Editor’s Note: The subject of medical malpractice and the effect on those involved must be acknowledged and addressed in all aspects of orthopaedic surgery training and practice. This account provides a vivid description of a case, and the wisdom gleaned from it.
“You have been served” were the words uttered by a man in a three-piece suit as he handed me an envelope. There I was, in the waiting room of a busy clinic, stunned, with my staff and patients looking on.
I sought refuge in my office while feeling flushed, weak, and with my heart racing. I opened the envelope and found it hard to make out the words on the notice of legal action against me. The word “negligence” was seared into my memory. This was my first adverse medicolegal experience. I immediately tried to remember where I kept the number for the malpractice insurance company. This was before cell phone directories. I also sought the immediate advice of a senior partner in my practice who was extremely kind and helpful. Don’t react, don’t discuss the case and secure the chart (which was paper in those days).
Somewhere along the course of this saga, I remember being told that it would take 5-7 years for the case to go to trial because the legal system moves at a glacial pace. If settled or dropped, the case would move more quickly. There would be depositions to participate in. I was told not to speak about the details of the case with anyone. I was marooned on an island of self-doubt and was prohibited from speaking about it.
So, you may wonder about the case in question. The patient was a 29-year-old man who required knee arthroscopy which I performed without incident. He had no pre-op red flags. 10 days post-op he had a heart attack. When he presented to an emergency department, the diagnosis was made. He was hospitalized and successfully treated. He had no venous thrombosis or pulmonary embolus, but he did have cocaine in his blood stream. At one of my depositions, HIS attorney called the case “half-baked” because in all likelihood, the cocaine ingestion precipitated his heart attack.
Half-baked or not, I had my practice disrupted by having to fly across the country for depositions, my income adversely affected by the expenses associated with the same and having to live with feelings of guilt whether it was justified or not. During this time, I began to wonder if men experience the same reactions as women do under similar circumstances?
I survived this experience with the help of a very supportive family. Although, I could not discuss details with them, they were there to reassure me that I was a good person, a good doctor and was loved. Also, the people I treated helped me endure. The day after I was served, I had three office patients tell me how grateful they were for my care and that I had made a very positive difference in their lives.
The malpractice case was dropped after 2.5 years but I was forever changed. By this I mean that I am now more cautious in my interactions with patients. I am careful to be very descriptive verbally, to answer questions fully, to get to know my patients a bit better and am compulsive about my documentation of all that was discussed with them. I overcompensate and now spend more time with patients which reduces my “production,” thus, making me less of a financial asset to my practice.
On a related note, at a deposition, the involved patient’s attorney told me that the patient “wanted to see me back because he likes me.” My attorney burst out with “Are you kidding?” This disputes the commonly held notion that patients don’t sue physicians they like. It also suggests that patients may not understand the psychological impact on a physician who is being sued, especially in a frivolous case. The effect on the doctor/surgeon is termed “moral injury.”
So what has all this taught me and what do I teach my students about the reality of providing medical care?
- Define yourself beyond medicine. It is not the sum total of who you are.
- Be mindful but be cautious when dealing with patients.
- Take time to make personal connections with patients.
- Document carefully.
- Do your best.
- Understand that you will make mistakes.
- Most patients are grateful.
- Current statistics suggest that you will likely be sued multiple times during your career. Be ready for it and have a network of support available.
- Seek professional help if you are a defendant in a malpractice case. Some malpractice insurance companies now offer useful resources.
A final anecdote to offer an alternative scenario:
While I was doing an in-patient revision knee arthroplasty, the patient sustained a popliteal artery injury. This is a known complication associated with complex revision cases. I identified the problem at the time of occurrence and managed it appropriately with the help of a vascular surgeon. I was very attentive and explained the situation fully and repeatedly to the patient and her family. She did not sue although she was advised by others that she should do so. She told me that her response was, “What would I gain from that?” I am happy to say she is 20 years out from her revision surgery and is doing “great.”