Skip to main content

View Diary: Medical Error, Liability, and Murtha (322 comments)

Comment Preferences

  •  Rep. Murtha's tragic death (7+ / 0-)

    should have been a rallying cry for Dems just like Sen. Kennedy's.  But they choose to ignore the problem and try to come up with the right words to say on the 6 o'clock news instead before going out for Martinis.

    Shame on them.

    Republicans===the party of the 1% rich people in America. Or in other words..The Party of NO!

    by jalapeno on Wed Feb 10, 2010 at 07:54:40 AM PST

    •  Democrats don't do rallying cries (7+ / 0-)

      it isn't in their DNA

      I am not against all health care reform, I am just against dumb health care reform!

      by justmy2 on Wed Feb 10, 2010 at 07:55:10 AM PST

      [ Parent ]

    •  Death or disability from a medical complication (12+ / 0-)

      is not a priori evidence of malpractice.  To conflate a tragic outcome with bad medicine is a common but illogical fallacy.  To link Murtha's death with tort reform is downright irresponsible.

      We do not have any evidence whatsoever that Murtha's post-surgical complications were the result of "mistakes".  They may have been- but there has been no informed suggestion that they were.  We live in a wacky society where physicians are required to be both infallible and omnipotent.  No matter what is wrong with you, and no matter what you did to contribute to the problems, physicians are expected to be able to correct the problem.  With or without tort reform, our society needs to develop more realistic expectations. cutting holes in peopls bodies runs a risk of infection, even in careful competent hands.  An infected gall bladder may seed the bloodstream regardless of surgical technique.  Did it in this case- neither the diarist, the responders or I know.

      That said, proper tort reform would result in a fairer system of compensation for people who are actually harmed by malpractice.  The current system is a lottery where there is a very poor correlation between actual malpractice and setlement amount- rather there is a good correlation between the severity of the outcome (regardless of whether malpractice occurred) and settlement.  People who were harmed by malpractice may get no compensation and people who had bad outcomes while good medicine was practiced- because medicine cannot cure everything, may win the lottery.  It depends far more on the lawyering than on the medicine.  The current system also only allows big cases because the cost of an adversarial system with paid "experts" on both sides is prohibitive.

      We need a system of separate malpractice courts, with a panel of knowledgable judges and experts paid by the state rather than each side to allow greater access to the courts and fairer compensation(for both physicians and patients).  the current system is great for the insurance companies and the lawyers- but not for patients ro physicians.

      •  Death due to nicking intestine (4+ / 0-)
        Recommended by:
        elfling, stitchmd, lp3161, Abra Crabcakeya

        The procedure was "routine minimally invasive surgery," but doctors "hit his intestines," a source close to the late congressman told CNN.

        So it was an error, although more evaluation is needed to determine if it was malpractice (which I doubt).

        •  Thanks for the update. (2+ / 0-)
          Recommended by:
          stitchmd, erush1345

          As you state, a complication.  Still completely undetermined whether or not malpractice occurred.

          •  If you nick an intestine during surgery (2+ / 0-)
            Recommended by:
            samddobermann, Abra Crabcakeya

            and you do not catch it and sew it up, you didn't do your job. Incompetence, carelessness, whatever you want to call it, there is no excuse for such sloppy surgical practices.

            •  A surgeon's job (12+ / 0-)

              Injury to bowel is a known complication of a lap chole.  General Surgeon's train a minimum of 5 years after med school.  This surgeon may have done an additional year of laproscopic fellowship.  So in short to practice you need to be reasonably well trained.

              "Sloppy surgical practice" are the mistakes that are easy to find.  It everything else that takes years to find and learn.  The surgeon may have seen the injury and his/her primary repair may have broken down.  It is quite hard to be definitive in your assessment with minimal information about the case.  I would argue that it is simply ignorant.

              Before I started my intern year my father also a doc told me "You will make mistakes.  Those mistakes will contribute to death of some of your patients.  That is the worse part of medicine.  It is your job to learn from them and to get better all the time"  

              I entered medicine because I care about patients.  I am a pretty normal guy other than being born with strong nerd tendnancies.  I am not all knowing.  All procedures have risk.  Complications do not mean I'm lazy, malicious, kill puppies, see all patients as dollar signs.  It just means I practice medicine.  I will continue to practice with all its ups and downs until I retire.  Some people I will help tremendously with my interventions.  Others I will make worse.  I will always strive to be better.

              •  bravo. Great comment. (1+ / 0-)
                Recommended by:

                thank you.

                Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                by stitchmd on Wed Feb 10, 2010 at 03:27:23 PM PST

                [ Parent ]

              •  Why not check? (1+ / 0-)
                Recommended by:

                If nicks are a known risk, why don't surgeons check to make sure that they did not nick and keep the patient in the hospital until septicemia is no longer a risk?

                •  they do check (5+ / 0-)
                  Recommended by:
                  Grannus, eyesoars, lp3161, BYw, pvlb

                  it's part of the surgical procedure, called "running the bowel." But small lesions can be missed. And given the rarity of this complication, keeping every patient in the hospital is not feasible. Indeed, if you did, you would run the risk that the patients would develop a hospital acquired infection. Furthermore, the benefit of the lap chole is that the patient does not need to stay in the hospital for a prolonged stay and the healing, when everything is going well, is much shorter than an open procedure.

                  Look, we cannot eliminate every complication. Period. Can't be done. We can reduce them as much as possible, but not to zero. It's a fallacy to think we can.

                  Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                  by stitchmd on Wed Feb 10, 2010 at 04:44:39 PM PST

                  [ Parent ]

            •  wrong (4+ / 0-)
              Recommended by:
              samddobermann, lp3161, BPARTR, Gravis

              especially in a laparoscopic case, small nicks can be very, very difficult to establish. You are dependent on a camera, which may miss small lesions. A sense of touch can improve the dectection but even then, small lesions can be hard to catch. Nevertheless, they can have deadly consequences, one of the potential risks of the surgery.

              If you've even been in a laparoscopic surgical procedure you'd understand how tricky they can be.

              We think this is a "simple" procedure because the healing is a lot better than it used to be. But it's far from simple, and actually lap chole's are technically far, far more difficult.

              Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

              by stitchmd on Wed Feb 10, 2010 at 03:26:41 PM PST

              [ Parent ]

              •  Stitch is right (2+ / 0-)
                Recommended by:
                stitchmd, Gravis

                MOst bowel injuries during laparoscopic surgery are not "nicks", rather they are burns from the hot instruments touching bowel- often out of view of the camera.  Imagine looking through a tiny telescope- as when we look at a star, the whole heavens could be exploding around us and we would only see the star upon which we are focused.
                Surgeons are taught to be very careful- but that doesn't mean that  burns cannot occur- or that the instruments cannot be faulty (allowing leakage current along their length, and not just at the tip where the surgeon can see.)

                Most of these comments result from the doctor/god complex- not that doctors think they are gods, but that patients think that they are.  Doctors are expected to be omnipotent and omniscient.  lay people presume that any bad outcome is ipso facto evidence of malpractice. Res ipsa loquitor.

                •  If that is the case (0+ / 0-)

                  Insurers are already saving money from laparoscopic surgery and patients are normally safer than they would be with open surgery, so why aren't patients held long enough in the hospitals to make certain that sepsis or other dangers from this known risk have not occurred?

                  •  see my other comment (2+ / 0-)
                    Recommended by:
                    BPARTR, Gravis

                    keeping people in the hospital has its own risks, and the potential for this complication is so low that it does not make sense to do so.

                    Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                    by stitchmd on Wed Feb 10, 2010 at 04:47:43 PM PST

                    [ Parent ]

                    •  In addition, (1+ / 0-)
                      Recommended by:

                      I am not sure that insurers save money with laparoscopic surgery- many laparoscopic surgeries are much more expensive than open procedures, but the recovery time is less and the morbidity is,  on average, less.  Depending upon how you account and charge for hospital bed nights, the overall costs may be higher or lower.

      •  We need to get rid of the few bad doctors (0+ / 0-)

        We are in a time where it is risky NOT to change. Barack Obama 7-30-08

        by samddobermann on Thu Feb 11, 2010 at 04:35:01 AM PST

        [ Parent ]

        •  I am sorry that you seem to have (0+ / 0-)

          such an angry response to physicians.  You have made multiple comments in this thread, and all are angry.  I don't know what experience(s) you had which so colored your opinion of us, but I am sorry for that.

          Are we different from the vast majority of other men and women? Perhaps, but only in that there is perhaps a stronger desire to help our fellow man.  Physicians for the most part are deeply caring individuals.  We sacrifice our family lives and our free time to care for patients because we care for patients.  Are we human? yes.  Do we make mistakes? yes. Do some of us have obnoxious personalities? yes. Are some of us motivated by things other than altruism and care for our fellow man? yes.  

          Are some doctors better diagnosticians, better surgeons, better crisis managers than others? of course. Are there bad doctors? of course.  Do doctors want to weed out bad doctors? of course.  the problem is defining a bad doctor.  It is much harder than you seem to think.  Fo example, in Forida, OBs  ( all OBs) get sued on average every 3- 4 years.  So a doc in practice for 20 years has 4-5 suits against him.  In Kansas, the number is much lower.  Are the docs in Kansas better docs?  Should anyone with 5 suits against him be barred from practice?  Good doctors and bad doctors get sued.  the risk of suits is highly correlated with specialty and practice location. Would you take away a person's life work because he chose a high risk specialty?  It is actually very hard to measure quality and safety.  Low risk events require enormous sample size to reach statistical significance.  Should we keep trying to measure quality? of course.

          That said- take control of your medical care, and choose doctors you personally trust.  Without mutual trust, care is not possible.  But recognize that doctors may also remove you from their practice as well. And doctors are human.

          •  The lowest estimate of deaths in hospitals (US) (0+ / 0-)

            from medical errors is 98,000 per year made in 1998. The latest based onNot all are due to doctors, of course; some are nursing some more generalized hospital system failures.

            There is a lot of literature showing that only a few doctors are the cause of the vast majority of malpractice cases. The first study I recall was of Calif ob/gyns. 93% of all malpractice cases were caused by 7% of the doctors.

            Cases hit the newspapers when the doctor is finally kicked out after 9 or 12 cases of proven malpractice.

            If doctors had more sympathy for patients than for other doctors, which injure all of their reputations, and took action to get rid of these we would all be better off.

            I think — no, know that most doctors are good but they tolerate and cover for the ones that are not.

            And as Atul Gawande has pointed out, there are so many different things to know, and check and do, that systems have to improve to cut down on the god awful number of mistakes. He started using a checklist in his surgeries thinking that of course, HE wouldn't need it, but he ought to use one because he was pushing check lists. He was shocked to find that at least once a week the use of the lists caught something that had been forgotten that could have damaged a patient.

            I want the improvements. I want changes to the handling of errors, and work toward their elimination. One of the barriers is doctor's defensiveness. Some of it is a crock.  I would welcome talking about real problems but I find statements like

            Do doctors want to weed out bad doctors? of course.  the problem is defining a bad doctor.

            It really isn't that hard. It isn't just claims filed. The trivial should be easy to bat down. Part of the problem is the med-mal insurers like to fight each claim like it's a war.

            I've had doctors scream in my face how awful the situation is; that people get big judgments when a child is born with Downs' Syndrome. Now that doesn't make sense; the evidence is overwhelming and easy to provide that the only cause is chromosomal at conception. So I searched for cases where a child was born with Downs'. i found two; one where a doctor talked a couple out of getting any test even though the said they were very concerned. He flat out lied and said it wouldn't be possible. In the other, the couple also expressed concern and the ultra sound showed that the child would have downs' and the doctor lied and said it was fine.

            In both cases the doctor refused to allow the test or tell the couple what he found because they didn't believe in abortion and would not allow anything to help it along.  So the parents worst fears came true. And they were horrified. And they had a burden they had been determined to avoid.

            I came across another interesting case. A couple who had IVF with a donor carefully matched by age, hair, eye color, intelligence and other factors was shocked when their baby was born — the wrong color.  The doctor had substituted his own sperm for their sample!

            I would love to talk with some of those doctors and learn more about the claims. There is something wrong going on. It maybe crooks going in and even faking being a lawyer (or a totally rogue lawyer) and demanding a payment to go away. If so, these cases should be turned over to the ethics board of the State Bar to investigate. If it is fraud whether by a lawyer or not, it should be prosecuted. Immediately.

            Incidentally lawyers have malpractice insurance because claims against them can be as worry some and as expensive as those against doctors. i just came across a couple of judgments against lawyers for badly screwing up on malpractice cases against medical personnel.  Frankly there should be more. Those lawyers that fell asleep during criminal cases where upper courts have accepted that that was good enough representation, should have been sued for malpractice. A few good wins against the SOBs might keep the other lawyers awake.

            I have to say, I am not doing well in the choice of doctors. I seem to get the ones that are coasting, burnt out or just weird.

            I do have one great one and I am so grateful. I just wish I could find a primary care doc just like him.

            We are in a time where it is risky NOT to change. Barack Obama 7-30-08

            by samddobermann on Sat Feb 13, 2010 at 04:42:23 AM PST

            [ Parent ]

Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site