Medical Malpractice and You
(September 13, 2016)

Medical malpractice is a subject that has been on my mind recently for -- well, never mind. Heh heh. It is a touchy subject for any doctor. But it is important, and there is more than one misconception about it in the minds of the general public. A couple of those inaccuracies are the windmills that I will be tilting at today.

If you follow the mainstream news and generally accept what it tells you, you probably believe that medical malpractice lawsuits are a huge problem in the U.S. You might think that there is a biblical-sized flood of unmerited malpractice cases clogging the courts, driving up the cost of malpractice insurance for hapless doctors, and making the cost of health care unmanageable for the innocent public.

The thing is, you have probably also heard by now that “medical error” is the third largest cause of death in the United States. And unless you are both unusually thoughtful AND have a bit of extra time to think, you may not have asked yourself how both of these things could possibly be true at the same time. Because, how can they?

We can argue around the edges of this quite a bit. But in the end, it is indisputable that in the normal course of business, doctors and hospitals kill and injure a breathtaking number of people -- between 200,000 and 440,000 people per year at last blush. Yet, each year, fewer than 20,000 medical malpractice lawsuits are filed.
 
You don't need much more than third grade math to figure out that relatively few serious medical errors actually end up in lawsuits. Because if that were not the case, the courts would be so loaded with cases as to be completely nonfunctional. Plus no one with an ounce of sanity would participate in the medical biz in any way. Then we could all just look stuff up on the internet and treat ourselves according to whatever we find there that strikes our fancy at the moment. Which sometimes it seems like is all people really want to do anyway. But I digress.

For all the media hand-wringing about the avalanche of malpractice suits, then, obviously most people who are harmed by malpractice do NOT sue their doctors. Interestingly, the ones who do aren’t even the ones who are hurt the most. They tend to be the people who are really ticked off about what they feel was the disrespectful way that they were treated by the medical people involved. That’s why doctors are so much nicer than they were 20 or 30 years ago. Hah! I bet you thought that that was because of some kind of moral evolution on the part of the profession. Not so.

If you like and trust your doctor, and feel like s/he was doing their best, you don't sue, even if your family winds up on the street as a result of it. Meaning that there are a huge number of people who are suffering from a doctor's negligent activities in silence, and bearing the entire burden of that error themselves. Mainly because they are good guys who realize that mistakes DO occur and they want to be fair. It is, however, not at all fair to the patients involved. 

Additionally, medical malpractice isn’t just the simple fact of harming a patient. You need negligence to be present as well. A doctor could theoretically cut quite the bloody swathe through the patient population as long as s/he did it within the conventional standard of care for the condition. That is one reason, by the way, that you don’t run into a whole lot of medical doctors that practice holistically. Much of what they do is outside the normal medical standard of care and if a patient gets into trouble, they are exposed in a way that a regular doctor is not. Which makes them very brave people.

So even if, say, an orthopedist has a pretty good idea that your back pain would be better cared for by a chiropractor but he operates on you instead because he has three kids in college, and you wind up worse (which happens more often than any of us like to think), he’s free and clear. Because unless some medical  orthopedic  society somewhere has put in writing, and it has become a standard convention of orthopedic care, that such cases SHOULD be referred to a chiropractor, there’s no negligence involved - and no malpractice. And no case.

Remember also that medicine is one of the few areas where if you don’t get a good result, you can’t get your money back. My contractor mucks up my hardwood floor, I get my money back and/or it gets fixed. You drop dead during surgery because your anesthesiologist was secretly playing Tetris, your heirs are still going to pay for that surgery and if you've got little kids, you'd better hope that your car is paid off and that it is a very big car. 

So what does all this mean? That there is an enormous amount of harm done in the normal course of modern medicine. That such harm happens mostly at the hands of well-intentioned people who are trying their best. And that even when that is not the case your chances of being made whole are akin to that of a one-winged butterfly surviving Hurricane Sandy.

You are ultimately 100% dependent upon your doctor's integrity, knowledge and ability. You can read forever and ever on the internet about your condition and become quite an expert on it, but as a layperson you will never have the entire picture. Your doctor's skill and familiarity with you and the idiosyncrasies of your personal medical issues are worth a hell of a lot more than a few bucks -- or even a few thousand.

In this day and age of huge insurance premiums for medical policies that don’t really cover anything, people frequently abandon practitioners who they know are competent and who have cared for them for decades in favor of someone "on their list". That is one of the stupidest things you can do. It's far better for you to stick with your family internist, chiropractor, pediatrician, whatever, even if it costs you a little more in the short run. Because it eventually could cost you a lot more if you don’t.

--dr. diane holmes
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