The Way I See It: Medicine is a blame game

April 20, 2007

Treating patients is a lot harder for this physician-and much less fun-in a climate of fingerpointing.

My upbringing, my training, and my prior career in naval aviation ingrained in me the duty to accept responsibility for my mistakes. I learned to make amends where necessary and correct my actions to avoid future problems.

Having been involved in two malpractice cases-one that resulted in a judgment against me and a second that was dismissed-I've learned something about efforts to assign blame. Despite the ruling of negligence against me, the hospital peer review (excluded from evidence at trial) found "excellent care, well-documented." The jury apparently disagreed.

Every day I work as a doctor, I must choose between committing malpractice and committing insurance fraud. If I order enough tests to show even a reasonable defense, I will be far exceeding the acceptable approach to diagnosing a common medical problem. My jury apparently believed that a CT of the abdomen is the appropriate test to order to "completely" diagnose a UTI or investigate diarrhea. My second suit taught me that if I order extensive radiological studies, I will still be sued.

Assigning blame, on the other hand, is like throwing a grenade. The goal is to destroy as much as possible. Anyone can blame-with no requirement to give reasonable, consistent guidance to the person being blamed. Expert witnesses widely differ in support or criticism of specific actions. Malpractice juries generally exclude physicians to avoid bias. Plaintiffs' attorneys globally launch attacks at your lack of motivation, intelligence, diligence, and compassion. The final judgment is merely "negligence." No specifics are available regarding the way in which the jury feels you erred. As a result, actions that aren't reasonably and clearly evaluated can't be corrected.

When I think about practicing medicine now, I feel hollow. I don't even know exactly what I lost. It's not as simple as "confidence." I once believed very deeply in a society I would have died for. Nearly three dozen of my military associates-young vibrant people-gave their lives to preserve this free society. That society is someone else's joke. The memory of my deceased friends doesn't allow me to join in the merriment of laughing at the legal system. Without laughter, it's tragic.

Three years after my trial for malpractice, I've not severed my ties to medicine. I work a few shifts a month in urgent care. I completed my board recertification in 2005-although it now feels like a pointless hoop that means very little to the public. I still don't want to burn my bridges, though. At the same time, I don't have any idea what could possibly change to reignite my enthusiasm for medicine.

I'm hoping that someday I'll remember enjoying medicine. I enjoy caring for patients. I revel in comforting a scared child. I relish notes of thanks I have received from the parents of my smaller patients. But it's hard to enjoy fear.

My situation reminds me of a science fiction story I read years ago. The Big Brother computer had taken over the world and was destroying people for amusement. The story was told by the last person on earth. The computer didn't kill him, because then it would have no more playthings. It had tortured and mutilated him until he no longer had features or limbs. The story closes with the line, "I have no mouth. And I must scream."