by Jarrod Shapiro, DPM
Joined practice July 2006 of
John K Throckmorton, DPM
Lansing, Michigan |
In part 1 of my rant about what I don't like about medicine, I focused on medical insurance as one of those factors I truly dislike as a physician. In this, part 2 of my series, I'd like to talk about practicing medicine in a litigious society. Most of us have heard the adage "You WILL be sued at some point in your medical career." I'm not sure if this is completely true (there must be a doc out there who made it through years of practice without being sued) but I'm not willing to contradict the odds.
We should all be well aware that medical malpractice tort reform has been on the agenda nationally for many years. Some have argued that tort reform is a necessary first step to decrease the costs of medical care in this country. As I understand it, the argument goes as follows: |
If physicians did not have to worry so much about being sued, we would not have to order so many tests, decreasing the overall cost of medical care. Additionally, physicians would not have to maintain extra staff to process the extra paperwork required and could carry lower insurance premiums.
On the other hand, others have argued that malpractice costs constitute a relatively small percentage of physician practice costs. They argue the majority of medical mishaps do not become lawsuits, and the rate of malpractice insurance premiums have not changed appreciatively over the past years.
Senators Clinton and Obama have published an editorial in the New England Journal of Medicine arguing for improving patient safety as the area of necessary focus.
 Advocates of tort reform have recommended changes such as limiting attorney fees and capping non-economic damages (which already exists in many states).
Depending on what sources you read and what side of the political aisle you lean, you're likely to agree with different sides of the story and different arguments. I'm not sure exactly where the problem truly lies. As a new doc, I don't have much personal experience with this issue (thank the lord) as yet, so I'm no authority.
I'd like to talk about this on a personal level now. Through my almost 2 years in practice, I've become increasingly wary of who I treat and how. I've even found myself wondering, "Is this patient likely to sue me if something goes wrong?" As time progresses, I'm practicing increasingly defensive medicine. I use this term "defensive medicine" specifically because this is a different way to practice than if we lived in an environment where doctors weren't sued. For example, my charting has become more and more comprehensive. I'll document more negative findings than necessary and be clearer on what I think the diagnosis isn't. You may argue this is better medical charting and care. Perhaps.
Here's an example:
We all very commonly see patients with plantar fasciitis who require surgery, in spite of many attempts at conservative care. In the past, I have found myself ordering extraneous tests to rule out other disease entities. For example, I've ordered bone scans to rule out stress fractures and EMGs to rule out radiculopathies and tarsal tunnel syndrome to protect myself medicolegally. In some instances, these tests may be required based on the individual situation. However, sometimes it looks like plantar fasciitis and it acts like plantar fasciitis and I know it's plantar fasciitis. It's a clear-cut case that is simply recalcitrant to non surgical care, and it needs surgery. In these cases, I don't want to order extra tests simply to cover my legal butt, but I feel the pressure. This is a completely wasteful situation.
The reality is we live in a litigious climate. Whether tort reform is accomplished or not, doctors get sued, and we want to avoid this situation as much as possible. So, here are some suggestions to help avoid and/or prepare for what seems to be the inevitable.
- Be kind and polite to your patients. A patient who likes you is less likely to sue.
- Listen to your patients. The best way to alienate someone is to ignore them.
- Treat your patients to the best of your ability. You have the best foot and ankle training in the world. Use it.
- Document as well as possible. You don't have to write a novel but be as reasonably complete as you can.
- Learn to read your patients. Unless it's emergent, don't schedule surgery on a patient the first time you meet them. Get to know them. Ask questions. Look for red light signs like patients who've seen 3 docs before you for the same problem.
- Provide some conservative care before surgery. It's easier to defend.
- If possible, use electronic medical records. They create a more complete chart.
- Use religiously the algorithm for obtaining a history and physical that you've learned in school and residency. You're less likely to leave out important details in your charting.
As for this new doc, I practice defensive medicine, but I'm taking a stand. I refuse to let fear of lawsuits dictate the way I practice. I will order what tests I feel are appropriate and treat my patients with top quality medical care. If I get sued, so be it.
Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]
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