Posts Tagged ‘darrell white m.d.’
Attitude (Adopted from Sunday musings 11/4/12)
It’s funny how stressful situations remind one of the truisms of life. We are now Day 7 without power in the White house, our own “Little House on the Prairie” complete with fireplace and communal bed (shared by 3 dogs). The tiny generator we were able to score powers the fridge and the sump pump (we had 6 flooded basement episodes in 2011) but not the furnace. The temp just went UP to 52 in the house.
And yet, it’s OK. We have food and we can cook. We have wood and offers of more if we need it. Randy has become a wizard at building and stoking a fire. Me? Grunt work like foraging for wood and fuel, and starting an epically awful beard. The extent of my pique, such as it is, is refusing to wear a tie to work until the power is back on.
We’re OK largely because we have CHOSEN to be OK. It’s a bummer, and it’s a nuisance, but it’s the hand we’ve been dealt, one that is not nearly as bad as others in Sandy’s aftermath. Our attitude is in stark contrast with others on display. One neighbor, a city councilwoman no less, de-camped to a hotel after bitterly complaining about the noise of the generators, our “little engine that could” especially. “We just couldn’t take it anymore.” Really?
My staff and most of our patients handled stuff with an equally sanguine attitude, re-scheduling when necessary, coming in early or staying late, whatever. The few folks who copped a bad attitude stuck out so painfully it was comical. The gal who hung up on me when I told her I couldn’t examine her pinkeye without power (M’am, all I have is a flashlight and a toothpick). The patient coming for a surgical consult, appointment confirmed by automatic email Monday night by a computer that was as dark and dead as the rest of the office when she arrived on Tuesday, who screamed at us for 10 minutes on the phone on Wednesday. Really?
Our circumstances often arrive unchosen and uncontrollable, and most often we are left with no choice but to react to them as well as we possibly can. While the circumstances are beyond our control we certainly can control our attitude, our outlook. We are in control of how we will approach the task at hand. We are in control of how we will approach the person at hand.
Frankly, I don’t know if a positive attitude makes the tasks any easier, or makes it more palatable to get through something tough like this Sandy thing What I DO know is that it is always easier if I come across someone in similar straits, or someone I’ll need for help, if they are at least trying to “put a good face on.” I think this goes for everyday life, too, and making this your baseline choice (a good attitude) might make it easier to keep your chin up when the chips are down.
Attitude is a choice. Your attitude says more about you than it does about your circumstances.
Half Right On A Malpractice Case
They got it half right. The jury that is. The jury in the malpractice case in which I just served as an expert witness got it exactly half right. Kind of like our whole medical malpractice court system if you think about it. A young woman had a bad outcome in one of her eyes following eye surgery, an outcome that has caused her quite a lot of unhappiness, quite a lot of difficulty. The jury was quite correct in recognizing this, and also quite correct in recognizing that this woman was going to need some financial help in order to make this difficult situation even a little bit better. In order to make this happen the jury found the doctor who performed the surgery guilty of medical malpractice.
Only one problem with that, though: no true malpractice actually occurred.
Herein lies the essential, fundamental problem with our medical malpractice tort system as it is presently constituted. Every single malpractice case is a “zero–some game” in which the only way that an individual who has been injured or otherwise suffered a bad outcome from some medical experience can receive financial help is for some doctor (or hospital) to lose a malpractice case. As an aside, the plaintiff’s attorneys, the lawyers who represent the victims of medical misadventure, must win the case in order to be paid. (The full–disclosure necessary here is that the only people who are guaranteed to be paid are the defense attorneys and the expert witnesses on both sides of the case.)
I’ve actually been up at night, literally losing sleep every night since the conclusion of this trial. That’s actually kind of odd, and doesn’t really make any sense at all because I received rave reviews for not only my testimony but also for the strategy suggestions I made over the four years it took to bring this case to its conclusion. Indeed, even the court reporter went out of her way to tell the defense team what a great job I had done. It’s kind of like getting all kinds of pats on the back for making 10 receptions for 200 yards in a football game your team goes on to lose–pretty empty feeling despite the fact that you did your part well.
What then, exactly, is medical malpractice? In the civil court system in the United States medical malpractice requires that two things have occurred. First, a doctor (or hospital) must commit an act of COMMISSION (do something) or an act of OMISSION (fail to do something) that falls below the Standard Of Care. This failure to meet the Standard Of Care must then result in some kind of harm to an individual. To be extremely technical and to–the–letter correct, the failure to meet the Standard Of Care is malpractice, and the resulting harm is malpractice liability. No need to get all tied up in that kind of detail; let’s just call the whole thing medical malpractice.
The Standard Of Care is a difficult concept. In effect, the Standard Of Care is defined as that care or medical decision-making that a preponderance of (most) similar practitioners would provide in similar circumstances at that time. Pretty nebulous, huh? Not a terribly rigid, hard, easy to put your hands around definition, and it’s a moving target on top of that. The Standard Of Care is an ever–evolving thing; new research findings, new technology, and new patterns of care will all combine to create a Standard Of Care that may be different today than it was even last year.
In this particular case there was never any question that it was a medical procedure that caused this patient to have such a bad outcome. There was never really even any question about the technical quality of the work performed by the doctor. No, what it all came down to was a question of whether or not the surgery should have been performed in the first place, and thus came into play that subtle little part of the Standard Of Care, the difficulty in describing to a jury of non-–physicians the difference between the Standard Of Care today and that of some years ago. The lawyers for the patient did a brilliant job of burying the jury with the details of HOW the complication arose, the difficulties that have arisen because of the complications, and the uncomfortable interactions that occurred between doctor and patient in the months following the surgery. They confused the jury about the difference between “could have done” (more than the Standard Of Care) and “should have done” (Standard Of Care). The lawyers were able to bury the fact that the Standard Of Care was followed by the doctor in question because at the time of surgery the PREPONDERANCE of similar physicians in similar circumstances at that time would have done the SAME THING.
The jury got it half right.
There, in a nutshell, is everything that’s wrong with our present medical malpractice tort system. In order for this woman, obviously harmed by this procedure, to receive some award so that she can do certain things that will make her life easier, she and her team had to “beat” a doctor and win in court. And oh yeah, she’ll also have to give 40% of whatever her award might have been to her lawyers. I think that’s a big part of why I’ve been having trouble sleeping. Not the lawyer payment thing, but the fact that a doctor who (in my opinion) practiced within the standard of care must now have a black mark against his name so that a patient can get some money that I frankly think she deserves.
Maybe a better analogy of my role in this “competition” would be something more like this: I was the consulting coach brought in to suggest an additional element to a figure skater’s program. Assuming that everyone in the competition was as conversant with the subtleties of the rules involved I suggested that the skater add an elegant, understated movement that would be obvious to any experts on the panel of judges, the jury as it were. Unfortunately, in our American system of medical malpractice, that’s not the case, and the opponents eschewed subtle elegance in favor of multiple quad jumps. The skater I assisted performed totally within the letter of the rules, but was penalized because the jury, the panel of judges, was not really an expert panel and missed the added element. And so he lost.
I DO wonder though what my reaction would have been if the opposing skater who landed all those quads had been the one who lost. Would I be up at night over that, too?