Dr James Schaller
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Death was the Doctor's Fault:
A First Grader's Guide to Growing Up

Recently one medical story in our local paper caught my eye. A man went in for a total hip replacement and died not long after the procedure. I asked one of my "wise" neighbors about it, and she said, "Yes, what a horrible thing was done to that man."

Of course, most people have not assisted in a hip replacement in an operating room, but the fact that any are successful is a miracle to me. Also, some folks must have trouble with English, because the massive risk forms that are filled out are seen as merely a formality, like removing the film before applying a Band-Aid. The fact is that 100 years ago anyone who had such an operation would be dead in an hour, and now if someone has an outcome that is not perfect, the surgeon messed up. It is really this stupid and simplistic. You see some people think no one ever dies from a medication and that surgery is merely simple magic.

My neighbor has company in her denial of reality and death, since juries also look at the outcome of medical care much more than the actual care offered:

... Medical malpractice is more likely to be found where the injury suffered by a plaintiff is severe; in other words, juries are judging the end result, rather than whether the defendant met the quality of care. [Insert italics and bold are mine] (From: www.pointoflaw.com/archives/000601.php)

But I cannot sit on a high horse as a doctor and accuse merely non-physicians of the denial of death, since physicians do the same. "Expert" witnesses, the paid prostitutes of so much dubious malpractice, often go against their own published writings to accuse a colleague of malpractice. (Saying "X was wrong," when they have published "X is the way to do the procedure.")

Amazingly, in a study of experts, they seem unable to separate the facts of the case from the outcome. Meaning, if Ann died in a car accident on the way to the mall, they blame the mall.

Surprisingly, one study finds that expert witnesses often suffer from the same [outcome] bias.

In 1991, the Closed Claims Project database was used to explore the possibility that the opinions of experts may be influenced by the severity of patient injury. [Italics mine] The specific goal was to determine whether severe injuries were more likely than minor injuries to predispose medical experts toward harsh judgments about the appropriateness of anesthesia care.

To study this question in a rigorous manner, 112 practicing anesthesiologists were recruited to judge the appropriateness of anesthesia care using 21 case summaries selected from the Closed Claims Project database. About one-half of the cases had temporary injuries and one-half had permanent injuries or death. For each case, a matching but "fictitious" version was created that was identical in every detail to the original case except that a plausible outcome of opposite severity was substituted. [My Italics] The original and fictitious cases were divided randomly into two sets and assigned to the volunteer reviewers, who were unaware of the intent of the study. The reviewers were asked to independently rate the appropriateness of anesthesia care in each case, based upon the conventional yardstick of reasonable and prudent practice applicable to the year the event occurred.

How did the ratings of appropriateness of care differ between the original and fictitious cases, which differed only in the severity of injury? The proportion of ratings for appropriate care decreased by 31 percentage points (from 67 percent to 36 percent) when the case outcome was changed from a temporary injury to a permanent injury. Conversely, the proportion of ratings for less-than-appropriate care increased by 28 percentage points (from 28 percent to 56 percent) when the case outcome was changed from temporary to permanent injury. [My insert italics and bold] These findings indicate that the severity of injury can have a substantial impact on a reviewer's assessment of the appropriateness of care.

From: www.pointoflaw.com/archives/000601.php

(Caplan RA, Posner KL: The expert witness: Insights from the Closed Claims Project. ASA Newsletter 61(6):9-10, 1997; Caplan RA, Posner K, Cheney FW: Effect of outcome on physician judgments of appropriateness of care. JAMA 265:1957-1960, 1991).

What is the point?

"The price
of freedom is
constant vigilance."
Thomas Jefferson

American's do little preventative medicine at an advanced level. Often those who beat up and damage their bodies the worst, have a magical view of medicine and our ability to fix them. If you played football for years and tore up your knee, and then went skiing on it and damaged it further, and ignored a Lyme bite and a true expert explained that the Lyme infection could simply dissolve your cartilage, perhaps you really need to hear the surgeon's new words. They may say in word or writing, "This is not a simple operation." Hear and read the fact that this is not a simple operation. We have you look at these forms and sign them, because people rarely die, but they do die. And if you have beaten your body up, you might be more at risk for complications and death.

Is anyone happy when a former smoker has respiratory problems during a surgery--of course not. Is anyone blaming the patient for avoiding taking basic essential nutrients, so the bodies required nutrients are present to help with healing? Of course not.

But do not blame the surgeons trying to serve and doing a procedure they have done a thousand times, if it fails. Or perhaps we should say, "If your body fails." On very rare occasions something serious happens, like an operation on the wrong leg--then you will get well-deserved compensation. (Unless you needed the other leg also fixed. Sorry, just kidding).

Part of growing up and being a man and a woman is realizing that bad things happen. We all die. We all get sick. We all usually get chronic diseases. And that is no doctor's fault.

So now I am going to call my doctor and yell and him for my abdominal cramps. I had beans and it is his fault that I am having such intestinal spasms.

By the way, I am not a surgeon.

But I would like to have access to one within 500 miles.

If the notion continues that only "bad, bad, bad" surgeons have some bad outcomes and get sued, which is "stupid, stupid, stupid." I will need a plane to go find someone for surgical care, hopefully in America. And some malpractice trials are "settled" or "won," because it is $100,000 to fight the lawsuit and the doctor's insurance company wants to settle for business reasons. In Florida and perhaps other states the trial lawyers actually want a three strikes and you are out law--you cannot do any medicine. Want the real deal on this simplistic proposal? If the doctor doing brain surgery on advanced cancers or the ER doc is trying to help someone with a heart attack and there is a bad outcome, and there is a lawsuitÉ If three settlements, both these doctors are done their medical career. You will lose all the major high-risk surgeons in the state. I recall one OB doc who was Chief of an inner city center, where women would come in with no prenatal care and high-risk pregnancies delivering as they entered the door. He had two large file drawers of malpractice cases. I bet if he sent them packing when they simply dropped in for a delivery, he would have quite a few less cases. Only a malpractice lawyer could think up something so utterly useless.

To Your Health and Sanity,

Dr. J

Bank Towers, Tamiami Trail, Naples, FL
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