless of liability.

Multi-million dollars suits (with exceedingly rare exception) involve grave injury and reprehensible malpractice. Despite your collective god- complexes, doctors kill and maim people daily for want of care and training. It's a fact. The sooner you come to grips with this, the better doctors you will be.

Judd

 

[jwin]

Originally posted by juddson
You people are idiots.

The types of lawyers and lawsuits you hate are the frequent 30-100k nuisance suits filed in response to every bad outcome, regardless of liability.

Multi-million dollars suits (with exceedingly rare exception) involve grave injury and reprehensible malpractice. Despite your collective god- complexes, doctors kill and maim people daily for want of care and training. It's a fact. The sooner you come to grips with this, the better doctors you will be.

Judd

lol...how many 30K suits do you think there are? the median award of cases that go to court is a million bucks.

read the freakin article about jonathan edwards in the ny times. his lawsuits were multi-million dollar suits, and they were not clear cases of negligence.

 

[Apollyon]

Originally posted by juddson
You people are idiots.

This from an attorney. Nice way to be collegial.

And, you think we're screwing everyone up every day? It must be just damn lucky of me that I've never killed a patient; the patients who've died on me, have died despite my best efforts, and not due to my actions or omissions.

And it is so simple to be in a bully pulpit, well-removed from actual life and death and healthcare, to call us idiots.

And, as long as J.E. Nicholas makes commercials with a child actor, who's holding a model of a forearm in his hands, and says, "No, Jimmy, we'll only go to court if it's absolutely necessary", all attornies, barristers, and solicitors will be tarred with the same brush.

And, finally, if dignity to you is 33% contingency (versus a person's livelihood and reputation, and no real malpractice, despite the argument you make), you're already lost.

 

[MacGyver]

In reading all of those Edwards trial stories, one thing stands out:

THE RATE LIMITING FACTOR IN A LAWSUIT IS THE PLAINTIFFS MEDICAL EXPERT!

Sure, John Edwards brought the suits initially, but his hands were tied until he found a plantiff expert.

In one case, he had to go thru 41 doctors before he could find one who would testify as a med expert. Yet that ONE expert got Edwards a multimillion dollar verdict.

You want to blame someone? Blame the plaintiffs experts. They are the rate limiting factor--without their help Edwards stood NO CHANCE of winning any of those lawsuits.

 

[MacGyver]

BTW, many of these so called "plaintiffs medical experts" are FULLTIME CONSULTANTS. They dont see patients, they dont work in clinics, they dont work in hospitals.

All they do ALL DAY LONG IS review cases for lawyers. Many of these consultants are actually full time paid staff OF THE LAW FIRM!

That is outrageous, and speeks to the hideous ethical violations that occur when doctors and lawyers partner up in sleezy relationships.

 

[edinOH]

Originally posted by juddson
You people are idiots.

The types of lawyers and lawsuits you hate are the frequent 30-100k nuisance suits filed in response to every bad outcome, regardless of liability.

Multi-million dollars suits (with exceedingly rare exception) involve grave injury and reprehensible malpractice. Despite your collective god- complexes, doctors kill and maim people daily for want of care and training. It's a fact. The sooner you come to grips with this, the better doctors you will be.

Judd

Dude, you're a ****ing premed. What the hell do you know about clinical medicine?

Kill and maim daily? Please. The big mistakes are kind of like airplane crashes. The reason you hear about them is because they are so rare. It would be very hard to achieve a more conciencious practice of medicine than what we have now.

Despite your collective god-complexes, you guys are nothing more than a group of scam artists who are getting rich on the backs of ignorant juries and subjective "evidence". In the end, your greed hurts everybody. It's a fact. The sooner you come to grips with this, the less dangerous to society you will be.

 

[dry dre]

Originally posted by juddson
You people are idiots.

The types of lawyers and lawsuits you hate are the frequent 30-100k nuisance suits filed in response to every bad outcome, regardless of liability.


Judd

How do you know what "us people" people hate? Are you reading minds or trying to wag the dog?

Pretty funny. But then again, I'm an idiot and am accordingly easily amused.

 

[neutropeniaboy]

People seem to forget that in this country, those people who are injured or wronged are entitled to compensation.

If you think for a moment that a patient isn't entitled to compensation for lost wages, reimbursement for hospital costs, physician costs, ancillary costs, and punatitive damage, then you people are truly living in the dark ages and are spending more time tooting your own horns than thinking about what you are really dealing with: patients' lives.

Doctors make mistakes. Please acknowledge this. Good doctors make mistakes, and patients suffer from those mistakes.

If that's all it were in reality, we wouldn't have this issue. However, polarized lawyers and physicians make it into a pissing contest.

Frivilous law suits are filed frequently and outrageous punative damages are awarded. The reason why this occurs is because the system permits (if I may anthropomorphize) these kind of law suits to continue. There is no worthwhile panel to review the merit of these law suits, and there is no ceiling to the amount a jury may award a plaintiff. (Please don't start with this "how much money is a human life worth?" hackneyed BS.)

A physician will never be judged by his peers. We may debate what the Constitution means until our ears bleed, but that much is certain. Prosecuting attorneys will excerise their rights to dismiss any juror with any sort of medical knowledge, and any physician who is lucky enough or unlucky enough will stand in front of lay people who haven't the slightest clue about either the complexities of the law or complications involved in practicing medicine.

Lawyers can form unions, but physicians cannot. The law makers generally arise from the humble beginnings of attorneys; no member of the Trial Lawyer's Association will ever sincerely promote malpractice reform to the extent where it becomes equitable.

This is the one and only reason why Edwards cannot become either president or vice president.

 

[juddson]

OK, let?s see here.


Well, there?s the definitive study done in 1991 by Harvard and published in the NEJM.

I didn?t have to look very hard to find this article on the internet (this is not my area of law). It does a good job of explaining the study and what it means. There?s quite a bit of quoted commentary as well. Don?t rely on the article. I encourage you to read the actual study and the commentary supporting it and critiquing it, of which this is just one. No study is perfect, of course, but it goes a long way in undermining your notions that you simply don?t make errors, and that even if you did, the errors do not lead to frequent injury and death. The article was written by William Gilson.

?As most Americans would, more than 30,000 patients who were admitted to 51 of the hospitals in New York state in a single year expected that the finest health-care system in the world would provide them every chance of recovery.
For some, the reality was otherwise: 1,133 of the patients suffered injuries caused by medical errors - not their underlying medical conditions. Of those, 154 died from the injuries.
Put another way, one of every 200 of the patients admitted to a hospital ended up dead because of a hospital mistake.
Those were among the key findings of the "Harvard Medical Practice Study," published in 1991 in the New England Journal of Medicine. It remains the most comprehensive and rigorous examination of hospital errors ever, while data supporting the findings throughout the country continue to mount.
"The facts are, we commit thousands of errors every week nationally," said David Nash, associate dean and director of the Office of Health Policy and Clinical Outcomes at Thomas Jefferson University.
"People get killed every day in hospitals," said Bertrand Bell, a professor at Albert Einstein College of Medicine in New York. "This goes on in every hospital in the United States. The public doesn't see it at all."
In interviews, top doctors at the University of Pennsylvania, Thomas Jefferson University, Harvard Medical School, Stanford University School of Medicine, the University of California at Los Angeles, and Albert Einstein College of Medicine in New York, said that medical errors are a serious and common problem at hospitals across the country. One reason, they say, is that the culture of medicine is founded on unattainable standards of perfection, and those ideals are reinforced by public expectations.
"The country spends an awful lot of money making sure cars and airplanes are safe," said David Gaba, a physician and professor at Stanford University. "But this is an issue that's been somewhat hidden because when there's a problem, it's not 100, it's one or two."
Lucian Leape, a pediatric surgeon and adjunct professor of health policy at the Harvard School of Public Health, who led the 1991 study, said those seemingly small numbers add up to one million people being injured by errors in hospital treatment every year - and 120,000 people dying as a result of those injuries.
When the Harvard study was published, it received little public attention. But organized medicine went on the defensive. The American Hospital Association disputed the conclusions. The American Medical Association attacked the researchers' methods and findings.
Medication mistakes represent a leading category of hospital errors, accounting for 19.4 percent of the adverse events in the Harvard study. Among the drugs most frequently at the center of medication errors are insulin, blood thinners and chemotherapy drugs. They are commonly prescribed in chronic conditions that can lead to hospitalization, and have lethal potential.
The largest number of errors - 48 percent - resulted from surgical treatment. By its very nature, surgery carries risks, some unforeseen and others preventable. Technical mistakes during surgery and wound infections afterward each accounted for roughly 13 percent of the adverse events identified in the study.
The Inquirer reported yesterday that internal records from the Medical College of Pennsylvania Hospital documented 598 incidents in which mistakes were suspected from January 1989 through June 1998. The confidential information became public as the result of a bankruptcy proceeding involving MCP's former owner. The hospital's experience reflects the events at hospitals across the country, according to national studies.
The Harvard study found that, on average, there was a 3.7 percent medical error rate at the hospitals in its sample. Other studies have found that only 5 percent to 10 percent of all medical errors are reported to hospital administrators; the remaining 90 percent to 95 percent go unreported.
At MCP, 140,000 patients were admitted during the period covered in the records. Based on an average error rate of 3.7 percent, 5,180 patients would be predicted to have experienced errors. The MCP records document 598 incidents. That represents about 12 percent of the predicted number of errors, which is consistent with the expectation that 5 to 10 percent of all errors are reported.
In addition, studies in New York and California have found that hospitals are sued for 2 to 10 percent of their medical errors. On that basis, MCP would be predicted to have faced from 100 to 500 malpractice lawsuits during the decade. The actual number of lawsuits was 266.
One study, published in part in 1997 in the journal Law and Contemporary Problems, found an overall error rate of 3 percent among 15,000 patients admitted to hospitals in Utah and Colorado. Another study, published in 1995 in the Journal of the American Medical Association, found that medication errors occurred in the care of 7 percent of patients at Massachusetts General Hospital and Brigham and Women's Hospital, major teaching hospitals in Boston.
The Harvard study examined the records of 30,121 randomly selected patients hospitalized in New York in 1984. Among the adverse events it found, 27.6 percent were judged as having been due to negligence, and 13.6 percent led to death. Adverse events were defined as injuries caused by medical management, not the underlying condition, that lengthened hospitalization or resulted in a disability upon discharge.
Harvard's Leape recalls that the late W. Edwards Deming, a pioneer in developing systems to improve industrial quality, told him that even a 99.9 percent proficiency rate was unacceptable in most industries. It would result in two unsafe airplane landings a day at Chicago's O'Hare airport; 16,000 pieces of lost mail every hour; and 32,000 checks deducted from the wrong bank account every hour. Assuming that rate could be achieved in health care, it would still leave thousands of patients dead each year as the result of medical error.

continued below

 

[juddson]

continued from above:

"Paul H. O'Neill, chairman of aluminum producer Alcoa and chairman of RAND Corp., a California think tank, spent 10 years in the White House developing health-care policy during the Johnson, Nixon and Ford administrations. O'Neill said in an interview that the error rate in hospitals could be reduced substantially.
Bell, the Einstein professor, practices medicine at Jacobi Medical Center. He said he is so aware of the potential for medical error at hospitals that he once left a stern warning for residents in the medical record of a patient whom he had admitted.
"I put in the chart: 'DO NOT KILL MR. CROOKS.' " Bell said the warning was not sufficient. Though medical residents did not kill the patient, they mistakenly gave him insulin, which caused a seizure. "They put him into hypoglycemic shock," Bell said. "I'll admit somebody to the hospital, and they'll do all sorts of things. This is at my own hospital!"
Michael Cohen spent 14 years as a pharmacist at Temple University Hospital and Quakertown Hospital. Today he is the full-time president of the Institute for Safe Medication Practices, a small nonprofit organization based in Huntingdon Valley. His group collects 50 to 60 confidential reports of drug errors each month and sends weekly alerts to 5,800 hospital pharmacies around the country.
Cohen got started in the field after a dire episode while he was at Temple in 1975. "A patient was killed by an insulin order," he said. In that case, Cohen said, the doctor wrote a prescription for 6 units of insulin, abbreviating "units" to the letter "u." The letter was read as a zero in the pharmacy, and the patient received 60 units of insulin, or 10 times the proper dose.
The reasons that mistakes occur are multiple and complex. Errors were a problem long before managed-care pressures led to cutbacks at hospitals in the last decade.
Many doctors point out that given the number of opportunities they have to err, it is remarkable that more mistakes do not occur. A study presented at a 1989 conference in Denver found that 178 "activities" were performed each day on the average patient in an intensive-care unit, with 1.7 errors occurring, or a 1 percent daily rate.
Many mistakes have what in retrospect seem to be simple origins in poorly designed systems, experts say. Patient care becomes fragmented as doctors and nurses change shifts or more consultants join the treatment team, multiplying the risk of communication breakdowns. Different medications may come in similar packages or have similar names. Handwritten prescriptions and medical charts are frequently illegible.
"People die of penmanship errors," said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania Health System. "Anybody who thinks that a system that keeps paper records in script is ready to deal with error is dreaming. You've got a 19th-century Charles Dickens system in an era of high technology."
Almost uniformly, doctors and researchers cite an unrealistic and less than honest culture among medical professionals as the single most important factor that contributes to errors.
Beginning in medical school, the culture of medicine discourages acknowledging mistakes, asking for assistance, exhibiting any weakness, or challenging a supervisor. In medicine's carefully ordered hierarchy, admitting or pointing out a mistake is frowned upon.
Doctors have traditionally dealt with errors at teaching hospitals' weekly "morbidity and mortality" conferences. They gather in confidential settings - with legal protection provided by state laws - to discuss among themselves what went wrong in the care of patients who died or suffered complications.
In addition, there is little incentive for hospitals to acknowledge and deal with the problem of medical errors.
Hospital executives, for example, face business pressures to deny the occurrence of medical errors, lest they be sued and have to pay for them. As in most other fields, colleagues are usually reluctant to say anything negative about their peers - especially to outsiders - while subordinates such as residents or nurses fear retribution. Lawsuits that are settled after serious errors are almost always resolved quietly in exchange for confidentiality agreements to avoid adverse publicity.
"It's a cultural barrier we have to overcome to talk about our defects," said Nash, the health policy director at Thomas Jefferson University. "What do hospitals do with their risk-management reports? We bury them as fast as possible."

 

[juddson]

Nuetrapeniaboy (is that right?) and I agree on a few things. doctors make mistakes. This should come as no suprise to you at all, if you are being honest with yourselves. Human smake mistakes, and doctors are human. What part of your training, childhood, upbringing, whatever. . .causes you to think that you are somehow infallable, and unable to error? What is it about your particular profession which seems to make you think that you, and you alone, can perform complex tasks and make life or death situations after having been awake for 30 hours, all without error?

many studies have suggested that being awake for 24 hours straight leads to impairment comparable to a blood alcohol content of .1% - that's the legal limit in most US states. Why is it that you think you are perfectly capable of handling a scapel on hour 33?

At least some of you have had the honesty to admit there is a problem - and the blaim is almost certainly properly placed at the foot of the medical education system and the traditions of residency training.

But you do yourself a huge diservice by pretending that you don't injure and kill people on a fairly regular basis.

BTW, most states have laws that prevent a the testimony of a medical expert unless he spends at least half his time practicing medicine. The idea of a professional witness whoring himself out to anybody willing to pay his fees simply is no longer current.

Judd

 

[juddson]

Originally posted by jwin
lol...how many 30K suits do you think there are? the median award of cases that go to court is a million bucks.

read the freakin article about jonathan edwards in the ny times. his lawsuits were multi-million dollar suits, and they were not clear cases of negligence.

The vast majority of cases filed for medical malpractice are under $100,000. Most are dismissed or won by the doctor (in fact, something like 87% of ALL suits are dismissed or won by doctors -ie., they had no merit). That's why I have suggested those are the suits that should never have been filed in the first place.

You misunderstand the legal standard for tort injury. Only a standard of "clear and convincing evidence" would require a showing of a "clear cases of negligence" by the victim. The leal standard for medical malpractice cases (and almost all civil suits) is the "preponderance of the evidence". This means that in order to win, the plaintiff need only show that there was a 50% + a smidgen chance that negligence occured. The current standard requires not that one show clear negligence, but that it is merely more likely than not that negligence occurred, and that the negligence caused the injury.

Look, I encourage you do read the thread regarding the central line mishap at Hopkins. There are many many testimonials from interns and residents just like you attesting to various degrees of error and injury in the placement of this device. Am I to understand that the lot of you are simply "better" than all of them? Maybe this just happens to be the "super competant" thread.

Judd

 

[juddson]

Originally posted by Apollyon


And it is so simple to be in a bully pulpit, well-removed from actual life and death and healthcare, to call us idiots.

And, as long as J.E. Nicholas makes commercials with a child actor, who's holding a model of a forearm in his hands, and says, "No, Jimmy, we'll only go to court if it's absolutely necessary", all attornies, barristers, and solicitors will be tarred with the same brush.

And, finally, if dignity to you is 33% contingency (versus a person's livelihood and reputation, and no real malpractice, despite the argument you make), you're already lost. [/B]

These arguments are intellectually dishonest.

You know as well as I do that I called you idiots not because you are capable of negligence and error (everybody who is human is), but because you seem to refuse to accept the fact that you are. My comment has nothing to do with your performance in the trenches and life in a clinical setting. In fact, I agree with you 100%. It's probably ****ing hard. Probably really difficult to avoid errors. That's all the more reason it seems to me (and people who do the studies) that errors are frequently made in such settings.

To suggest that a ambulance chasing attorney with a tacky advert on TV represents all attorneys (for your part, I gather, rightfully so) is the same as my suggesting that as long as one among you is a poor clinician, all of you are. If all attorneys are to be judged by the bottom 5% of us, perhaps all doctors should be judged by the bottom 5% of you. Try to be a bit more circumspect next time.

The final argument you set forth is the worst of all. I find it just amazing that you can compare the 33% contigency fee earned by the attorney against your reputation and livelihood without, even once, mentioning the injury sustained by the patient. The contingency fee is the reason the lawyer represents the patient (its true, lawyers don't work for free - I know all of you do), but the injury and negligence is the reason the patient brings the suit. The intellectually honest argument would weight the costs to your reputation and livlihood against the patient who must undergo a radical pelvic exteneration because cervical cancer was missed, or (more mundanely) the dropped lung caused by a botched central line placement.

Judd

 

[juddson]

Originally posted by dry dre
How do you know what "us people" people hate? Are you reading minds or trying to wag the dog?

Pretty funny. But then again, I'm an idiot and am accordingly easily amused.

You know what I meant. What the medical establishment riles againts (and what accounts for the bulk of the rise of insurance rates) are the frequent filings and the cost to defend against nuasance suits of the variety I mentioned above. Of course I cannot read your mind. These are the suits are SHOULD be upset about. You do yourself no favors by failing to admit, even begrudgenly, that sometimes doctors make errors that result is garve injuries to patients, and that these patienst deserve (rightfully) to be compensated.

Judd

 

[dry dre]

Originally posted by juddson
Despite your collective god- complexes, doctors kill and maim people daily for want of care and training. It's a fact. The sooner you come to grips with this, the better doctors you will be.

Judd

Medical errors kill something like 85,000+ people a year in the US in the most recent report I read. What percentage of these are due to physicians' "want of care and training" (which was your previous point)? Pony up some evidence to support your argument, not some article on systemic problems (ie global iatrogenic vs physician-specific as you claim).


At least some of you have had the honesty to admit there is a problem - and the blaim is almost certainly properly placed at the foot of the medical education system and the traditions of residency training.

Everyone will admit that there is some problem. What evidence do you have to support your claim that the medical education system is the root cause, other than your opinions? Obviously there is a problem. You get paid for strawman arguments in law, but not credit here...


But you do yourself a huge diservice by pretending that you don't injure and kill people on a fairly regular basis.

Do you tell this to every physician you meet? If not, why not? If you really want to help people, why aren't you saying this to every physician you meet? Now this is pretty funny. Prove this point with evidence (eg studies, white papers etc). Reference them here in this forum.

Maybe this just happens to be the "super competant" thread.

If you ever practice medicine as poorly as you attempt to make intellectual (or even lowly legal) arguments, you will kill and injure every day you practice.

 

[Apollyon]

Originally posted by juddson
To suggest that a ambulance chasing attorney with a tacky advert on TV represents all attorneys (for your part, I gather, rightfully so) is the same as my suggesting that as long as one among you is a poor clinician, all of you are. If all attorneys are to be judged by the bottom 5% of us, perhaps all doctors should be judged by the bottom 5% of you. Try to be a bit more circumspect next time.

But therein lies the rub - my circumspection is that all people see are high-profile defense attornies (Johnnie Cochran, F. Lee Bailey, and the superstar in every city, etc.), all of these commercials (indeed, tacky as hell), and the gazillionaire John Edwards, and think that they are representative of the bar in general. And, you must admit, most people will spend more time with their doctor, than their lawyer, and, most people stay (or at least revisit) their doctor, so their opinion must be, at least, that the doctor is "acceptable". If people don't see an attorney in person, they substitute other persons' experiences (or, lacking that, perceptions from others and the media).

My point is that you may judge all doctors by the bottom 5%, but people that see doctors probably won't agree that THEIR doctor is one of that percentage. However, if all people know of attornies is some cheesy shmuck, that tars all with the same brush. Even the people that BENEFIT from attornies will often turn their head at the tactics undertaken on their behalf (like any person who ever was in an adversarial divorce proceeding).

Hell, myself, I've dealt with 4 attornies in my life, and gotten a good result from each, but paid dearly for it - and that's all I saw it as: getting what you pay for. Morality is a lost cause. Just like a surgeon, I don't want a friend - I want a tactician, and don't want to spend any longer than I have to with any lawyer OR surgeon.

If I ever get sued, I will either have (or get, on good recommendation) an ass-kicking, junkyard dog, suave, killer mouthpiece to square me away - and I'll pay for it, gladly. And I will still not think that attornies, in balance, do more for society than take from it.

 

[juddson]

I have no idea why most of what follows is in bold. Sorry.

Quote
Medical errors kill something like 85,000+ people a year in the US in the most recent report I read. What percentage of these are due to physicians' "want of care and training" (which was your previous point)? Pony up some evidence to support your argument, not some article on systemic problems (ie global iatrogenic vs physician-specific as you claim). . . .

Everyone will admit that there is some problem. What evidence do you have to support your claim that the medical education system is the root cause, other than your opinions? Obviously there is a problem. You get paid for strawman arguments in law, but not credit here...

end quote

I've included some abstracts at the end. let's deal with what you have written first. Unfortunatley, I'm afraid I don't understand what you are getting at in the first place. You admit that there are upwards of 85,000 deaths a year caused by medical errors. But your post makes it abundantly clear that these errors are NOT physician specific (but rather iatrogenic - a distinction without a difference if there ever was one). And yet, you refuse to accept the notion that much of these errors come down to medical training and the residency system in general. So, where are we then? You admit there are 85,000 deaths a year caused by medical errors. But they are not caused by phsycian specific negligence, and they are not iatrogenic. What does that leave us with? The nurses? Is that your answer. The nurses are to blaim for the 85,000 deaths each years caused by medical error?

Of course the term iatrogenic included nurses as well. It means medical errors which lead to injury caused by any person who provides health care. Remember the stat. It's not just adverse events resulting from care. It's adverse events resulting from errors in care. You can't have it both ways.

Take the rather mundane example of dropping a lung as a result of putting in a central line improperly. If we assume this resulted from the relative inexperience of an intern on her 31st hour on the floor, we'd certainly call this an iatrogenic event. But it's also physician specific. The intern failed to comply with the prevailing standard of care (remember, the stat talks about medical errors, not just adverse outcomes resulting from other causes). That's negligence. Adding an extra 0 to a scrip is an iatrogenic error. It's also physician specific.

Quote

Do you tell this to every physician you meet? If not, why not? If you really want to help people, why aren't you saying this to every physician you meet? Now this is pretty funny. Prove this point with evidence (eg studies, white papers etc). Reference them here in this forum.

end quote

What are you talking about? I didn't start this thread with the intent of making sure everybody knew they were fallable. You people started this thread with the suggestion that you never made errors, and that all malpractice lawyers (and therefore all malpractice claims) are suspect. I rebutted those ridiculous claims by asserting that doctors make make medical errors all the time, and that as a result of that not all medical malpractice claims are bunk. Prove WHAT point with evidence? That I really want to help people? Or that physicians are fallable and that they make medical errors which lead to injury and death. I've included some citations below. But what's the point anyway. You've admitted as much. You said 85,000 people die from medical errors every year. Who do you think committs the medical errors? surely SOME of them are committed by doctors.

Quote

If you ever practice medicine as poorly as you attempt to make intellectual (or even lowly legal) arguments, you will kill and injure every day you practice. [/QUOTE]

end quote

strong argument. You are smooth. I

OK: Without much looking, i lifted these from http://md-jd.info/abstract/iom-00.htm, which, i think, lifted them right from the abstracts for the NEJM. These represent just two studies.

They are in the next message:

 

[juddson]

Incidence of adverse events and negligence in hospitalized patients. TOP
Results of the Harvard Medical Practice Study I.
Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, Newhouse JP, Weiler PC, Hiatt HH. Division of General Medicine, Brigham and Women's Hospital, Boston, MA 02115.
N Engl J Med 1991 Feb 7;324(6):370-6
BACKGROUND. As part of an interdisciplinary study of medical injury and malpractice litigation, we estimated the incidence of adverse events, defined as injuries caused by medical management, and of the subgroup of such injuries that resulted from negligent or substandard care.
METHODS. We reviewed 30,121 randomly selected records from 51 randomly selected acute care, nonpsychiatric hospitals in New York State in 1984. We then developed population estimates of injuries and computed rates according to the age and sex of the patients as well as the specialties of the physicians.
RESULTS. Adverse events occurred in 3.7 percent of the hospitalizations (95 percent confidence interval, 3.2 to 4.2), and 27.6 percent of the adverse events were due to negligence (95 percent confidence interval, 22.5 to 32.6). Although 70.5 percent of the adverse events gave rise to disability lasting less than six months, 2.6 percent caused permanently disabling injuries and 13.6 percent led to death. The percentage of adverse events attributable to negligence increased in the categories of more severe injuries (Wald test chi 2 = 21.04, P less than 0.0001). Using weighted totals, we estimated that among the 2,671,863 patients discharged from New York hospitals in 1984 there were 98,609 adverse events and 27,179 adverse events involving negligence. Rates of adverse events rose with age (P less than 0.0001). The percentage of adverse events due to negligence was markedly higher among the elderly (P less than 0.01). There were significant differences in rates of adverse events among categories of clinical specialties (P less than 0.0001), but no differences in the percentage due to negligence.
CONCLUSIONS. There is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care. PMID: 1987460

The nature of adverse events in hospitalized patients. TOP
Results of the Harvard Medical Practice Study II.
Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, Hebert L, Newhouse JP, Weiler PC, Hiatt H.
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115.
N Engl J Med 1991 Feb 7;324(6):377-84
BACKGROUND. In a sample of 30,195 randomly selected hospital records, we identified 1133 patients (3.7 percent) with disabling injuries caused by medical treatment. We report here an analysis of these adverse events and their relation to error, negligence, and disability.
METHODS. Two physician-reviewers independently identified the adverse events and evaluated them with respect to negligence, errors in management, and extent of disability. One of the authors classified each event according to type of injury. We tested the significance of differences in rates of negligence and disability among categories with at least 30 adverse events.
RESULTS. Drug complications were the most common type of adverse event (19 percent), followed by wound infections (14 percent) and technical complications (13 percent). Nearly half the adverse events (48 percent) were associated with an operation. Adverse events during surgery were less likely to be caused by negligence (17 percent) than nonsurgical ones (37 percent). The proportion of adverse events due to negligence was highest for diagnostic mishaps (75 percent), noninvasive therapeutic mishaps ("errors of omission") (77 percent), and events occurring in the emergency room (70 percent). Errors in management were identified for 58 percent of the adverse events, among which nearly half were attributed to negligence.
CONCLUSIONS. Although the prevention of many adverse events must await improvements in medical knowledge, the high proportion that are due to management errors suggests that many others are potentially preventable now. Reducing the incidence of these events will require identifying their causes and developing methods to prevent error or reduce its effects.
PMID: 1824793


Relation between malpractice claims and adverse events due to negligence. TOP
Results of the Harvard Medical Practice Study III.
Localio AR, Lawthers AG, Brennan TA, Laird NM, Hebert LE, Peterson LM, Newhouse JP, Weiler PC, Hiatt HH.
Center for Biostatistics and Epidemiology, Penn State University College of Medicine, Hershey 17033.
N Engl J Med 1991 Jul 25;325(4):245-51
BACKGROUND AND METHODS. By matching the medical records of a random sample of 31,429 patients hospitalized in New York State in 1984 with statewide data on medical-malpractice claims, we identified patients who had filed claims against physicians and hospitals. These results were then compared with our findings, based on a review of the same medical records, regarding the incidence of injuries to patients caused by medical management (adverse events).
RESULTS. We identified 47 malpractice claims among 30,195 patients' records located on our initial visits to the hospitals, and 4 claims among 580 additional records located during follow-up visits. The overall rate of claims per discharge (weighted) was 0.13 percent (95 percent confidence interval, 0.076 to 0.18 percent). Of the 280 patients who had adverse events caused by medical negligence as defined by the study protocol, 8 filed malpractice claims (weighted rate, 1.53 percent; 95 percent confidence interval, 0 to 3.2 percent). By contrast, our estimate of the statewide ratio of adverse events caused by negligence (27,179) to malpractice claims (3570) is 7.6 to 1. This relative frequency overstates the chances that a negligent adverse event will produce a claim, however, because most of the events for which claims were made in the sample did not meet our definition of adverse events due to negligence.
CONCLUSIONS. Medical-malpractice litigation infrequently compensates patients injured by medical negligence and rarely identifies, and holds providers accountable for, substandard care. PMID: 2057025

A study of medical injury and medical malpractice.
Hiatt HH, Barnes BA, Brennan TA, Laird NM, Lawthers AG, Leape LL, Localio AR, Newhouse JP, Peterson LM, Thorpe KE, et al. Harvard School of Public Health, Boston, MA 02115.
N Engl J Med 1989 Aug 17;321(7):480-4



Incidence and types of adverse events and negligent care in Utah and Colorado. TOP
Thomas EJ, Studdert DM, Burstin HR, Orav EJ, Zeena T, Williams EJ, Howard KM, Weiler PC, Brennan TA.
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Med Care 2000 Mar;38(3):261-71
BACKGROUND: The ongoing debate on the incidence and types of iatrogenic injuries in American hospitals has been informed primarily by the Harvard Medical Practice Study, which analyzed hospitalizations in New York in 1984. The generalizability of these findings is unknown and has been questioned by other studies.
OBJECTIVE: We used methods similar to the Harvard Medical Practice Study to estimate the incidence and types of adverse events and negligent adverse events in Utah and Colorado in 1992.
DESIGN AND SUBJECTS: We selected a representative sample of hospitals from Utah and Colorado and then randomly sampled 15,000 nonpsychiatric 1992 discharges. Each record was screened by a trained nurse-reviewer for 1 of 18 criteria associated with adverse events. If > or =1 criteria were present, the record was reviewed by a trained physician to determine whether an adverse event or negligent adverse event occurred and to classify the type of adverse event.
MEASURES: The measures were adverse events and negligent adverse events.
RESULTS: Adverse events occurred in 2.9+/-0.2% (mean+/-SD) of hospitalizations in each state. In Utah, 32.6+/-4% of adverse events were due to negligence; in Colorado, 27.4+/-2.4%. Death occurred in 6.6+/-1.2% of adverse events and 8.8+/-2.5% of negligent adverse events. Operative adverse events comprised 44.9% of all adverse events; 16.9% were negligent, and 16.6% resulted in permanent disability. Adverse drug events were the leading cause of nonoperative adverse events (19.3% of all adverse events; 35.1% were negligent, and 9.7% caused permanent disability). Most adverse events were attributed to surgeons (46.1%, 22.3% negligent) and internists (23.2%, 44.9% negligent).
CONCLUSIONS: The incidence and types of adverse events in Utah and Colorado in 1992 were similar to those in New York State in 1984. Iatrogenic injury continues to be a significant public health problem. Improving systems of surgical care and drug delivery could substantially reduce the burden of iatrogenic injury. PMID: 10718351

And the next message:

 

[juddson]

finally over:

The incidence and nature of surgical adverse events in Colorado and Utah in 1992. TOP
Gawande AA, Thomas EJ, Zinner MJ, Brennan TA.
Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
Surgery 1999 Jul;126(1):66-75
BACKGROUND: Despite more than three decades of research on iatrogenesis, surgical adverse events have not been subjected to detailed study to identify their characteristics. This information could be invaluable, however, for guiding quality assurance and research efforts aimed at reducing the occurrence of surgical adverse events. Thus we conducted a retrospective chart review of 15,000 randomly selected admissions to Colorado and Utah hospitals during 1992 to identify and analyze these events.
METHODS: We selected a representative sample of hospitals from Utah and Colorado and then randomly sampled 15,000 nonpsychiatric discharges from 1992. With use of a 2-stage record-review process modeled on previous adverse event studies, we estimated the incidence, morbidity, and preventability of surgical adverse events that caused death, disability at the time of discharge, or prolonged hospital stay. We characterized their distribution by type of injury and by physician specialty and determined incidence rates by procedure.
RESULTS: Adverse events were no more likely in surgical care than in nonsurgical care. Nonetheless, 66% of all adverse events were surgical, and the annual incidence among hospitalized patients who underwent an operation or child delivery was 3.0% (confidence interval 2.7% to 3.4%). Among surgical adverse events 54% (confidence interval 48.9% to 58.9%) were preventable. We identified 12 common operations with significantly elevated adverse event incidence rates that ranged from 4.4% for hysterectomy (confidence interval 2.9% to 6.8%) to 18.9% for abdominal aortic aneurysm repair (confidence interval 8.3% to 37.5%). Eight operations also carried a significantly higher risk of a preventable adverse event: lower extremity bypass graft (11.0%), abdominal aortic aneurysm repair (8.1%), colon resection (5.9%), coronary artery bypass graft/cardiac valve surgery (4.7%), transurethral resection of the prostate or of a bladder tumor (3.9%), cholecystectomy (3.0%), hysterectomy (2.8%), and appendectomy (1.5%). Among all surgical adverse events, 5.6% (confidence interval 3.7% to 8.3%) resulted in death, accounting for 12.2% (confidence interval 6.9% to 21.4%) of all hospital deaths in Utah and Colorado. Technique-related complications, wound infections, and postoperative bleeding produced nearly half of all surgical adverse events.
CONCLUSION: These findings provide direction for research to identify the causes of surgical adverse events and for targeted quality improvement efforts. PMID: 10418594

Costs of medical injuries in Utah and Colorado.
Thomas EJ, Studdert DM, Newhouse JP, Zbar BI, Howard KM, Williams EJ, Brennan TA.
University of Texas-Houston Medical School 77030, USA.
Inquiry 1999 Fall;36(3):255-64
Patient injuries are thought to have a substantial financial impact on the health care system, but recent studies have been limited to estimating the costs of adverse drug events in teaching hospitals. This analysis estimated the costs of all types of patient injuries from a representative sample of hospitals in Utah and Colorado.
We detected 459 adverse events (of which 265 were preventable) by reviewing the medical records of 14,732 randomly selected 1992 discharges from 28 hospitals. The total costs (all results are discounted 1996 dollars) were $661,889,000 for adverse events, and $308,382,000 for preventable adverse events. Health care costs totaled $348,081,000 for all adverse events and $159,245,000 for the preventable adverse events. Fifty-seven percent of the adverse event health care costs, and 46% of the preventable adverse event costs were attributed to outpatient medical care. Surgical complications, adverse drug events, and delayed or incorrect diagnoses and therapies were the most expensive types of adverse events. The costs of adverse events were similar to the national costs of caring for people with HIV/AIDS, and totaled 4.8% of per capita health care expenditures in these states. PMID: 10570659

 

[juddson]

Originally posted by Apollyon
But therein lies the rub - my circumspection is that all people see are high-profile defense attornies (Johnnie Cochran, F. Lee Bailey, and the superstar in every city, etc.), all of these commercials (indeed, tacky as hell), and the gazillionaire John Edwards, and think that they are representative of the bar in general. And, you must admit, most people will spend more time with their doctor, than their lawyer, and, most people stay (or at least revisit) their doctor, so their opinion must be, at least, that the doctor is "acceptable". If people don't see an attorney in person, they substitute other persons' experiences (or, lacking that, perceptions from others and the media).

My point is that you may judge all doctors by the bottom 5%, but people that see doctors probably won't agree that THEIR doctor is one of that percentage. However, if all people know of attornies is some cheesy shmuck, that tars all with the same brush. Even the people that BENEFIT from attornies will often turn their head at the tactics undertaken on their behalf (like any person who ever was in an adversarial divorce proceeding).

Hell, myself, I've dealt with 4 attornies in my life, and gotten a good result from each, but paid dearly for it - and that's all I saw it as: getting what you pay for. Morality is a lost cause. Just like a surgeon, I don't want a friend - I want a tactician, and don't want to spend any longer than I have to with any lawyer OR surgeon.

If I ever get sued, I will either have (or get, on good recommendation) an ass-kicking, junkyard dog, suave, killer mouthpiece to square me away - and I'll pay for it, gladly. And I will still not think that attornies, in balance, do more for society than take from it.

Well, at least we agree on a few things. lawyers are in fact judged unfairly based on the actions of only a few. I'm afraid I can't do much about that. But you should realize that doctors are reviled only slightly less than attorneys (your post seems to suggest that as well). Anyway, I agree with it. We are painted with the same brush.

But you should not be so quick to devalue us. Shakespeer (sp) understood our true value when he said "first kill all the lawyers". Rather than derision of what we do (which is the way it is often understood) it is actually uttered in the course of planning an overthrow of the sitting powers. Lawyers, as he understood it, were the pillars of the rule of law and the backbone of the social contract. he who uttered that phrase understood that anarchy and (eventually) despotism could not flourish as long as there existed lawyers. We represent you before medical ethics boards. We defend you when you are imprisoned. Blah blah blah.

judd

 

[Sessamoid]

Somebody hijacked my thread.

 

[Foxxy Cleopatra]

Hey Juddson-

I don't think that anyone here is denying that doctors and the hospital system makes errors. However, medicine is not perfect; sometimes you can follow the book in every way possible and things still go wrong. It is a part of life, that for whatever reason, people think that doctors should be punished.

If I "botched" someone; a.k.a. amputated the wrong leg, I would gladly admit to an error and probably want to compensate the person. But there is a difference between that and suing because you are unhappy with the outcome. It is sad to me that, more often that not, you don't hear, "my sister is alive today after a horrible car wreck because of this hospital" nearly as much as you hear "she still has pain in her arm, it's your fault, I'll see you in court."

As for lawyers calling doctors "idiots" for thinking they do not admit to error... well, that's like poop telling vomit that it stinks.

As for referring to the Hopkins line incident as "botching," if you are a pre-med and accepted into medical school, come back in 5 years when it happens to you and tell us if you feel the same way.

 

[margaritaboy]

Originally posted by juddson


No study is perfect, of course, but it goes a long way in undermining your notions that you simply don?t make errors, and that even if you did, the errors do not lead to frequent injury and death.

juddson,

Exactly who are you refering to here? I couldn't find any posts in this thread that make claims that doctors "simply don't make errors," as you say above.

I agree with foxycleopatra's poop-vomit sentiment above.

 

[MacGyver]

Juddson,

Lets get one thing clear right now. Those 85,000 deaths include ALL MEDICAL ERRORS, COMMITTED BY ALL PARTIES.

That includes errors committed by doctors, nurses, support staff, family, AND patients.

so when a patient takes alcohol with a barbituate and dies, that death is classified as a medical mistake committed by the patient.

Yes, doctors account for a good portion of the mistakes--but to put ALL of them on doctors is spin-doctoring typical of lawyers.

 

[MacGyver]

judd also remember that doctors are NOT inherently more mistake-prone or screw up more often than other groups.

Its just the consequences are much higher. You are trying to spin this into an argument that doctors are somehow abnromal in the number of mistakes made and negligence/malpractice committed.

What is an "acceptable" number of deaths from medical mistakes? 5,000? 3,000? If there were only 3,000 people dying from medical mistakes per year, you'd STILL BE SCREAMING ABOUT INCOMPETENT DOCTORS.

Your standard for doctors is that they must be 100% perfect. Sorry, but thats not going to happen no matter how you change the system.

 

[Tenesma]

juddson:

gimme a break... as a 1st year medical student you have absolutely no clue whatsoever regarding hospital mistakes...

AND, all those studies you cited are well-established as far as improving Q&A in the hospital system, BUT!!! none of those studies account for mortality rate of that patient population had they not been admitted to a hospital in the first place!!!

That is like suing a vaccine manufacturer for 1,000 deaths when nobody is taking into account the much higher death rate that was avoided by providing that vaccine....

while i wouldn't say that mistakes are OK - they are part of the system and crucial for our evolution towards safer medicine (if we didn't make mistakes we couldn't improve or create better technology), and thus all of your points regarding law vs medicine, in my humble opinion, are useless....

why don't you wait till you are done with medical school and you create a femoral pseudoaneurysm in an end-stage liver patient with your attempt at central venous access, and the patient dies 3 days later from complications from that.... i am sure a lawyer would love to depose you!!!

 

[juddson]

Originally posted by Foxxy Cleopatra


As for lawyers calling doctors "idiots" for thinking they do not admit to error... well, that's like poop telling vomit that it stinks.

As for referring to the Hopkins line incident as "botching," if you are a pre-med and accepted into medical school, come back in 5 years when it happens to you and tell us if you feel the same way. [/B]

I'll combine the comments above with those from McGyver and the poster who follows him.

I find the line of reasoning above pretty ironic given that the premise of this thread was essentially "hey, look at that peice of vomit Edwards, screwing us all over for no reason. But everybody knows our **** don't stink". Show a little bit of integrity here and realize that this thread (1) was started as an attack on a lawyer (and through subsequent posts, on all lawyers by association) and (2) the ridiculous implications that these suits are baseless because doctors don't actually make mistakes.

All I have done is to suggest (with facts and figures) that in fact doctors ARE human and, as humans, make mistakes which injure people.

You're blinding fury and disgust with attorney's has caused many of you to read into my arguements assertions that are simplu not there. For instance, what gave any of you the idea that i thought attorneys made fewer mistakes than doctors do? Or that I somehow think that when I am practicing medicine, I won't also make mistakes which injure and kill people.

And why do some of you keep saying things like "You're just a premed - wait till you're an intern and see how it feels". These sorts of statements support the very position I am trying to advance here, not impune in. Are you trying to suggest that because I haven't work in a hospital before with no sleep in the last 24 hours I don't know how hard it is?? Well, that's my very point, isn't it? I bet you it is hard as hell. I bet it's nearly impossible to do everything right all the time. I bet the demands on your time and attention are so crushing that it's nearly impossible to be perfect.

BUT THAT"S MY POINT. How can any of you (if you are being intellectually honest) assert on the one hand how hard it is to be an intern/resident (if only this sorry premed-attorney knew as much) and then on ther other hand claim that errors are not made?

Your arguments are not intellectually and logically consistent. You claim on the one hand that when I'm a doctor one day "I'll get mine" and "you'll see how bad you feel when you screw up" and then claim that you never screw up. This is a ridiculous line of reasoning.

Foxy's example is a good one. It's designed by her (assuming you are a she) to obfuscate the issue I am trying to address here (that EVEN doctors make mistakes) by (1) claiming the incident was NOT an error, and (2) that when I make the same error one day, I'll see how it feels. Doesn't anybody else see the internal inconsistency of this argument???

I'm glad Foxy understand the difference on the one hand between comforming with the standard of care and STILL a bad outcome results, and on the other hand, failing to conform with the standard of care which results in a bad outcome.

I understand the difference too. Remember, the statistics and studies I cite above discuss "errors" which result in injuries and death NOT the mere incidence of adverse outcomes alone. It is not enough (in reality it is, but that is another story) to show only a bad outcome. You also have to show a deviation from the standard of care. . .ie., you have to show an error. The 1991 study discusses errors. So, while I'm 100% sympathetic, Foxy, with your assertion that even when you do everything correctly, bad things still happen, that's kinda inapposite here. I grant as much. Now let's get back to talking about when doctors DON'T do everything they should.

In any event, as I understand the Hopkins incident, the intern punched the Carotid Artery rather than the Jugular Vein. Rather than catch her error, she proceeded to dilate the wrong blood vessel - which resulted in the injury complained of. I'm 100% sympathetic with the notion that punching the wrong vessel is sometimes unavoidable. It's freaking hard sometimes to find the vein rather than the artery. And I'm 100% convinced CONVINCED that even when the doctor is doing every single thing she she is supposed to do, she may STILL punch the wrong vessel. BUT, to dilate the artery and procede with the guidewire is clearly an error which devated from the applicable standard of care. There are several posts on the other thread suggesting a number of ways to discover that the wrong vessel was hit BEFORE you dilate the thing and insert the guidewire.

Given all the facts we have (as we know them) I'm not sure why Foxy does not consider that to be a botched procedure. Due to inadaquate supervision, overc onfidence, lack of training, being tired, whatever . . .the intern failed to properly place the central line, and the patient was injured (I'd say somewhat seriously) as aresult of the errors as I've set them forth above (again, only in so far as the facts as we know them today - of course, I have no idea what actually happened).

Is the same thing going to happen to me? Hell yes. Will I punch the wrong vessel? yes. Will I dilate the wrong vessel? Probably. Will I, more than once, push the guidewire harder than I should causing a pneumothorax? Probably more than once. Will I always use a Ultra sound for guidance when one is available? Probably not. And in each case I'll have to admit that getting it right is hard sometimes - and that sometimes I'm just not as good as I should have been . . .as the standard of care required me to be. I'll have been negligent because I was too tired, or too cocky, or too inexperienced. And it will suck. But it will be the truth.

So, yes, Foxy. I sympathize with you, and I'll make all the same mistakes you expect me to. But your personal insults (is if the true incidence of doctor error are somehow impacted by the fact that I'm a peice of poop, er, and attorney) don't change the basic facts here. You are fallable and will make mistakes just like the rest of the world.

Judd

 

[juddson]

Originally posted by margaritaboy
juddson,

Exactly who are you refering to here? I couldn't find any posts in this thread that make claims that doctors "simply don't make errors," as you say above.

You are being too literal here. There are plenty of posts here suggesting that by and large lawsuits are frivilous, that the attorney's who bring them are "scam artists" and that the errors we hear about are like "plane crashes" . . .rare and isolated - but that these are the ones we hear about.

The studies I cite (not my opinions, but the studies I cite) say the contrary. That medical errors are frequent, and that sometimes they lead to injury and death.

So now you are saying (essentially) "well, nobody said we don't make ANY mistakes that injure people." I understand your propensity to soften the ridiculous implications set forth above by admitting (essentially) that well, of course, doctors make SOME mistakes. At least you are moving in the right direction.

BTW, what exactly are the purposes of M and M's conferences anyway?? Huh??

Judd

 

[juddson]

Originally posted by MacGyver
Juddson,

Lets get one thing clear right now. Those 85,000 deaths include ALL MEDICAL ERRORS, COMMITTED BY ALL PARTIES.

Dude,

That's your stat. I'm happy to stick to the NEJM study. I'm also happy to acknowledge that all medical errors are shared equaly between doctors, nurses, staff, and, even, patients (though I'd be suprised if the Harvard study included self-inflicted errors. It doesn't my main assertion one bit - that even doctors make medical errors .

Judd

 

[juddson]

Originally posted by MacGyver
judd also remember that doctors are NOT inherently more mistake-prone or screw up more often than other groups.

Its just the consequences are much higher. You are trying to spin this into an argument that doctors are somehow abnromal in the number of mistakes made and negligence/malpractice committed.

What is an "acceptable" number of deaths from medical mistakes? 5,000? 3,000? If there were only 3,000 people dying from medical mistakes per year, you'd STILL BE SCREAMING ABOUT INCOMPETENT DOCTORS.

Your standard for doctors is that they must be 100% perfect. Sorry, but thats not going to happen no matter how you change the system.

I'm so glad you brought this up. It shows how your rancor and dogmatism blinds you to the arguments I'm actually making and substitutes the arguments you'd like to think I'm making.

I've bent over backwards to say that doctors are human, and as such, make mistakes. I've not suggested even once that they are more prone to mistake than others (nor have I "spun" it that way). Rather, I've tried to rebut the ridiculous assertions (we can call them "spin") that by and large (certainly those by Edwards and his blood-thirsty ilk) bring suits against doctors for no reason . . .that these sorts of suits are frivilous and ridiculous, and that they unfairly hurt doctors because, as we all know, doctors rarely error. right?

Your second paragraph is 100% wrong. I have no touched on, in the least, what i think the number of acceptable errors is, or whether doctors should be given a free pass. These assertions are made by you simply because ytou don't like lawyers.

But since you ask, I happen to think that medical care is a public good. My version of tort reform would elevate the standard for negligence from "deviates from the prevailing standard of care" to "substantially deviates from the prevailing standard of care". In addition, in order for a patient to prevail in a lawsuit for medical malpractice, I would elevate the standard of evidence from "a propenderance" to "clear and convincing".

My positions are intellectually more honest than most of yours. Why? Because I recognize (and would admit) that doctoring is hard, and that mistakes which injure and kill people are frequent and inevitable. But that medicine is a public good, and as a result of that, only those mistakes which are "substantial" or "reckless" or "wonton" or which deviate "substantially from the standard of care" would be actionable.

My position would eliminate suits for which it is claimed that a physician didn't prescribe the "best" treatment, as long as he prescribed an "acceptable" treatment.

You see, it recognizes that medicine is probably one of the most difficult things to do in this world, and that nobody is perfect. But because medicine is so important to us, we should be prepared to accept some level of error.

JSo, you see, I've not suggest anywhere in this thread that i think doctors should be perfect. In fact, I think just the opposite. What I rile against is the notion that doctors far too often think they ARE perfect. At least two previous posters have said that doctors make mistakes. What do they know that some of the other don't. At least you know you're not perfect.

Judd

 

[juddson]

Originally posted by Tenesma
juddson:

gimme a break... as a 1st year medical student you have absolutely no clue whatsoever regarding hospital mistakes...

AND, all those studies you cited are well-established as far as improving Q&A in the hospital system, BUT!!! none of those studies account for mortality rate of that patient population had they not been admitted to a hospital in the first place!!!

That is like suing a vaccine manufacturer for 1,000 deaths when nobody is taking into account the much higher death rate that was avoided by providing that vaccine....

while i wouldn't say that mistakes are OK - they are part of the system and crucial for our evolution towards safer medicine (if we didn't make mistakes we couldn't improve or create better technology), and thus all of your points regarding law vs medicine, in my humble opinion, are useless....

why don't you wait till you are done with medical school and you create a femoral pseudoaneurysm in an end-stage liver patient with your attempt at central venous access, and the patient dies 3 days later from complications from that.... i am sure a lawyer would love to depose you!!!

read everything I have written above. We've gone from "show where it says that doctors make a lot of mistakes" to "we need to make mistakes to learn - you'll make them too".

I agree. You have no quarrel with me. Mistakes that injure and kill people are a part of medicine. I think I've said this about a billion times in this thread. I;m glad some people are getting it.

And by the way, I have not compared medicine to law. Why do you people keep doing it. The comparisons are not relevant.

BTW, I'm citing studes by harvard published in the NEJM. I'm not making up these stats. I'm simply citing to them. Your being in a hospital all day, I'm sure, does not put you in a better position than me in reading these studies. My being a premed has no bearing on whether doctors make mistakes. I think I've been accused of being a premed like 20 times in this thread. It's such a sorry sobbery.

Judd

 

[Apollyon]

Originally posted by juddson
somehow impacted by the fact that I'm a piece of poop,

Did you realize the medical joke you made here?

Good one! (Really!)

 

[Apollyon]

Originally posted by juddson
BTW, what exactly are the purposes of M and M's conferences anyway?

In a recent NEJM or JAMA (I think it was JAMA, but it was just sitting around, and I was reading it absently), this was the topic of a study - it showed that 1. surgery was more forthright about mistakes and 2. surgery made more mistakes (mostly intraoperative). It was something like a factor of 10 between surgical and medical mistakes, but that the surgical mistakes were presented much less adversarially/punitively.

The cynic says that M&M is a way to "get closer to Jesus", since you seem to get tortured in a similar vein.

 

[juddson]

Originally posted by Apollyon
Did you realize the medical joke you made here?

Good one! (Really!)

Not at the time, but I see it now. Hah!!

Judd

 

[RADRULES]

What a long and painful discussion which yields very little useful information.

I have been involved in a medmal case before, and it is horrible experience. The experience taught me some very important lessons.

1. Lawyers could give 2 sh#ts about the patient, they are looking for a payday.

2. They care even less about you, your many years of training and sacrifice, your wife and kids, etc. They have no qualms about destroying your career and future.

3. There is a doctor out there who will say anything under oath for the right amount of money.

4. Many of your patients which you care for have no qualms about turning around and trying to take your moeny. You are nothing but another "rich doctor" to them.

5. Nothing will hurt your case more than your own pride and arrogance.

6. Lawyers are much, much more slimy than you are or ever will be... do not put ANYTHING past them.

7. Medicine is a business, as is the medical malpractice industry. The whole thing is a game, and the sooner you realize this the better off you are. Do your job well, but don't think you are immune from the game. Use your smarts to protect yourself (ie. asset protection, homestead, etc) and outplay the lawyers at their own game.

8. We think we are in some way superior morally and ethically to lawyers, and we probably are. But, to know your enemy sometimes you must stoop to their level.

 

[juddson]

quote

Lawyers could give 2 sh#ts about the patient, they are looking for a payday.

end quote

This is, by and large, the sort of bull**** that passes all too often here for an argument. Lawyers are people just like you are. Even plantiff's attorneys are people. We come in all shapes and sizes, some of us more empathetic than others - just like you. In the aggregate, a plaintiff's attorney cares about the well-being of his client just as much (or as little) as the doctor cares about his patient. You've no more cornered the market on empathy than you have on infallability. Aren't you just a little embarrased by how little very little circumspect you are?

quote

They care even less about you, your many years of training and sacrifice, your wife and kids, etc. They have no qualms about destroying your career and future.

end quote

This is essentially true. In fact, a lawyer is bound by the Code of Professional Responsibilty and the Rules of Professional Conduct (I may have twisted the wording of those codes a bit) to be a "zelous advocate for his client" exclusively. The American "advesarial" system is designed to work when both sides are represented by counsel. It is not the plantiff's attorney's job (nor should it be, nor could it be) to care about the defendant. That's the defendant's counsel's job. The plaintiff's attorney's job is to defend and prosecute the legal rights of his client first, foremost and almost exclusively.

quote

There is a doctor out there who will say anything under oath for the right amount of money

end quote

perish the thought! a filthy doctor? I don't believe it.

quote

Many of your patients which you care for have no qualms about turning around and trying to take your moeny. You are nothing but another "rich doctor" to them.

end quote

This is almost certainly true. The typical patient lies in wait, ready to pounce on unsuspecting rich doctors out of greed and averace. I can't believe I have to be saying this too, but patients are people too, just like you are. They are no more or less greedy than you. They are no more or less empathetic than you. They aren't out to get you. They sue you when they believe that you may have injured them wrongly. It's no more complicated than that. Nobody's out to get you. You may want to see somebody professionally about this.

quote

Lawyers are much, much more slimy than you are or ever will be... do not put ANYTHING past them

yes. We're born filthy. Anyway, see my responses above to this kind of filth.


Quote

We think we are in some way superior morally and ethically to lawyers, and we probably are. But, to know your enemy sometimes you must stoop to their level.

end quote

Lawyers are not your enemy. Seriously, think about the psyc consult.

 

[Goober]

Originally posted by juddson
quote

Lawyers could give 2 sh#ts about the patient, they are looking for a payday.

end quote

This is, by and large, the sort of bull**** that passes all too often here for an argument. Lawyers are people just like you are. Even plantiff's attorneys are people. We come in all shapes and sizes, some of us more empathetic than others - just like you. In the aggregate, a plaintiff's attorney cares about the well-being of his client just as much (or as little) as the doctor cares about his patient. You've no more cornered the market on empathy than you have on infallability. Aren't you just a little embarrased by how little very little circumspect you are?

.

Let me ask you this- how many lawyers would get involved with these lawsuits if they got paid nothing for them? My guess would be very few. How many docs do you thing would still treat patients if they didn't get paid? Not all but I can assure you it the percentage would be many times higher than the lawyer group.

 

[edinOH]

The following comment is naive, I know, but I still think this way sometimes...

The thing about med mal that gets me is that, for the most part, we are sincerely doing our best in an often times unperfect situation. Except for the rare case of outright negligence, it is not the physician who put the pt. in the position that they are in. The physician is acting in good faith to provide the best care possible for the pt with the circumstances provided. It seems to me that pts. and their attorneys rarely take this into consideration.

This is the naive part. I think in the end, some mistakes should be acceptable. It should be understood that while we strive for perfection, it is unattainable. I'm usually a "results oriented" kind of guy, but in the case of medmal, I think "intent" should play a bigger role.

As it stands now, it is a lottery system. I don't think attorneys take cases based on wether a pt was really injured, just if they think they can win. Sometimes this goes hand in hand, but I think just as often it doesn't. If a lawyer needs to shop 99 docs to find the one who will call an event malpractice, he needs to look closely at whether or not he is doing the right thing by bringing a case forward. The search for truth and victory are not necessarily the same thing.

I've had the same thoughts about criminal defense, but that is a different subject.

 

[ADT]

How about we as docs collectively sue the living **** out of every lawyer who brings a frivolous lawsuit against any of our peers...akin to legal malpractice...and don't think we can't find a lawyer to sell out one of his own...

 

[juddson]

Originally posted by Goober
Let me ask you this- how many lawyers would get involved with these lawsuits if they got paid nothing for them? My guess would be very few. How many docs do you thing would still treat patients if they didn't get paid? Not all but I can assure you it the percentage would be many times higher than the lawyer group.

The exact same number of lawyers would do it as doctors would, in the aggregate. In fact, lawyers have the same sorts of professional obligations to do free work (pro bono work) as doctors do (or do doctors have these obligations at all)?

Some lawyers work as public defenders for next to no money at all. Some work at Souther poverty law centers. Some in psychiatric wards. Some in homless shelters. Some work for the ACLU. Some for the NAACP. Some spend 50% of thier time doing nothing but pro bono work. Almost all Gaurdian ad Litems are attorneys. Some doctors work in rural health clinics for next to no money. Some work in Uganda. Some in inner-city free clinics.

Some attorneys work for large law firms and make $500,000 a year, and would sooner flush thier spare change down the toilet than give it to a homeless person. Some plaintiff's attorneys are the same way. So are some doctors. Just as many, I'll guess.

But some are not. Some plaintiff's attorneys take and prosecute medical malpractice cases because they believe a wrong has been committed, and they want to help correct it. They are moms and dads, brothers and sisters, grandparents. They are people. My father, for one, spent six months of his life trying to get a young boy a bowel (was it bowel? I'm not sure it was, but it was some big transplant) transplant because the insurance company wouldn't pay for it and the doctors wouldn't do it for free. He was paid nothing for this. The boy died, eventually despite having the procedure. And my father spends most of his time chasing abulances in every sense of the word as you know it (seriously, he's exactly the kind of attorney you hate). But he's just a person like anybody else.

You need to get over this holier than though attitude. It doesn't serve you well now, and it won't serve you well later (and it does nothing for you in front of jury, BTW).

Judd

 

[juddson]

Originally posted by edinOH
The following comment is naive, I know, but I still think this way sometimes...



This is the naive part. I think in the end, some mistakes should be acceptable. It should be understood that while we strive for perfection, it is unattainable. I'm usually a "results oriented" kind of guy, but in the case of medmal, I think "intent" should play a bigger role.

As it stands now, it is a lottery system. I don't think attorneys take cases based on wether a pt was really injured, just if they think they can win. Sometimes this goes hand in hand, but I think just as often it doesn't. If a lawyer needs to shop 99 docs to find the one who will call an event malpractice, he needs to look closely at whether or not he is doing the right thing by bringing a case forward. The search for truth and victory are not necessarily the same thing.

I've had the same thoughts about criminal defense, but that is a different subject.

I agree with you 100%. Read my posts from above. i favor a system which, essentially, permits and accepts a certain level of imperfection because, as you say, perfection is impossible (so glad to see some of this coming around). I favor a system that only permits a case to procede if there has been a "substantial" deviation from the prevailing standard of care, not just a mere deviation.

This may be unfamiliar to you, but lawyers and law firms (and plantiff law firms) come in all shapes and sizes. There are plenty of small time lawyer who look at these cases as lottery tickets (no doubt about it). But there are plenty more plaintiff firms that won't take cases for which negligence is not clear.

Why? Because remember that a lawyer must front the cost of the litigation out of his own pocket (plaintiffs rarely have any money). It's only if he wins does he see that money back. It would not be uncommon at all to spend $100,000 to bring a full med mal case to court. And quite frankly, most (reputable) attorneys simply won't bring a case they don' think they can win (that is, don't bring cases just for nuisance settlement value). Of course there are lots of unreputable attorneys as well who will. We come in all shapes and sizes.

Judd

 

[juddson]

Originally posted by ADT
How about we as docs collectively sue the living **** out of every lawyer who brings a frivolous lawsuit against any of our peers...akin to legal malpractice...and don't think we can't find a lawyer to sell out one of his own...

Frivolous lawsuits suck. Agreed. Just realize that just because a suit is unsuccessful doesn't mean it is frivolous. Not every losing suit is a spin at the lottery wheel.

Judd

 

[Sessamoid]

Originally posted by juddson
The exact same number of lawyers would do it as doctors would, in the aggregate. In fact, lawyers have the same sorts of professional obligations to do free work (pro bono work) as doctors do (or do doctors have these obligations at all)?

Not all state bars require pro bono work. Pretty much all doctors do a certain amount of free work. I have more than a few family members who aren't required by their respective state bars to work for free. Any doctor who is on a on call board of their hospital (pretty much all of them) is going to end up doing a certain amount of indigent care. As an emergency physician, about 20-25% of the patients I see are "cash pay" (i.e. "no pay"). So that's about about 300-400 hours per year I work without getting paid. But it gets worse than that. Because of slimy sh*ts like Edwards, it actually costs me money to treat these patients since I still have to pay malpractice insurance for these non-paying patients. So don't give me a line about how poor, underappreciated (and underpaid) lawyers have it tough. Let me know when you have to pay someone else for the privilege of working for non-paying clients.

I'm not counting Medicaid patients among those non-payers. Medicaid typically pays only 20% (or less) of your bill. The government prohibits us from going after the other 80%. How would you feel as a lawyer if he government decreed that you were only allowed to charge 20% of your regular fees to a large segment of the population?

 

[avendesora]

Anyone ever hear the adage that 90% of malpractice lawsuits are not the result of malpractice and 90% of malpractice does not result in legal action? (I hope somebody didn't already say this). Obviously there's no data for this, but from my personal experience it could easily be true. Despite what you may think, some patients need the barest of suggestion to sue. Usually the medicaid patient who paid nothing for the service to begin with.

No reasonable physician would argue that docs are perfect or that mistakes don't happen. In fact, they probably happen at a rate similar to those of the general population. The problem is that whereas a businessman (or lawyer) might mistype a slide in a PP presentation, when the slide comes up at a meeting, laughs all around, the end. For a physician, a mistake of the same magnitude (2mm off for a central line, miswriting a script) can result in the end of a career.

The reasonable thing would be a system that could absorb mistakes within the range of normal human nature without catastrophic result. Take the airline industry -- pilots no doubt make mistakes about as often as physicians, yet very few planes crash. The current system, though, where any admission of guilt or self reporting can end a career and cost millions, precludes improvement.

 

[Sessamoid]

Originally posted by avendesora
Despite what you may think, some patients need the barest of suggestion to sue. Usually the medicaid patient who paid nothing for the service to begin with.

I don't have a citation for this, but my attendings in residency said that the patients most likely to sue were not the indigent, but them middle class. The rich don't need the money, and they can afford the best docs anyway. The poor often don't even recognize that they have an avenue of restitution when they are injured.

The reasonable thing would be a system that could absorb mistakes within the range of normal human nature without catastrophic result.

We have such a system in the medical malpractice system. Unfortunately, it's designed poorly, and it's being badly abused by a (relatively) few really bad apples.

If this were slashdot, I'd have given you a "+1, Insightful" mod.