WHEN YOUR DR. SHOULD TELL YOU TO GO TAKE A HIKE
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Should part of the informed consent discussion include your physician’s telling you that you would get better care elsewhere? That is the subject of a fascinating article in today’s NY Times. Reporter Denise Grady discusses the awkward situation that can arise when your local surgeon, for example, should tell you that your rectal cancer would be better addressed at a big-city teaching hospital, despite your wish to remain close to home. Is the surgeon obligated to do so? Good question.
Ms. Grady provides a couple of useful links for people faced with decisions regarding surgeries. You can find out how well (or poorly) a hospital does in performing operations, and treating illnesses, at www.hospitalcompare.hhs.gov. Additionally, you can find information on hospital infection rates in some states at www.hospitalinfection.org.
4 Comments on this post
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Supremacy Claus said:
Andrew: Do you have a personal physician? I am curious. What kind of appeasing, vile lawyer collaborating doctor would take a plaintiff land pirate as a patient? I suggest you try to not age. As you do, an organ will fail every few years. Only a fool of a doctor would accept you as a patient, since you are a blood enemy of clinical care and a land pirate.
In another comment, I suggested the overwhelming fraction of medmal cases are weak. Please put your track record on the web site, so we may judge if you are filer of weak cases, an established form of legal malpractice.
January 6th, 2009 at 11:05 pm -
Andrew Barovick said:
I do have a personal physician. I chose him because he is an excellent doctor. He knows what I do. He also knows that for most of my career in civil practice, I defended doctors and hospitals in medical malpractice cases. All I can tell you is that there are lawyers on both sides who do not act ethically. However, most of us do.
My “track record” is a matter of public record, so that if you truly wish to investigate it fully, be my guest. As for your concern about filing weak cases, first, neither I, nor any competent med mal attorney can afford to file weak cases. There is more than ethics at work here. There is economics to consider. A med mal case is costly to bring. If it is not strong to begin with, you’re wasting your time and money. Your concerns about the filing of weak cases being “legal malpractice” are misplaced. Legal malpractice requires proof that the lawyer’s lack of care caused his client damages. Filing a weak case does not fit into this calculus.
Finally, medical malpractice effects everyone, even physicians (many of whom have brought cases on behalf of themselves or relatives). It sounds as if you would like to deprive the victims of medical negligence of their day in court. If I have heard you right, how do you suggest we address the problem of physicians whose negligence kills or severly injures people?January 7th, 2009 at 8:43 am -
throckmorton said:
This is a good article, I do think that it misses the boat a bit when it stressess where the surgery is performed rather than who performed the surgery. The best example is a neurosurgeon who has excellent skills at pituitary tumors but only does 50 or so a year. Would you rather have him/her do your surgery or a guy who is so/so that does 100/year.
If you really want to know who should do you or your family members surgery, the people to ask are the scrub techs and nurses who work in the OR. They know the best.
As to the surgeons obligation to tell them that they can go elsewhere. Isn’t this holding the physician accountable for what should already be obvious to the patient. When a possible client comes into your office, do you immediately have to tell them that there are other attorneys?
January 7th, 2009 at 11:22 am -
SeaSpray said:
Hi Andrew-thank you for this post. I bookmarked the links.
Anyway, a couple of years ago, one of my physicians recommended I have a high risk surgery in a teaching hospital in NY. It wasn’t doable for a bunch of reasons and I instead decided to go to a teaching hospital in our state. Both options were about an hour away.
I was a resistant patient and wanted to stay with my doctor and partners and with the community hospital that I have gotten 98% (in my opinion) stellar care. (physician care care-100%) I’ve heard stories where the doctors are excellent in the teaching hospitals but the post surgical nursing care is lacking.
That bothers me …because one of the concerns my physician had was about the first 18 hrs of perioperative care and is why he wanted me in a facility where the wings specialize in a particular kind of care, doctors on staff 24/7, etc.
That being said…he wouldn’t have recommended it if I was more at risk going to another surgeon and hospital.
Hindsight being 20-20…I also know now that I was being silly to not want to follow his advice and go to someone new because people travel around the world to get the medical care that they need…I only had to drive an hour… and people want to go to these hospitals.
I know I am not the only patient to feel that way… but I do see that it was tunnel vision. Thankfully, I have managed to avoid the surgery.
I respect my doctor for wanting the best for me. I have a story where one did not have my mother’s best interest at heart but thankfully…she ended up alright. Her doctor cared more about his ego and was insulted that she opted to use a specialist for some of her care… and dropped her after almost 20 years!
After reading the article and Throckmorton’s comments…it seems it could go either way and how does a patient really know what the best option will be for them?
Volume (experience) vs quality? Volume + quality = the ideal… but how can a patient know who or where?
In my case…the post surgical care is critical because of the risk of complications which could be serious.
So on the one hand…it makes sense to be on a wing that specializes in that area of surgery, staff trained to see complications, etc… but then in a community hospital…staff is very attentive and spends more time with the patient then in the large teaching hospitals.
I was glad to read the article though because it did reassure me regarding favorable outcomes in the larger hospitals where the doctors may be more cutting edge, etc. (Although..I do believe my surgeon is as well.)
January 10th, 2009 at 10:03 am