A Thoughtful Man

I recently read a commentary by Dr. Manoj Jain in the Washington Post about the impact of malpractice on the way we practice.  Dr. Jain has become a physician leader in the arena of quality improvement and he writes honestly about the spiritual jolt every physician feels when they receive news of a malpractice lawsuit or even a potential lawsuit.

"I stood, stunned. My white coat, which held the daily tools of my profession -- my list of patients, the Sanford antibiotic manual, a black stethoscope -- felt extraordinarily heavy."

He relates the statistics all physicians know so well-that most suits (>80%) involve NO malpractice and also that injury that results from medical negligence (98%) never result in a malpractice case.  Before concluding he reminds us about the cost of this errant system.

"A lawsuit threatens my livelihood. It alters my judgment; it's like the difference between the "right thing to do" and the "politically right thing to do." Surveys of physicians conducted by the Massachusetts Medical Society found that 80 percent practice "defensive medicine," ordering extra tests that some say add billions annually to our health-care expenditure."

I wish more conversations about liability reform could maintain this civil, thoughtful analysis rather than the usual hyperbolic rhetoric.

Dr. Manoj Jain

7 Post Challenge

If I have a blogger hero it has to be Suture for a Living-she single handedly inspired me to pursue my own blog, to understand how to make it work for me, and her blogs are always interesting, informative, well written and linked to others who help make the medial blogosphere worth being a part of.  As usual, she led me to the 7 Post Challenge which I just couldn't resist.

Polish Kebab Anyone???

1. My first post now seems like such a novice effort.
2. The post I enjoyed writing the most allowed me to combine man aspects of storytelling that I most like and tries to demonstrate how I as a woman/person/mother/neurosurgeon deals with the variety of patients I encounter every day.
3. A post which had great discussion...well I have to say I haven't been the most popular but writing about medical malpractice seems to generate the most notice.
4. You can always visit TBTAM for a wonderful mix of food, travel, musings or Toni Brayer, MD for insightful medical thinking.
5. Obviously none of my blogs have been life-changing-but that isn't why I am blogging so I would offer up Exercising Your Brain and Rage Against Golf as ones I think would be helpful if more people read them.
6. Titles? Perhaps I should spend more time thinking about them, I am usually most concerned with getting my thoughts down but I did have fun writing Pop, pop, fizz, fizz when Congress was failing miserably in addressing the Medicare cuts.
7. I wish more had read my blog about JAMA review of Heart of a Lion, Hands of a Woman: What Women Neurosurgeons Do because I am so proud of this book and wish the blog would encourage more people to buy it and discover the amazing talent of this group of women neurosurgeons.

Twice in a Day: We are our own worst enemy

The medical liability system is broken-every one who works in it or who is touched by it knows this but changing the system is harder than allowing inertia to just keep on keeping on.  The subject (my ruminations and potential solutions) is far too large to tackle head on but I would like to offer two cautionary tales, let me call them "The Enemy Within".
Chapter 1: The Enemy Strikes
I have always reviewed cases and offered to testify on both sides because otherwise, I am little more than a hired gun.  So, last week, I had a scheduled discussion with a lawyer who requested my expert review on behalf of the plaintiff.  Briefly, the case involved a veteran underwent a CT scan at the onset of a number of emotional issues.  The scan revealed a benign lesion of the cerebellum which was unrelated and further work-up was not pursued.  Years later (and after significant escalation of the psychiatric problems), new neurological symptoms developed and it was found the lesion had grown and surgery was necessary.  Surgery and recovery were uneventful but still the man opted to pursue a malpractice case against the physicians who first found evidence of the benign tumor.  I was baffled so I had to ask the lawyer what prompted the suit.  "That's easy," he said, "the neurosurgeon showed the patient the initial scans and then said something like, 'I can't believe they didn't see this back then.' That's what got him angry and after that, there was no turning back."
Chapter 2: The Thoughtless Enemy
Later on that same day, I received a communication from a former patient.  She has moved away but as we always had a good relationship (her words) she reached out when she developed some neck pain many years after the surgery I performed.  While she thought it was muscular, because of her history, she decided to see a local spine surgeon (which I had encouraged).  He told her I had completely messed up the surgery, had placed the screws in the wrong place and that is why she was having so many problems-urgent surgery was the only option.  Needless to say, my patient was angry and confused-the final outcome of this tale has not yet been told.

Epilogue: Think First, then Talk
Many studies have shown the key role physicians play in instigating malpractice suits.  Most are a result of a careless comment but some are related to greed, envy, competition and haughtiness.  Wake up doctors! Keep in mind that hindsight is always 20-20.  We constantly ask for congress and state legislators to help us out.  Let's start by helping ourselves.