"It's not a matter of if, but a
matter of when," warned the CMPA representative at the
lunchtime seminar. He went on to present a case about
a missed aortic dissection where the hospital, attending
staff and resident were successfully sued.
Although the number of lawsuits
against doctors has decreased, rising settlement costs
and publicity surrounding high profile cases are enough
to scare me. I don't think I practise medicine itself
any differently, but I certainly take care to detail
exactly what I do. As my program director likes to say,
"If you didn't document it, then you didn't do it."
THE
S-WORD
But there are times when, no matter what I do, the patient's
family is never happy and litigation threatens to rear
its ugly head.
One such case was Mr Ratchen, a
68-year-old with leg weakness. What made the Ratchens
particularly difficult to manage was that not only were
there lawyers in the family but doctors as well. Certainly,
I would do all I could for my father if he were sick,
but I definitely appreciate the conflicts that arise
from trying to be a son and doctor at the same time.
In Mr Ratchen's case, his physician son-in-law was "telehealthing"
daily with the family from Toronto, feeding them intelligent
but context-removed questions.
At one point, the medical team
decided that a lymph node biopsy was necessary. Mr Ratchen
was quite pleasant and agreeable at first, but as the
days turned into a week on the OR waiting list and he
kept getting bumped for more urgent cases, Mr Ratchen
mentioned his lawyer daughter more and more frequently,
occasionally dropping the S-word — "sue."
I couldn't believe our luck when
the biopsy report came back as fibrous tissue and was
non-diagnostic. The Ratchens were understandably upset,
but they went so far as to accuse the surgeon of punishing
Mr Ratchen for complaining by deliberately and maliciously
choosing a poor specimen to biopsy.
We did our best to reassure the
family but weren't hopeful when all four family members
started carrying note pads, jotting down everything
we said.
The attending asked the other resident
on the team to avoid writing notes on Mr Ratchen's chart.
"I've seen situations like these before, and you don't
want to be involved if you can help it," he advised.
QUE
SERA SERA
Even though I eventually rotated off the service and
didn't hear about the patient again, I still carry with
me a nagging question of when the lawsuit will come.
Would it be the Ratchens who include me in their lawsuit?
Or would it be someone else later down the road?
I've been told that you can be
sued years after an incident takes place, with the case
working through the legal system for years afterwards.
Sometimes everyone on the chart with a legible signature
is initially named in the lawsuit.
I guess there isn't really anything
to do but wait and see. In the meantime, for better
or for worse, I document my activities for legal purposes
first, education second. Then again, who's to say this
isn't part of my medical training?
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