The physicians who appear as fictional characters on television each week can serve examples of what NOT to do.....
Just How Much Malpractice Does
Dr. Gregory House Commit....
(not to mention other lapses such as Board of Medicine violations, ethical lapses, and more).
FOX airs a television drama every Tuesday, called "House." Dr. Gregory House is portrayed as a brilliant diagnostician who is able to differentiate between horses and zebras. Each and every week, he makes the correct diagnosis of a zebra just before the show ends, and often just before the patient expires. House manages to order hundreds of thousands of dollars of tests, often before the first commercial. Further, I have never seen anyone obtain pre-certification for any procedure. Amazing.
Dr. House has a surly, combative personality and pisses off virtually every human being he encounters.
Message #1: You are more likely to be sued if you condescend to the patient, fail to listen to what the patient is saying, fail to answer any questions, and avoid even meeting your patient's gaze. That is not to suggest that such actions will sidestep potential litigation. But, proper communication with the patient is a useful first step in enhancing patient safety and preventing a downward spiral to the courtroom.
With as much testing that goes on, the only apparent documentation is Dr. House's use of a dry erase marker on a whiteboard. Moreover, it is unclear that anyone on the show has ever entered any information into the medical record. Coincidentally, I never saw Jack Bauer, on the FOX television show 24 perform any documentation either. It would seem that after blowing up a building and killing several bad guys, the very least Bauer should do would be to document that trail of destruction.
Message #2: The medical record is all that will be available to exonerate a doctor when everyone's memory has faded. Take time to make sure it is complete and accurate as possible at or close to the time diagnosis and treatment are performed.
In one recent episode, Dr. House made the stunning diagnosis of hemachromatosis for a patient with rage disorder, hypogonadism, and progressive liver / kidney failure. Of course that diagnosis would be obvious to any first year medical student based on those symptoms alone. Nonetheless, Dr. House wanted to demonstrate his mastery of minutia. He limped to the patient's room (who incidentally was a teenager being visited by his mother) and brusquely informed the patient that he was going to live. Surely a time for celebration. Then, in his haste to initiate "treatment" (which ordinarily would consist of periodic phlebotomies), he grabbed the kid's arm, took some sharp instrument, and cut the arm, allowing it to drain into an open trashcan. I will not comment on whether the trashcan had a biohazard bag to collect the offending liquid. But, I can say that by not taking the 30 seconds to obtaining informed consent from the parent, Dr. House committed battery.
Message #3: Battery is an intentional tort whereby one causes a harmful or offensive contact. An affirmative defense is consent to the harmful act. But, as you can see, Dr. House neglected that formality. Please note that the good doctor's good intent does not negate a charge of battery. It is irrelevant that the battery placed the child on the road to recovery.
An intentional tort is generally not covered by a physician's professional liability policy. Further, intentional torts can expose the actor (no pun intended) to punitive damages. That said, most states now mandate that malpractice based on lack of informed consent be tried as a case of negligence rather than an intentional tort. The moral of the story is to take the extra time, obtain an informed consent from the patient / guardian, and avoid feeling the need to slash a patient's wrist to perform a stat phlebotomy over the closest wastebasket.
Just How Much Malpractice Occurs
on ABC's Greys Anatomy...
It seems that the physicians on Grey's Anatomy (which airs on ABC on Thursdays) are always causing and then averting some crisis of their making. It is refreshing indeed to see that their patients can withstand prolonged hypoxic insults in the operating room (often associated with episodes of ventricular fibrillation or even asystole), be revived, and wake up with perfect cognitive function. In fact, one gets the impression these patients just woke up after a nice, long nap. How do they master such results? I cannot say. What I do know is that each time Dr. McDreamy, the neurosurgeon, is shown using bipolar cautery, he is holding the instrument upside down. In that position, his hand cannot help but obstruct his field of vision while using the operating microscope. Perhaps that is the secret of these post-operative miracles. Interestingly, this is the same TV surgeon who felt comfortable repairing a subclavian pseudoaneurysm to decrease pressure on his friend's (fellow surgeon, Preston Burke) brachial plexus. Still, it remains unclear why the show featured a neurosurgeon performing a peripheral vascular reconstruction procedure. Perhaps the credentialing procedures at the hospital are not stringent.
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