Marianne Dekker Mattera

Doctors who've been sued for malpractice know a special kind of pain. Recently, a Louisiana internist told us about the anguish he felt for six long years while a case against him wound a long and tedious course through to settlement. He used phrases like "sick feeling," "anxiety and dread," "drained and bitter."  

He described the course of treatment and the unexplainable events that brought a woman into the ER with chest pain and saw her discharged minus most of one hand. He talked about normal blood enzymes, upper GI series, and gall bladder scan. He talked about a cardiac cath, angioplasty, a tear, bypass surgery. He talked of psychosis, a neuro consult, CAT scan of the brain, repeat EKGs and other lab studies, all to evaluate the patient's continued complaints-of chest pain, headache, abdominal pain, insomnia, nervousness, back pain, and, at the end, of the pain in her hand that progressed rapidly from a by-the-way reference to pain in hand to complete absence of blood flow despite good pulses at the wrist. At least six other physicians were involved in the patient's care; initially, only the internist was named in the suit. 

It took this doctor 14 single-spaced, typed pages to tell us his story, and it convinced me that there was no malpractice, despite the bad result for the patient. And yet he settled. On advice of counsel, because it was a good deal-"only $150,000 for a lost limb; it could be millions in front of a jury."  That scenario is all too familiar to physicians these days.  

With that restriction, I'd be done now.   

Can a physician truly describe a complex clinical situation in 2,000 characters, so that anyone who sees his name in the NPDB will understand that he settled only because it was the lesser of two evils, not because he did anything wrong?  

I don't know. I do know that it will take all the editing prowess you possess. My suggestion: Do what I do. Write what you want to say, then edit it down. Chop out words you don't absolutely need. Use short words. Abbreviate clinical terms whenever possible without risking clarity. And leave emotion out of your account. You will feel it; you must feel it, or why would you have become a doctor in the first place. But you can't afford to let it take 14 pages-or even one-when you've only got 2,000 characters.  

Articles

From the Editor

This summer a medical pioneer died. Elisabeth Kübler-Ross changed the way physicians, nurses, mental health professionals, and, indeed, the world looks at the process of death.  			

shed light on a subject with which few in the medical profession were comfortable. With the 20th century institutionalization of death, doctors had become almost afraid to acknowledge the inevitability of death; they were uncomfortable with dying patients and too often devoted themselves only to their dying patients' physical needs, ignoring completely their psychological and emotional needs. Some of this is understandable-facing death, acknowledging that it is near, is not easy from the vantage point of youth and good health. Sadly, some health professionals are still uncomfortable around the dying, and maybe that, too, is understandable.  

Kübler-Ross brought the subject into the open. She faced the needs of those who were dying, interviewing them extensively, with students in tow. Those interviews helped her recognize and define the five stages of grief that those who are dying go through. The stages that today are familiar to anyone who's had even the briefest brush with psychology. The stages that today are applied to all kinds of death, from the loss of a limb to the end of a relationship. 

Kübler-Ross should be resting in peace. God knows she paved the way for millions of others to more peacefully meet their ends. And God bless all the physicians who have read and heeded her message over the years, who have taken what she termed the "challenging opportunity to refocus on the patient as a human being, to include him in dialogues, to learn from him the strengths and weaknesses of our . . . management of the patient, . . . as we can help them much during their final hours."  			

Author | Marianne Dekker Mattera

Articles

From the Editor

Memo from the Editor