A chill comes over me...


Today was going so well (actually getting work done, few distractions or problems)-until a certified letter from a lawyer came across my desk this afternoon requesting the medical records of a patient I saw over a year and a half ago. Looking over the clinic notes, I see that I saw this patient only twice, once to do a fine needle aspiration of a palpable breast mass and once to have what I characterized in the chart as an hour-plus long discussion (during which the patient and her family "asked many questions") after the results of that fine needle aspiration showed cancer. The chart then notes that, a few days later, the patient picked up her mammograms and went elsewhere for a second opinion. I never saw her again. I don't even remember her.

It is irrational, the cold chill down the spine that reading this stupid letter causes. It's highly unlikely that this patient is planning to sue. There's no basis I can find, despite frantically looking up her office notes on the computer. My clinic notes document in nauseating detail that everything I did and recommended was well within the standard of care. I diagnosed her tumor correctly and recommended appropriate surgery. Whatever the reason, the patient decided to go elsewhere for a second opinion (and presumably for her surgery and adjuvant treatment). Nonetheless, I could get dragged into this thing to give a deposition if something went wrong and this patient is suing the poor surgeon who actually did take her case. And I still can't know for sure that this lawyer isn't planning on adding my name to the suit. Lawyers always seem to manage to find a reason.

Here's the problem. Lawyers intimidate us doctors, and they know it. They take full advantage of it. Even letters from lawyers intimidate doctors more than they should. One reason is because there is no predictability to the medical malpractice system. It seems nearly random and serves neither patients nor doctors well. Too many patients who are victims of malpractice either don't sue or sue and lose, and too many doctors are sued for bad outcomes not due to malpractice, even though they did nothing outside the standard of care. Even if they win, the experience of the lawsuit scars them. If they lose, their malpractice rates can skyrocket to the point that they can no longer obtain insurance. Virtually every surgeon gets sued at least once in his/her career, often multiple times, and getting sued has little to do with a physician's competence. I know surgeons who are excellent doctors who have been sued two and three times. We all know that even doing everything correctly will not protect us.

Intellectually, I know I'm very likely getting all worked up over nothing. I get a couple of these requests a year. But, in today's malpractice climate, it's hard to suppress a feeling of dread. A chill has come over me, and it hasn't gone away yet. I have no way of knowing if my turn to be sued has finally come. Most likely, in the back of my mind, for the next several months I will be wondering when or if the other shoe will drop.


  1. Dread naught, Dr. Orac! Look upon a malpractice suit as a game of wits (not unlike the contest between S. Holmes and Dr. Moriarity), and play the game with verve and meticulous attention to detail. You'd be surprised how your attitude changes when you think of it this way - "it's just a game".

    Of course this works best when you know you are innocent!

  2. I'll be crossing my fingers for you, Orac!

  3. If deposed, get your revenge by charging big bucks for your time.

  4. Certainly I will do that if I am not a defendant. Of course, if you are a defendant, you don't have the option of charging for your deposition.

  5. My condolences. Just make sure you charge the maximum fee per page of record copied, copy every scrap on a separate page, and require pre-payment including handling and postage before you mail in the records. It'll help pay for all the Zantac you'll consume while you sit and stew about this.

    Also make certain and clear to them that you charge by the minute for any phone consultations (check around for an appropriately inflated rate). Keep a log of the time you spend on this. If you are not a defendant you'll want to be re-imbursed.

  6. Medical malpractice needs a cap on it. Sometimes doctors mess up, sure, but sometimes things just go wrong. Patients sue because they want somebody else to suffer with them, some one else to get hit the way they did. But it's getting out of control, especially in the fields such as obstetrics, where doctors are being driven out of practice because they can't afford their own insurance. They move to other fields or other states. Malpractice suits rarely do any good, they end up hurting nearly everyone, competent doctors and the general public (all of whom are possible patients). In the end, it is only lawyers, the leeches on society, who profit.

  7. @ Emily "Sometimes doctors mess up" - yes they do and that is why Med Mal is necessary. Your childish "leeches" comment belongs on a propaganda blog, not one of facts - grow up!

  8. Emily, I once worked for one of the largest medical malpractice insurance carriers---they are as deserving (if not more) for inflated premiums as an attorneys. When the market goes down...premiums go up. They are also at the bottom of more actual legal actions than you would think.

    I know this because I helped set them.


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