Pondering The Unthinkable — The Doctor Is Human

Interesting synchroniticy.  I was reviewing this posting originally done several years ago and about to update for Facebook.  Saw an article in today’s NYTimes regarding high rates of physician suicide.  This piece touches on some of the same issues.

I’m going to raise an issue that makes everyone involved uncomfortable. By everyone I mean the general public as well as the medical profession. The only group of individuals who will pleased are, of course, the trial lawyers.  The issues is simply this–doctors are human beings.

As most of you readers are human beings I don’t need to remind you of the truth–we all make mistakes.  It pains me (really) to have to write about this truth. The fantasy exists that physicians are above all of that.  The fantasy exists that we are trained to be perfect and that when we make a mistake, fail to order the right test, have a complication of a procedure, fail to provide all the time and compassion that you think you deserve, we deserve to be punished and you deserve monetary compensation.

Of course our sincere “friends”, the trial lawyers who so conveniently remind us of their “concern” for the welfare of the average citizen with incessant advertising, are the real financial recipients of legal action that results.

Now for some full disclosure–I have made mistakes.  I know my patients and their families, some of whom I have treated over 34 years and three generations, will be saddened and shocked to hear this confession.  Some of them might have believed that I was a very good doctor.

Another confession–I have been involved with several malpractice cases over my three decade career.  Almost all of them where either dropped or I was released from the suit.  Ironically, there was one I was forced to “settle” on my insurance policy was  because the other sued physician, an ER doc, changed her version of the case which conflicted 180 degrees with mine, actually involved NO medical error on my part at all.  Another one still pending may involve another “settlement”.  The insurance company will see to that.

The unfairness of life, I must assume.  I am quite sure that some of my “mistakes” did not sue me.  Perhaps they were unaware. Perhaps they understood the obvious–like the vast majority of my fellow physicians, I am a human beings whose intentions are to serve my patients as best as I can. Perfection is not a term expected of the rest of humanity. This is not true of physicians.  We are held to a higher standard and understandably so.  We deal with the most sensitive aspect of human existence–health and illness, life and death.

It should be noted by my fellow citizens…..In an average working day the average physician makes literally thousands of medical decisions regarding a patient’s health.  This may involve the decision to order a medication, to stop one, to change one, to order a test, to perform one, to recommend referral to another physician etc. etc.  Each one of those thousands of decisions might be considered “actionable” in the legal sense.  In other words, each one of those thousands of decisions could result in a malpractice claim, litigation, stress, aggravation and perhaps the end of a career.

Few physicians can keep that truth forefront in their consciousness.  If the did, they just might not come to work that day or any subsequent one.  This is an extremely complex and difficult topic.  As a consumer (I am as well) of medical care, I do need to know the source of errors and omissions.  As a practitioner I fear what intense scrutiny will cause—further defensive medicine, more tests ordered, more consultants called in to diffuse the risk of mistakes, more power of the trial lawyers lobby to prevent tort reform.  It will also lead to more stress on physician’s psyches with good physicians leaving the profession prematurely.

Perhaps the answer are robots.  They don’t make mistakes, they are computers. The patient will submit their symptoms, the robot will analyze and order, the patient will have no choice but to follow.  Perhaps that will eliminate that annoying trait that today’s physicians possess–their humanity, their imperfection. Just don’t expect the robot to hold your hand or hug you when you discuss a recent loss of a loved-one or receive a terrible diagnosis.  Will a robot detect the deep sigh, the welling up of tears? Perhaps in the future the only ones shedding tears will be the trial lawyers. They might just be out of business. At least until they can figure out a way to sue robots.

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