Tuesday, February 12, 2013
Medical malpractice, tort reform and James Bond? Let me explain
Sometimes, I feel like I belong in law enforcement.
There was a time in my life that I seriously considered a career where I would haul in the bad guys and make society a better place. Of course, every American male youngster fantasized that he would one day drive the Aston Martin, get the girl, defuse the bomb, and sip on a martini that was shaken, not stirred. I was no different.
I was 10 years old then when my pal Lewis and I were secret agents with the requisite weapons, invisible ink and secret codes. At the risk of disclosing that I have a tincture of obsessive compulsiveness, I still retain the files of our secret organization. While Lewis has expressed concern that these files in the wrong hands could threaten international order, I have reassured him that the enemies of mankind will be unable conquer our layers of sophisticated encryption. At risk of being accused of hyperbole, Israeli and American intelligence agencies studied our secret files as a template for the Stuxnet worm.
I have had many patients who are law enforcement professionals. I respect them and the work they do. I have had patients who served in the FBI, the Secret Service and all levels of local law enforcement. I feel a kinship with these folks. Like a community gastroenterologist, much of what they do is routine. We both endure endless paperwork that often seems to serve no useful function. We both are exposed to extremes of the human condition. We both get scared. We both serve a public that is sometimes skeptical of our biases and motivations. We both may need to make urgent decisions relying upon our training, experience and instincts. We both deeply understand that sometimes the right decision leads to a dark result.
Last November in Cleveland, two people were killed by police after a harrowing high-speed chase. It was a tragic finale that left many painful and raw questions. Thirteen officers fired 137 rounds that killed two citizens who were ultimately found to be unarmed. Understandably, there was outrage in the communities, and the matter continues to be under investigation. As expected, the initial facts were murky and in dispute. Anger and haste are poor catalysts to develop the truth.
I have no opinion at this time if law enforcement personnel should have held their fire and pursued a non-lethal strategy of capturing these two individuals who were fleeing from them at high velocity. A dispassionate investigation will determine this.
But, while it absolutely necessary to investigate this tragic episode, as a doctor, I am very sensitive about being judged after the fact by investigators who have endless manpower, resources, audio and video evidence and months of time to evaluate the propriety of a split second decision. A catastrophic outcome is not evidence of negligence, despite the ease of reaching this conclusion, particularly by those who have been injured and their families.
In addition, a fair judgment on what transpired must consider the context of one who had to make an immediate decision to act. If an investigation requires a four-month inquiry involving dozens of professionals to conclude that an officer erred, could the policeman be expected to reach the same conclusion in two seconds in the field?
When football referees review a call on the field, sometimes the call is reversed. Of course, the review offers instant replay in slow motion at various angles, none of which were available to the official who first made the call. Get the point?
None of us envies a cop who faces a situation where he must discharge his weapon. Sure, there is training, but as every professional knows, one can't train for every contingency. This is not a board exam; this is real life with lethal consequences and no time to ponder the alternatives. Was the suspect reaching for a weapon or an innocuous item? I can't imagine the lifelong trauma one would endure after killing another person, even if this was a necessary act. I suspect it would be a greater trauma if a policeman didn't pull the trigger when he should have, and missed the opportunity to save innocent lives.
I was raised to respect law enforcement, and I do. While their job is tougher than mine, I can personally relate to their profession. We both serve and protect the public. We both make decisions based on what we know at the time, which is often less than we want to know. We agonize when something awful happens and wonder if we contributed to the outcome.
There's something else that binds our professions. We both are often judged retrospectively by those who weren't there when we were blinded by white heat and couldn't see then what later seems to be in such clear focus.
We learn from our errors and misadventures. As readers know, I believe that the negligent must be accountable for their actions and resultant consequences. The process to determine this, however, must operate at the highest level of fairness and integrity. Too often, this standard is not achieved or even reached for.
And now, my thoughts wander back to Miss Moneypenny, "Q", boat chases and ejector seats, when I contemplated a profession that I know now is better left to other others.
This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
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Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
Controversies in Hospital
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
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Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
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Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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