Complications 186
| Complications: A Surgeon's Notes on an Imperfect Science | |
| author | Atul Gawande |
| pages | 269 |
| publisher | Metropolitan Books |
| rating | 10 |
| reviewer | Stella Daily |
| ISBN | 0805063196 |
| summary | What happens when humans do an inhumanly difficult job. |
Complications is a look at the medical profession from the inside -- written by surgical resident Atul Gawande, it is a frank, thought-provoking commentary on what happens when fallible human beings do a job that requires infallibility. In its chapters, he reveals that doctors make mistakes more often than most of us think -- and that while there are bad doctors, the more usual case is the good doctor having a bad day, or the problem for which all the training in the world would not have been enough.
Gawande is refreshingly honest about the limitations of medicine and of how much doctors, despite years of training, do not know. Witness the titles of the three sections of the book: "Fallibility," "Mystery," and "Uncertainty." He shows us myriad facts and stories that seem designed to make us lose confidence in our physicians. The study that showed that a doctor's confidence in her diagnosis was not related to whether the diagnosis was correct. The colleagues who chose to remain silent when a well-known surgeon began to show signs of incompetence, choosing instead to quietly redirect patients to other doctors when possible. The studies that show that autopsies reveal misdiagnoses in between thirty and forty percent of cases. Yet Gawande suggests physicians are doing the best they can: given the complexity of the human body, the short amount of time they often have to make decisions, and a host of diseases, injuries, and conditions that mimic each other, it is a titanic task we ask of them. Often a doctor has little more than her intuition to go on; sometimes that intuition can result in messy complications, but just as often it results in a spectacular save.
Complications tackles other issues as well: How do we reconcile the needs of patients to have experienced hands performing procedures to the needs of physicians who must teach the procedure to residents so that a new generation of doctors will be able to perform it? What does a doctor do with a patient whose symptoms show no discernible cause? How much say should a patient have in his or her medical treatment? As Gawande describes, until quite recently, the answer was "none -- doctor knows best." But whose body is it, anyway? While the reader might find himself, as I did, indignantly reacting with, "Of course I should be able to decide what happens to me!" Gawande raises an important point. Sometimes a patient really is not in the best position to decide, as when a patient in pain demands the treatment that will alleviate her pain now but cause her serious trouble down the road, unable to consider anything but how much it hurts now. The doctor's dilemma of when to step in is one I do not envy, and one Gawande describes poignantly.
While you will pick up Complications for the ideas and questions it raises, it is the stories Gawande tells, and the polished magazine writer's style with which he tells them, that will make you unable to put it down. Whether it's the television anchorwoman who couldn't stop blushing, the star orthopedic surgeon who inexplicably began doing shoddy work that hurt more than it helped, or the beautiful young event planner who was saved from a deadly infection by Gawande's lucky guess, the stories are about fascinating human beings, and Gawande tells them with riveting language.
If Complications has a weakness, it is that the chapters sometimes seem disjointed, without adequate transition between them. In the acknowledgments, the reader learns that the book originated from several essays Gawande wrote for The New Yorker. When the book is considered as a collection of essays rather than a unified whole, the lack of continuity is not a problem, and even without knowing this, it is still a more than worthwhile read.
Complications is about, as its subtitle says, an imperfect science, but not just any imperfect science. Arguably more than any other field, medicine's failures are held under a microscope and second-guessed ad nauseam; we expect our doctors to be perfect, and when they are not, our disapproval can be severe indeed. While Complications may shock you with its admissions of how deep the errors run, in the end it will give you a better understanding of what it is to be a human being doing an inhumanly difficult job.
You can purchase Complications from bn.com. Slashdot welcomes readers' book reviews -- to see your own review here, read the book review guidelines, then visit the submission page.
in all truth (Score:5, Insightful)
No man is perfect, and therefore, no doctor is perfect. Seek a second (or third) opinion.
Just my two cents
Re:in all truth (Score:2)
people will make mistakes
Even machines, computers, etc since they are too made by humans. Lots of examples out there (Ariane rocket, anyone?)
It's not that we have to eliminate human error completely, in an excruciating manner. It just happens. We just have to deal with it accordingly.
Re:in all truth (Score:1, Offtopic)
Re:in all truth (Score:2, Offtopic)
Re:in all truth (Score:1)
Re:Medicine vs. agriculture (Score:1)
Doctors PRACTICE. (Score:3, Insightful)
Re:Doctors PRACTICE. (Score:3, Insightful)
M@
Re:Doctors PRACTICE. (Score:2)
What I would like to see more of, are doctors who say "I don't know" and then research the issue, rather than saying "here, take this, it might help."
Like a lawyer? (Score:3, Interesting)
Ask a doctor to operate; the responce will be "Most Definitly".
Re:Like a lawyer? (Score:3, Insightful)
As for lawyers, very few would recommend that you sue for most disputes until you've tried a few letters or other ways of resolving the issue. The big liability cases get all the press because the numbers are so big (at least for the lawyers) but those are rare compared to everyday legal matters.
Re:Like a lawyer? (Score:1)
number two: just from the angle of self interest, only a stupid surgeon would operate on a patient that wouldn't benefit from the procedure. the most important part of a successful surgery is careful patient selection. a surgeon's worst nightmare is a patient that keeps coming back to clinic with complaints that the surgery didn't help...or, god forbid, with complications of a surgery (surgeons like to operate, not see patients in clinic).
but i see i've already put more thought into this response than you put into your troll, so you win this round...
Re: dentists are worse, in my exp. (Score:1)
I've ignored them, and have no compacting, no cavities, no pain, no problems. My teeth look and feel great (and yes, I have gotten treatment, when I *needed* it).
I'm not saying that their recommendations are based solely on profit, but the financial incentives shouldn't be ignored when dealing with anyone (lawyers, doctors, dentists, auto mechanics, etc.).
Re: dentists are worse, in my exp. (Score:1)
While I was out for the actual extraction, my recovery time was much worse than the average person. I went through a lot of pain because I waited. I would venture to say that they tell you to have them removed sooner than later cause the suckers are going to have to come out, and the longer you wait, the worse it is for you.
Now having said all that, this is what second (and third) opinions are for. If you do not think it is necessary, get a second opinion, and tell both doctors (dentists). Tell the second one, that you are there for a second opinion only, and want to kjnow what his (hers) opinion is. Do not tell him what the other doctor said, let him come to his own conclucion. Of course this will cost you.
dentists where what I was talking about (Score:2)
A capped root canal almost exploded. While removing the root canal another dentist caused me to vomit. None of the @#$@#$ing morons believe that novocain has no effect beyond a slight tingle on me and I feel every @#$@#$ing moment of it!
My Automotive Mechanics teacher told us on the first day not to screw anyone over. The previous experiences of his customers caused them to be wary around all mechanics, even those such as himself that ran an honest business. I apologize to all nobel doctors, mechanics, dentists, lawyers, and (if they exist) M$ programmers. Nah, just the first four.
Lie (Score:2)
Re:Like a lawyer? (Score:2)
the responce will be "Most Definitly".
No. The response will be "Most Definitely."
Because lawyers and doctors can spell.
No, not really (Score:2)
do dentists? (Score:2)
Doctors don't nessicarily take a hypocratic oath. (Score:2)
Surgeons do not. The hypocratic oath contains
the phrases 'I will not cut, not even for stone.'
So those folks doing surgery can't take it or they're out of business
Re:Like a lawyer? (Score:2)
On the whole, operations are expensive affairs.. And they leave the medical team open to later attack by lawyers.
One thing I hear more and more from my friends in the medical profession is that they're approaching not being able to do anything because they're having to practice so much defensive medicine, simply to avoid having lawyers sicced on them, and perhaps losing their ability to continue doing the jobs they've spent years training to do.
More and more these days, it's a damned if you do, damned if you don't. Operate on a sick person, and they die, the doctor gets sued for anything the Lawyers can find. Don't operate and the person dies from what would have killed them in an operation, and the doctor gets sued for not doing anything.
What I'm seeing is doctors being relegated almost to advisory positions, and the patient saying 'Do this!'. That way, at least it wasn't a the doctor's decision, and there's the signature on a contract to prove it.
So, really, when you ask a doctor if you should operate, the response is 'Ask the Lawyer'.
Malk
Body mechanics (Score:2, Insightful)
You don't have to be a doctor to have your life screwed up over one bad decision, btw. All you need are two fingerprints and a SS number.
Re:Body mechanics (Score:1)
Re:Body mechanics (Score:1)
I usually make my own diagnosis, go to the doctor and I tell them what I know, how I want to be treated, and I usually get it. Sometimes there are minor differences - amox vs ampacillin, etc. I've never had a doctor disagree with me in any big way yet. And even though I go in, and we go through this song and dance, they charge me the same even though I'm there for 5 minutes.
Recently, I requested one hazardous chemical for treating a temorary skin condition normally found on kids (it's used for a variety of things, in this case, it would just speed up the recovery) I was told: you can hurt yourself with that, so no. It ticked me off that they can trust diabetics with needles, which can be deadly, or they prescibe drugs that make you drowsy but you feel good enough to drive, yet I can't get a topical treatment!
Today, the medical profession is the biggest monopoly. Breakignin take years of schooling. We give them money to get better, then we stop giving money. Hell of a way to run a system!
Patient Pays for Health, Doctor Pays for Sickness (Score:1)
* a healthy patient makes payments to the doctor
* a sick patient receives payments from the doctor
Now I wish more doctors would admit it (Score:1)
Re:Now I wish more doctors would admit it (Score:1)
No Sympathy (Score:1)
I have no grandparents. (Score:1, Troll)
Both my paternal grandparents died before I was born of lung cancer caused by cigarretts that the manufacturers swore caused no complications even though they knew otherwise. There is a fine line between accidental complications and a murderous lie.
I hope I gave you something to think about, and if not I hope you do get -5.
Re:I have no grandparents. (Score:2, Insightful)
They got lung cancer from cigarettes. Yes, the manufacturers lied about the complications, and they should pay for that. The fact of the matter is your grandparents chose to smoke, and it is very obvious that inhaling smoke is bad for you, even without a warning. I do not need a warnig label telling me that drinking gasoline is going to kill me, and I didn't need a warning on cigarettes to tell me that they weren't good for me either.
I'm sorry if I offended you, that was not my purpose. I understand your plight, but I do not think that was the point of this book.
I was just trying to show (Score:2)
With surgical robots appearing more frequently, how long before M$ convinces a manufacturer to run windows on it? They are also guilty of lieing to consumers about side effects; how long before similar consequences insue?
I never met my grandparents; I can live with that. It's much harder to see the pain behind your father's eyes when he mentions them. It's much harder to know that such pain was caused by an industry's greed.
no one will read this anyways, and I've got karma (Score:2)
Re:I have no grandparents. (Score:2)
The system is currently set up so that if you're brave and forthright and honest and decent and take the high road and say 'Yes, our product is intrinsically dangerous, but people are adults and can make their own choices.' you will be CRUCIFIED in court.
The lawyers on the other side will take the low road and say 'SEE??? HE *ADMITS* IT!!'
That's because people are not adults but babies in the eyes of the State. The State is intrinsically motivated to see people like that because it gives the State an excuse to slap a few more bars on everyone's cage 'for their own good, of course! Not because we are lusting after power at all!'
Because of this behavior corporations must also take the low road and do things like lie about cigarettes so they can shrug in court and go 'We had no idea, your Honour!' and calculate the cost benefits of fixing the Pinto against paying the estimated law suits, etc.
People deride this as soulless capitalism but they are the first in line to put the diapers on when it looks like a payday at the expense of the suits.
Re:No Sympathy (Score:2)
Your attitude is the cause of this.
Deserved (Score:2)
I'm not advocating open season on doctors without a good cause. Some things just can't be fixed. My father had a heart attack (first and last) at the age of 38 and died in front of a 30 year old doctor who I'm told was seriously rattled by losing so young a patient. I don't blame him in any way whatsoever, my father treated his body like crap. But if a good, sincere, well-meaning doctor does fumble the ball then I don't have a problem with stripping them of the fruits of their 8 years of college.
I'm not sure that we should view a doctors credentials as any more sacred than that doctor views their patients life.
Re:Deserved (Score:3, Interesting)
The book itself I have read some of - it makes a series of excellent points; one of which in the tagline - "notes on an imperfect science". We don't know very much about the human body compared to how much there is. All a doctor has to go on is a series of symptoms and an examination, followed by some lab tests. Most illnesses are diagnosed from the symptoms. Surprisingly few from the examination. Lab tests are mostly non-specific - they can confirm or refute your diagnosis, but a minority will actually make a diagnosis on their own.
The problem is that symptoms are very non-specific. Only a tiny minority of people with chest pain have a cardiac (or other "serious")cause for it. At the same time, a few people will have a serious disease but the symptoms are not typical of it. Do you investigate everyone for every disease? No, takes far too much resources with only a tiny return. What is done instead is the doctor listens to the story, examines the patient, and tests for the likely (in view of his findings) causative process, and also any serious (i.e. missing these would be bad shit) things which might give similar symptoms.
Everyone has an area of expertise - and also a finite amount of knowledge. Doctors cannot know everything, but will, if indicated, refer to another specialist with an appropriate area of interest, which will increase the chances of a diagnosis.
Bear in mind another few things - half of all people are below average intelligence; i.e. half of physicians are of below average ability; symptoms are often misleading, and tests and investigative surgery can cause their own problems, and you see my point - any area of medicine is a risk/benefit analysis. At the end of the day it's all probability - gambling with your life, in essence.
Doctors, usually, do try and make the best decision. It can't always be right. Incompetent and dangerous docs are one thing - they should be re-trained if possible, and struck off if not. The point made by the book is that all good doctors make mistakes as well. This is part of human nature, the problem is that the consequences can be grave.
The thing is, is it any different to be treated by the best surgeon in the world, with the lowest complication rate (there is no such thing as no complications), or the worst in the world, with the highest? If you get complications, you are still in the same boat. But what if you get no complications from the shit guy? What if he's competent, but that the unit he works in isn't, because it has less support staff than another unit?
One or both of them might be competent or not. But the fact that someone suffers a complication is a far more difficult question to deal with - it may be that no one is at fault. Some of these things simply just happen.
Re:Deserved (Score:2)
balloonhead writes:
"The book itself I have read some of - it makes a series of excellent points; one of which in the tagline - "notes on an imperfect science". We don't know very much about the human body compared to how much there is. All a doctor has to go on is a series of symptoms and an examination, followed by some lab tests. Most illnesses are diagnosed from the symptoms. Surprisingly few from the examination. Lab tests are mostly non-specific - they can confirm or refute your diagnosis, but a minority will actually make a diagnosis on their own."
I would have more respect for this angle if doctors weren't so opposed to tools specifically designed to aid them dramatically in this area [zutnet.org].
"The problem is that symptoms are very non-specific. Only a tiny minority of people with chest pain have a cardiac (or other "serious")cause for it. At the same time, a few people will have a serious disease but the symptoms are not typical of it. Do you investigate everyone for every disease? No, takes far too much resources with only a tiny return. What is done instead is the doctor listens to the story, examines the patient, and tests for the likely (in view of his findings) causative process, and also any serious (i.e. missing these would be bad shit) things which might give similar symptoms."
Agreed. But this is why I placed the "with a rate of success that is expected for that same illness or complication" caveat.
"Bear in mind another few things - half of all people are below average intelligence; i.e. half of physicians are of below average ability; symptoms are often misleading, and tests and investigative surgery can cause their own problems, and you see my point - any area of medicine is a risk/benefit analysis. At the end of the day it's all probability - gambling with your life, in essence."
Mm. Good point there. Elimination of the lower half would just raise the bar and create a new level of "deficiency."
"One or both of them might be competent or not. But the fact that someone suffers a complication is a far more difficult question to deal with - it may be that no one is at fault. Some of these things simply just happen."
I agree. But it is the reaction to it that I'm concerned about. I believe that if a panel of peers (ie, doctors) cannot unanimously or near-unanimously agree that the doctor was greviously in error they should not be cited for it. I think fellow doctors would be sensitive to what a doctor can and cannot do. But then you have the invisible flipside -- the financial pressure on an institution when a lawsuit is brought to bear. Then the doc is the sacrificial lamb. So I would advise that the review board be entirely seperate from the organization or institution with which the doctor is affiliated.
Re:Deserved (Score:2)
Doctors would do well to use computer aided diagnosis - if they prove their potential. A few things stop that - lack of suitable computer facilities ( you wouldn't believe some of the machines running in some hospitals, in major cities - for instance windows 3.1 and sub 60MHz processors(!)), a certain level of distrust (remember a lot of the previous generation of doctors never used, and still can't use, computers), lack of evidence (all the evidence is pretty anecdotal - no double blind randomised controlled trials, which is really what has to happen). Until one has shown these to be statistically significantly better than humans, using one only opens yourself up to litigation. What if it's wrong? If it isn't standard practice, you are up shit creek. It will come eventually, but these are recent databases (at least with any real usability - the shit ones have been around a while) and have to prove themselves. It will take off when the recent crop of computer-literate docs progress through the system, probably as an adjunct to traditional diagnosis, at least in the early stages.
As for the rate of success / complication... the problem with this is that even if you have good success rates, any individual you operate on has either a 0% or a 100% chance of (significant) complication. As I said about the good doc / bad doc scenario, having the best success rate in the world may not necessarily mean that failures are simply accidents. Equally being crap doesn't mean that patients suffer complications.
The current system - audit, whistle-blowing and peer review, is probably the best system given the circumstances. However, for several reasons (grudge, patient's unhappiness with treatment regardless of result or possibility of error) this system is bogged down with doctors, suspended on full pay, often for months without appeal, for whom the allegations are eventually shown to be false. Certainly the system has to be in place to allow this review, but the vast majority of accusations are found to be baseless.
Essentially, the current system is by no means perfect. Shit docs get away with ineptitude, and good docs suffer vendettas. But it's still the best system available, allowing anonymous accusations from worried colleagues as well as review of success rates.
A last problem is the perception of blame. A surgeon can perform a faultless operation, care can be perfect, but the patient can still suffer problems. In a climate of litigation, this can still result in a successful claim - certainly in Britain where I practice, the NHS provides some liability cover. However everyone takes out their own insurance as the hospital risk managers will rarely opt to defend a case - even when it is patently defendable, to avoid legal bills which are often in excess of the offer.
The review board is usually separate from the institution (e.g GMC here) and is generally acknowledged to be fair. It also has non-medics on it.
Essentially, there is no right or wrong answer currently - but until someone proposes a better system, we are stuck with this one. Incompetent docs have to be accountable, but the problem is that these are the minority, and (very) often good doctors make mistakes too.
We? (Score:2)
No, we do not. More and more people are realizing that doctors are people, not robots.
It seems older generations (I'm speaking from personal experience here) are the ones that accept everything a doctor tells them without questioning. The later generations seem to be more involved in diagnosing (sometimes correctly, sometimes wrongly) their own ailments.
Re:We? (Score:2)
- No, we do not. More and more people are realizing that doctors are people, not robots.
Hear, hear! My father's in the end stages of pancreatic cancer right now, and neither he nor my mother will even consider the possibility that their doctors could be doing a better job. Drives me crazy...It seems older generations (I'm speaking from personal experience here) are the ones that accept everything a doctor tells them without questioning. The later generations seem to be more involved in diagnosing (sometimes correctly, sometimes wrongly) their own ailments.
insurance (Score:2)
Re:insurance (Score:3, Insightful)
Re:insurance (Score:1)
Its the Lawyers (Score:2)
Two sided coin... (Score:4, Insightful)
The same things that make humans fallible, also make us efficient and effective. The same "intuition" that may lead a doctor to be wrong, will many times lead them to be right. I would not want a computer diagnosing me. That human intuition may be able to quickly identify my problem, and fix it.
Think about this, if every person could write their own prescriptions (I'm NOT advocating this, just a thought experiment) they could probably treat their known illnesses well (assuming they are responsible, and a bit intelligent). It's not hard to find research data on different drugs. The information is relatively easy to come by. I could compare the different drugs used to treat my condition, evaluate the effectiveness with the risk, and make the decision. I realize that this is a huge oversimplification, but my point is that the biggest reason I go to the doctor is for his/her intuition in my diagnosis (and because I can't write my own preciptions).
Why Doctors Kill (Score:2)
Why Some Doctors Kill [abc.net.au]
Demon Doctors - Physicians as Serial Killers [galenpress.com]
Medical Serial Killers [kaiserpapers.org]
Britain plans wide probe of serial killer doctor [cnn.com]
..when a patient in pain ... (Score:4, Interesting)
Because it is the patient who is experiencing the pain involved, unless the physician can provide alternative pain management measures, and as long as the treatment desired is valid (no "Hit me on the head with that skillet" or "I demand you sacrifice a goat to Baal"), a patients wishes should be honored even if there are forseeable side effects to the treatment. Since the most oft used reasoning on limiting pain management is the possibility of addiction (which is not as great a risk as is currently taught in most institutions), the patients wishes should definitely be respected and the pain should be treated.
Re: ..when a patient in pain ... (Score:2, Informative)
1. It often interferes with blood pressure and other systems.
2. It most often interferes with diagnosis.
3. It very often makes anaesthesia more difficult in case of surgery.
Anyone who thinks that a screaming patient just rushed in from the ambulance should be given something like morphine just because they 'hurt real bad' without a proper exam and consultation is insane.
MOD PARENT UP! (Score:2)
Complications.. (Score:1)
There are good and bad doctors everywhere. I don't know the statistics, and they're probably unknowable. But I do observe that our expectations are raised when we read about the wonders of modern medicine and the peaks of what can be accomplished. That makes the cases in which miracles are not accomplished, or worse, all the more disappointing. My own situations involves a surgeon who didn't react promptly or decisively enough to a complication. He's now off the case, but those who have replaced him have done very well and have been a pleasure to deal with.
Gawande's story makes worthwhile reading for anyone who deals with -- or may have to deal with -- medical professionals. I think that means pretty much everyone, sooner or later. The book will give you an appreciation of what MDs are up against, but also for the wide range of how different doctors DO deal with their patients, disease, and the uncertainties of the field.
That's why... (Score:1)
IMO doctors don't get paid nearly well enough. During residency, if you compare the hours worked vs. pay, they don't get paid nearly as well as one might think. Plus most start working with a massive student debt to pay off.
No, an engineer's life for me.
Sleep! (Score:5, Informative)
Long Hours, Little Sleep [ama-assn.org]
Sleep Deprived Medical Residents Ask for Limited Work Hours [talkaboutsleep.com]
Fatigue, Sleepiness, and Medical Errors [ahcpr.gov]
Doctors Are The Third Leading Cause of Death in the US, Causing 250,000 Deaths Every Year [mercola.com]
Lack of Scientific Background and Hubris (Score:5, Informative)
In my experience, there are two rather large things wrong with physicians that could be improved. Both of these would have a positive effect on outcomes. Neither are discussed much. It sounds like neither of these are touched on in the book.
First is a lack of scientific background. Now, I don't mean that some doc didn't have a BS in biology or whatever. They don't think like scientists. Far too often, physicians build up a mental table of symptoms. When a new patient presents with a condition, the table is consulted. This works fine in general, but falls apart miserably in corner cases. To solve those corner cases, some deductive (and inductive:) reasoning is called for. It is staggering the number of physicians who lack these skills. In some ways, newly minted MD's are better in this respect. They haven't had the time to develop a catalog, so they are reasoning through EVERYTHING. Sure, it makes them slower, but everything will be reasoned through. Docs with 5, 10, 20 years of experience have built a corpus of knowledge that they refuse to look beyond.
But all is not well with new docs. All physicians suffer from hubris. No kidding that this is one of the seven deadly sins. Most doctors are convinced of their own godhood. Check out Alec Baldwin's character in "Malice". Yes, it is a caricature. But there is also a grain of truth in his portrayal. For most doctors, questioning a diagnosis or treatment plan is a surefire way to piss them off. Being correct when they are wrong will drive them to either apoplepsy or catatonia. Is this something they come out of med school with? I think so. Older physicians seem to be better in this regard. There are two possible explanations that immediately come to mind. First is that they have experience to show their human failings. The other explanation is the makeup of the teachers and instructors in most universities today. Thirty years ago, they were staffed by former physicians, those who had had private practices, large patient caseloads, etc. Today, like much of academia, they are staffed by professional instructors. If you can't see the problem with this, I can't help you.
What's the solution? I really have no idea. Once the hubris disappears or is mitigated, it should be possible to learn the thought processes necessary to do good medicine. But how do you convince someone that they have too much pride? This is a real world problem for me, as my practice has several new doctors. They have potential. They can be great. But can they get past their own thoughts of superiority to recognize their weaknesses in certain areas?
the power of Hubris and Shamans (Score:1)
Hubris (Score:2, Interesting)
My mother came out of residency (as a psychiatrist) about 6 years ago. From what she has said, your first explanation is plenty on its own. Being in medicine constantly teaches you how human you are. You start out thinking you will be the perfect doc, and then you make a mistake. You decide you will never make a life-threatening mistake -- and then you do. You revise this and decide you will never make mistakes because of tiredness, or ignorance, or sheer gutwrenching stupidity -- and then you do all of these. Then, well, you will certainly never make the same mistake twice, right?
Eventually, if you're honest, you have to recognize that you're human, and sometimes you're going to screw up. I wonder if this is a process that psychiatrists navigate more easily than surgeons?
Arrogance is a huge factor (Score:3)
PKI system. It's a computerized diagnosis system
that most doctors are reluctant to use because
it does a large part of their job. They absolutely
refuse to admit that the PKI system can diagnose
a patient better than they can, or even be
considered a useful tool. I can draw parallels with
certain UNIX Guru's I've had the displeasure of
working with that absolutely refuse to embrace new
technology, then go ahead and blow deadlines because
they "Know the right way to do something, and that's
their way". Figure out a way to force medical
professionals to embrace life saving technology
like the PKI, make the use of a computer a
mandatory skill for the degree program, and you
might see a lessening of misdiagnosis.
A Sympathy for the Doctor? (Score:3, Offtopic)
I have not read the book. I'm planning on it, when finances permit me to spend something on myself again that isn't required for my profession (we've all just come through the annual gift-giving frenzy).
There's a saying: You can find "sympathy" in the dictionary between "shit" and "syphilis". That pretty well sums up my feelings about sympathy in general. Unfortunately, it also sums up my feelings about the medical industry, of which, like it or not, doctors are a part.
Now, Americans live in a country where crisis medicine (medical procedures used to treat catastrophic and sudden bodily failures, like injuries due to vehicular accidents or sudden onset of acute illnesses, like appendicitis) is king, and is very well developed. Why? Several reasons.
Unfortunately, the very nature of quick fixes is that they are prone to mistake. So, we see doctors make mistakes. No reasonable person would fail to cut someone slack for making an honest mistake. Of course, that's the rub. Most people aren't all that reasonable, period, much less so when they're in pain.
But the flip-side to that is what I'm going to focus on, and it's a point alluded to in the review above. When doctors make mistakes that aren't honest. Maybe they were being sloppy. Maybe they were in too much of a hurry, not for good reasons, but for a golf game. Or maybe he just had to get to the bank. [cnn.com] In the cases of the most notorious failings, like Dr. David C. Arndt (mentioned in the linked story), national coverage guarantees that he won't work in this, or any, town again. But what about the ones who don't make the headlines?
In 1994, I had surgery to repair a hernia. It was a dime-sized hole in my left lower abdominal wall. The surgeon that my GP sent me to declined to do the surgery laproscopically, even though it was acknowledged as a method of reducing the recovery time. "We've had problems with the procedure," he told me. So I had the old method used, an anterior incision that was 4.5" long and had a piece of nylon mesh sewn in to close the hole. The surgeon prescribed codeine for the pain. Not co-tylenol, just codeine. When my wife went to the pharmacy, the clerk told her that no one had prescribed that alone in over 15 years. I later found out that the surgeon definitely had had trouble with the laproscopic procedure: he had been the surgeon working the procedure when he clipped the artery of a patient, nearly killing him on the table. Of course, I was never told that. I was never offered that information, and if I had asked, the surgeon, the hospital, the medical community as a whole would have zipped their lips to protect one of their own.
There is where the doctors fail in a way that could be avoided. Be honest! Be open! Educate me in the why's and wherefore's of your past mistake, and I'll be much more likely to give you credence in the future. But if you keep it quiet, and I find out later, then you're toast. I'll sing like a bird to anyone who will listen, and that's when the power of "word of mouth" advertising really shines.
Sympathy for their mistakes? Sure, if it's warranted. I'll cut that much slack for anyone. But if you hide it all from me, I'm going to assume you don't want me to know, and I'm by nature a very suspicious person...
Re:A Sympathy for the Doctor? (Score:3, Interesting)
In a word, 'Bollocks!'.
So.. Every user in a system needs to be told 'This is the sysadmin who accidentally deleted someone's files years ago, and didn't have things on backup', so they can use a different sysadmin?
You want to be told 'This taxi driver once had a car crash! I wouldn't use him if I were you'... This checkout attendant once shortchanged..
Where on earth do you get your clue from? If you want to be educated, go get a medical qualification. Start on proper courses to train you in exactly what being in the profession means..
Honestly, you're sounding like one of those 'holier than thou' people we so often see in politics. Of course they would never make a mistake, but everyone else needs to be open and honest, and let them know all their little failings..
The world is a big bad place. Bad things happen. Nothing is infallible. Some people actually spend many years training to try and help, and perhaps make a difference for the better..
When you can make a difference as profound as a doctor, carry the stress of the decisions day in and day out, and be perfect, then feel free to cast your stone.
My counter story is that each member of my immediate family have at some point had accidents that would have been fatal, if not for some person who trained and knew enough about the body to fix them, and they lived.
Would it have helped to know that these same doctors had lost patients on the table, or the ward days before? Not in the least.. If you go that route, you'll never havea doctor operate on you.. And thus, when it's needed, you'll be too paranoid to accept the risk, and just plain die of neglect.
Malk
Re:A Sympathy for the Doctor? (Score:2)
Well, of course! If I found out that a prospective sysadmin's carelessness with the delete key coincided with his cavalier attitude towards data security, I'd fire him and replace him. The delete might been an accident, but the lack of backup was most certainly not. And that's the difference between an honest mistake that wouldn't get a doctor blackballed and culpable negligence that would.
Let me get this straight: you're actually comparing a clerk who short-changes someone once, with a doctor that kills or maims a patient due to negligent behavior? I don't think I need to address this point any further, other than to suggest you might want to be better armed in this arena. That one was pathetically weak.
Causing severe injury, maiming, or death of a patient is not a "little failing". You're trivializing a life, which I'm sure is easy for you, since you seem to be having difficulty understanding that we're not talking about simple mistakes. We're talking about the willingness to cover up negligence.
False, half-true, and true, in that order. The world is a place, period. Things happen that can be viewed as good or bad, depending on perspective, and we finally have agreement on one point: nothing is infallible. Incidentally, I don't know where you're from, but I have a guaranteed right to speak my mind, even if it's to cast stones. I neither asked for nor need your permission. And since you have no idea what I do with my life, I'll just ignore your implication that I don't do anything as "profound as a doctor". I will say this: I certainly don't worship them, and I don't think the "D" in "M.D." stands for "Deity".
Would it have helped to know that these same doctors had lost patients on the table, or the ward days before?
As I said in my original post, crisis medicine is what western medicine is all about. Among many other reasons why, it gives the doctor that ability to be an action hero. Most of our western societies like that image. It's why TV shows like "ER" are so popular.
But to answer your question, the answer is Yes, although seeing how narrowly you're trying to frame the commentary, I can see why you missed the correct answer. Would it have mattered to your family, no... at the time of the accident. Would it matter to the larger society of which you're a part that a given doctor has a mortality rate three times higher than his colleagues? Hell, yes, it matters. And we, as a society, deserve to know why. If it's a string of bad luck, well... that happens. Maybe we find out it's the doctor, using bad hygeine. Maybe he's careless. Or maybe we find out that this doctor is using the training he's received perfectly, and the training itself was in error! But without the full disclosure, we won't know.
Re:A Sympathy for the Doctor? (Score:2)
I'm not one, I just date one, so have a lot more clarification of what really goes on that most do.
Sitting down at the end of the day, and listening to the amount of decisions they have to make each day is sometimes pretty harrowing. One thing I'm awfully glad about is that I'm not one myself.
Where I'm from is the UK.. And over here there's a chronic shortage of people in the medical profession, largely due to low effective salaries (made to high pay by ridiculous hours).
There is very much a large amount of work to be done, and only a few people to do the work... So, the choice is:
a) Give the doctors time out, and simply don't treat people coming through the doors (leading to fatalities, and thus people suing, and the media crawling all over it).
b) Make the doctors work overly long hours, which can be pretty dangerous. The media climbs onto a few cases now and again, and hauls the doctors over the coals.
As for things being all emergency medicine, I'd like to dispute that. In my early 20's, a rugby accident put me way out of comission.. For this, I got Physio, treatment with a Chiropractor, and time at a chronic pain center. None of this was surgery. It took time. It wasn't a quick fix..
It worked too.. For which I'm eternally grateful.
In my comment about checkout attendants, I wasn't trying to trivialise life (as I'm pretty sure you'd have worked out, from the little glimpse I put from my family history.. Life's rather important, as I know full well just how fragile it is). I was simply asking the question of where you draw the line?
Negligence is a word often thrown around by people who, not knowing what really goes on in a profession, and seeing something come out with less than perfect results, sees a fast buck to be made, and quickly files a lawsuit.
This leads to doctors practicing defensive medicine, and deciding not to perform certain actions (such as surgery), as the risk of being sued is way to great, due to outcomes not being absolutely guaranteed perfect.
To someone who sees a family member go into hospital once in an average, say of every 10 years.. Then something going wrong is a huge thing.. It eclipses everything else.
To a doctor working on ITU, where, it's likely that you'll lose about 50% of the people who arrive through your doors, simply because med tech can't fix them, the view changes.
If you add to the list of work they have to do, and force the disclosure of every patient they'd lost, do you think anybody would ever ask them to work under your initial request for disclosure?
My point was, that being outside the profession, we get the odd glimpse in, with a really skewed perspective.
I'm a systems architect myself. I've seen things happen where large portions of data have been lost late in a day (you don't have permanent backups running all day do you?). I've seen Bad Thngs(TM) happen with GUI tools. I've made some unholy cockups in my day too in my way to where I am now.
I'm lucky enough to be in a profession where when things go wrong, someone's life isn't hanging on the end of it, merely a few hours of work.
I don't tell the ground floor users of systems I build about the configuration methods, and operating requirements, and everything else techs need to keep them running and develop. They use it, and I try my best to keep them happy.
It's the same in the med profession. I wouldn't understand a tenth of what they'd need to do to complete any repair of my body, from any point (local doc that prescribes a pill to the docs at the hospitals cutting bits out to fix me).
I hear enough to know that there are internal review boards, which can force doctors to go back for retraining if they don't seem up to par, or cast them out of the profession altogether if they're really not up to scratch.
Personally, I'd prefer to trust to that system. I honestly don't want to know too much.. The more I've learned about what goes on in operations, the risks, and procedures, and the sheer scope there is, even in the best of situations, for things to go hideously wrong, I almost backed out of a recent tonsilectomy, as I was half scared to death!
And trust me, that op needed to be done. There were complications, but they were nasty tonsils.
I certainly don't worship doctors, but, I trust them. Some of them get bad press, and some of them could be better, but at the end of the day, they're trying to help, and I'm glad they're there. They do a job that'd turn me grey in a short amount of time, and burn me out.
I know that, and accept it, thus, I give them credit where it's due for having the guts to do what they do.
As a public, I think it does the health of the population in general good to have the image of doctors as the great action heroes. It lets them trust a little more, and have peace of mind at a stressful time.
They did a show over here written by a cardiac doctor which showed pretty much exactly what went on in hospitals. People didn't watch it. And the feedback they generally got was that it made people nervous.
Simply, it stressed them out, where there was simply nothing that could be done about it. They didn't like the fact that doctors have to be a little objective about patients.
As to the dispute about the world being a big bad place.. It is... It's always been a fight, evolution requires that. Now humanity's past the having to fight predators, it fights itself.
It can be very big and bad. Where it's safe, I choose not to see that. It's an illusion, but one I choose, where it's safe to choose. It keeps me happier and less stressed.
Bad things do happen, so I don't think that's half true. Some are grey areas of perspective, but truly bad things do just happen. It's part of the workings of the world (unless you think a random avalanche killing a few people would actually have a bright side, and from your posting, I seriously doubt that).
If you honestly, and truly want full disclosure on everything, then, I think you're setting yourself up for a lot more stress than you need.
I tend to trust certain things, like the medical profession, to do their best. Not be perfect, just do their best, and to keep watch to try and keep the people as safe as possible.
I know it's an illusion that I'm safe when I go into a hospital, but, it's one that I choose. It'll give me a little peace of mind, and not affect the outcome of the situation one iota.
I'm not trying to prevent you having your say, and I'm honestly glad you replied. It put more things in context, and I understand more of what you were trying to say. I think we just share a different perspective on life, which is all fine and good. I just want to be able to place trust that someone, somewhere is trying to do the right thing. And a doctor's a fair place to start.
Malk
Re:A Sympathy for the Doctor? (Score:2)
Re:A Sympathy for the Doctor? (Score:2)
WHY did I not think of library? Thank you. I clearly needed a kick in that direction. I'll look into it.
Re:A Sympathy for the Doctor? (Score:2)
From personal experience (Score:2)
From a Doctor's standpoint, they often have to make a determination even when the patient refuses to believe they have what the doctor claims. Bro-in-law just got treated for stage two syphilis - he swore up and down that he'd been celebate for the last four years...Even after we reminded him of the 'evidence' we found after he house sit for us (for the last time.) So add signal-to-noise ratio from patient.
OTOH, I've got two brand new Twin boys. They were born almost five week prematurely. They've spent the last 9 days in the Neonatal ICU while their systems catch up with their birthdate. The insurance company has been charged $5k per day, per kid for the 'hotel stay'. Nearly $100k so far, and that doesn't include the C-section, the two OBGYN's, the endocrinologist or the geneticist. I have no clue what the final tab will be, only that the insurance company will cover it, and we're out about $200 in co-pays.
I'm curious if there's an additional negotiation AFTER that bill, perhaps there's an additional 80% 'hospital to insurance carrier' discount we don't hear about...If not, I can't possibly see how my $400 a month in insurance premiums could HOPE to cover the medical expenses (20 years at $400 a month is only $96000, heaven forbid I got sick AND had twins.)
Re:From personal experience (Score:2)
Re:From personal experience (Score:2, Informative)
Yes, there is, though it's only about 50%.
A few years ago, I had to have surgery to repair a broken bone. The insurance company paid it, then a year later rescinded payment, So, the hospital sent me the bill. However, since it had already gone through the insurance system, it was the version of the bill that went to the insurance company. Right down at the bottom was a 50% discount for the insurance company.
This is also where I learned that the hospital administration was padding the bills. Had the anesthesiologist even given me half of the vials of medication on the bill, it would have killed me. Both the surgeon and anesthesiologist were well known to my wife and I, and flatly denied any knowledge of claiming that much medication on the bill. Seems this is the way the hospitals are "getting back" at the insurance companies for fixing prices so low on what the hospital is allowed to charge for a procedure.
Lessons learned? #1, Cash-paying customers are taking it in the shorts because of strong-arm tactics by the insurance companies. #2, if you need to pay cash on a hospital bill, especially for a surgery, have a medical professional review your bill before you pay it.
I ended up not paying the bill for two reasons. First, the insurance claim was legitimate, it wasn't my fault the hospital was stupid enough to give the money back without consulting me. Second, I told them that if I ever saw that bill again, I'd have them in court for fraud. I never heard from them again, and the charge was removed from my credit report.
Contracts and Incompetence (Score:2)
Screwups in the paperwork costs an amazing amount for both hospitals and insurance companies. Patient theft is another big loss.
Patients changing insurance companies every year or more just adds to the screwups.
It starts when a patient is admitted, and the poorly trained (Thankx Anderson Consulting!) receptionist gets the forms wrong, usually by sins of ommission, or glitches with the insurance company's pre-approval process. Then the correct medical billing code (very thick books with the standard codes are updated every year) needs to be used. While the billing systems have fields for extensive notes, since they aren't required to be entered, allmost no one does. Nor do they bother to read them.
Hospitals have contracts with insurance companies which are similar to Microsofts OEM contracts, details are hidden by an NDA. These provide substantial incentives *PROVIDED* claims are submitted on time, if not, then the hospital doesn't get 100% re-imbursment. Even if the hospital makes the deadline, the insurance company will claim it didn't. Since often neather side's peons has a copy of the contract, and the hospital's peon has more incentive to simply clear another case rather than save the hospital $20K or $30K, the point isn't argued.
At this point, the insurance company now has a payment deadline, unless there is a mistake found in the claim. Or the patient's chap 11 dot com "forgot" to send in their insurance payments. Or a claims reviewer is using an old copy of the codes. Or the pre-approval code doesn't match the final code because the code number changed during the process. Or......... (Hmnn, what's the intrest on $50K for 6 months?)
The real fun starts when a patient gets the re-imbursment check. Lets see, on one hand a terminally ill person can use the $100K on trips and quack treatments, or he can just send it into the hospital where maybe an underpayment mistake will be found. Or the patient can just "forget" they ever had a procedure done. (true story, patient needed to be reminded that a 6'5" 260# doctor shoved a 2 foot tube up her ass before she acknowledged that there was a reason she owed the hospital money. Makes me wonder what she usually shoves in there since the experiance hadn't been memorable)
HMO's and hospital love the pointy-haired logic that a surgeon can be paid a fraction of his standard rate since he can "make it up in volume". And if a surgery goes over the esimated time, he doesn't get paid extra since he can just work faster on the next one.
To sum it up, hospitals are effectivly giving insurance companies discounts by screwing up their claims and collections, and cutting doctor's fees.
Doctors and Garage Mechanics (Score:3, Insightful)
He/she does not have a complete manual of the 'car'. Constant updates to the 'manual' are occurring but they are often contradictory and not settled upon as fact. Also, due to the heavy specialization diagnosis can often be off because the mechanic/doctor has never seen the problem before and will try to fit the condition into the wrong pigeonhole.
Under these conditions, are you going to accept the word of the first doctor you see? You shouldn't. Depending on the seriousness of the condition, getting second and third opinions are lifesavers.
The fix is going to have to be a revolution in diagnostics, where vast comparative databases are at the doctor's fingertips, and the whole weight of medical wisdom is brought to bear on each person's case.
We will need doctor success rates for the purpose of identifying doctor mistakes quickly for correction not punishment, means to make sure people are not turned away because they will likely lower the doctor's 'batting average', truly incompetent dangerous doctors are weeded out less expensively, and an understanding by the general populace of the risky nature of any medical care.
Define incompetence, then (Score:2, Insightful)
I expect a doctor to follow a similar process, maybe even more rigorously -- ater all, no one dies if my database does down in flames. However, there is the additional constraint of time, which may require parts of the process to be sacrificed. In my mind, competence is following this process and making sound judgements. Incompetence is hurrying so he can make his tee time.
Unfortunately, determining competence is complicated by the fact that it is fairly subjective. Someone has to look at all the facts and decide, did this guy screw up negligently? And that's the jury. Not that I think our court system is very good at getting to the truth and assigning proper damages.
I think that if something went wrong while in a doctor's care, if the doctor went to the patient, honestly explained the situation, and apologized sincerely, many (I won't say most) people would accept that. But hospitals are so terrified of lawsuits that they would never allow a doctor to do that, because it would be a huge liability, tantamount to a "confession" that could be used in court. And many doctors, I think, don't feel enough compassion for their patients to want to make that kind of gesture (maybe not, but that's my impression, given that doctors spend very little time with each patient).
So we're left with a situation that if anything goes wrong, we don't work it out mano a mano, but we go to court.
Bull-@*($*(@ (Score:3, Insightful)
1. The psychiatrists are often idiots. It is amazing to discover the number of psychiatrists who went to med-school in the third world. Rough estimate: 75%. After three psychiatrists I couldn't understand, I ran into one who did speak English. Of course, he was also a wacko running what appeared to be a cult out of his office.
2. The psychiatrists are often wrong. The first psychiatrist I went to (for ADHD that had been thoroughly diagnosed by two separate psychologists before I was willing to pursue medication) decided after 15 minutes that I was bipolar. He then prescribed a mood stabiliser that made for the worst month of my life. I would sit there, all day, unable to feel anything. I was calm - but I was miserable, couldn't sleep, and developed carpal tunnel from the water retention that was a documented side effect of the drug he gave me. Turns out this drug was brand new, very expensive, and heavily advertised.
3. Let's say I am mis-medicated and develop manic tendencies, and go on a rampage. (A distinct possibility with some of the meds used.) Who goes to jail?
The doctor?
Hardly. I go to jail. The p-docs want total authority, but it is hilarious to watch the way they dodge responsibility.
The bottom line is, I refuse to surrender my control to any idiot with an MD. I now have a doctor who has finally figured out that (a) I have done my homework, (b) I am more aware of what's going on in my head than ANYONE else, and (c) he can prescribe medication, but he can't make me take it -- I'm adhd, not psychotic and not committable. I can be fairly functional with no meds at all so long as I don't go to school. So he has to convince me that the med he proposes is the best course of action. He is okay with this, and he has to be if he wants to continue getting my money.
The sad part is that, if I weren't so stinkin' stubborn and didn't read so much, I would have either roled over and played dead or given up on the whole process. The point of all this is not that all psychotropic meds are bad - in fact, getting the ADHD medicated has made a tremendous contribution to my welfare and the welfare of my family - but that you shouldn't trust someone just because he's a licensed physician.
Re:Bull-@*($*(@ (Score:2)
As it turns out, I am ADHD (which I have suspected my entire life) and mildly autistic (Asperger Syndrome). Only just now (at 26) am I figuring this out and that is from online research and meeting people in the community.
My current psychiatrist initially said I had an anxiety disorder (which I do), a depression disorder (which I do), I was probably ADHD, but I was "too high functioning" to have any form of autism. I started questioning him about his knowledge of Asperger Syndrome and quickly figured out I wasn't going to get any useful input from him. He was clueless. Utterly clueless.
Eventually I found a psychologist within my HMO who was somewhat familiar with it (and more importantly, was interested in learning, and actually read the research I had done) and agreed that it fit the bill eerily well. I am off to see an autism-specialist Psychiatrist next month to finally get my final AS diagnosis (not that it will make any difference in my life, I know who and what I am), but I have lost more respect for the mental-health field in the past year than I could ever place in words.
Welcome to America (Score:2)
There are doctors in certain states who are retiring early or leaving because of malpractice lawsuits. For example, many states of shortages of OB-Gyns b/c everytime a baby comes out retarded its blamed on the doctor, rather than their pot-smoking, alchohol drinking, stale sperm or old age of the parents. Its sick! Its hard enough for a doctor to pay their student loans AND make a nickle off the HMO's, but now they get rejected for malpractice insurance applications as well.
just like programmers (Score:2)
Enough! (Score:4, Informative)
First, I ran through the numbers a few weeks ago. Financially, if one became an RN (Registered Nurse) instead of a Physician Family Practitioner, you would be financially ahead of the physician by the time you account for deferred earnings and accrued educational debt until that physician had been out of residency for 10 years. That means that the nurse who began a career on graduation with a BS at 23 would be 41 before their counterpart that did premed and went to medical school would be financially even with them. Smart investing and good use of shift differentials as well as perhaps a masters degree in nursing could put them ahead indefinitely.
Further, medicine isn't recession proof. In the metro Seattle area, over 40 primary care doctors have become unemployed because the closure of a couple of large groups and layoffs by the big local HMO. Those guys don't just bounce into new jobs overnight.
The money in medicine is going elsewhere (lookup Tenet (NYSE: THC)). It's funneling into giant management corporations and insurance houses. Those of us out working with patients see very little of the money that comes in. Most family practices have overheads in the 50-60% range would greatly cuts the amount to the physician paid by the insurance. That combined with the endless gameplaying where insurance companies pay only a fraction of billed amounts.
As for the implication that doctors would rather operate than anything else is silly. I do office procedures, yes, but those are time consuming and pay relatively poorly. Besides, it's still possible to do the right thing without constantly thinking about the bottom line. I'm sure there are unscrupulous doctors out there, and frankly I've seen some questionable things done over the years but it's hardly the rule.
Most docs are out there humping it just ot make the debt service for their student loans. The days of fat cat doctors who made millions is long since over. I'd recommend getting ahold of a recent copy of Medical Economics to anyone who'd like to get a sense of what primary care physicians are up against. For those who intentionally decided on engineering instead of medicine, you made the right choice. A decent engineer makes as much or more than a family doc and has no call and minimal liability.
When medicine becomes a commodity (Score:2)
The healthcare system in general, is out of control. We've got managed care facilities who attempt to minimize costs, rushing patients through the process whether or not they've accurately diagnosed or treated the patient's illness. We've got hospitals that charge whatever they can get away with for a given treatment regimen. We've got a growing population that thinks it's everyone else's responsibility to look after their medical needs after years of abusing their health. What does this have to do with doctors and their ability to practice medicine? One might reason that it's just one more facet of the same problem- a large disconnect between the medical community, the people they serve, and the individuals that ignore the responsibility they have toward their own physical well-being. In short, if we took better care of ourselves, it's likely that we'd spend less time in the doctor's office, thereby lessening the potential for any of the anomalies cited by the author.
Moore's Law for Medicine (Score:2)
By the time I finish my residency,the information available when I started medical school will have doubled.
A writer of a textbook put it best when, to paraphrase, he said "If one were to read for an hour a day every day for a year, he'll be 8 years behind at the end of that year alone."
I know the author... (Score:3, Interesting)
For those of you calling for doctors to be punished when they screw up : grow up, please. Life is never that simple. There are some bad doctors, but even the very best make mistakes, often for reasons beyond their control. If you read the book you'd understand a bit more about how seriously screwed up our medical system is.
Take the Residency system, for example. Simply, the Federal Government pays for a certain number of Residents (recently graduated MDs seeking speciality training in their chosen field) for each hospital. They are essentially 'free' labor for that hospital, so they are worked the hardest. The janitors earn more than they do, on an hourly basis (and even with the new hour restrictions coming in, $40K a year for an 80 hour week where you could kill people through tiredness isn't all that swell).
As the cheapest labor in the hospital, Residents spend a lot of time doing 'scut' work that should be done by porters or nurses, rather than doing what they're trained to do - you could do a lot of good if you spent that entire 80 hours a week being a doctor, but you'll be lucky if you spend half of that time actually using what you learned from med school. It's grossly inefficient, and since the alternative would cost hospitals money (they'd have to hire, and pay for, more porters or nurses) there's no incentive to change. That's just one of the many, many things that makes the delivery of medical services in this country so damn expensive and inefficient.
And that's not even mentioning the patients on State medical insurance who call out an *ambulance* in the middle of a *blizzard* because they have a freaking *sore throat*. My tax dollars at work. Gah.
Re:I know the author... (Score:2)
What about the doctor that told us it was alright tha a child didn't speak before they are three? because od the medical advice, my child will have a speech issue his entire life. Should I just "grow up" and let the whole thing pass with a whimsical chuckle?
how about the ghuy who wakes up to find out that the Dr. cut off the wrong limb? should he just "grow up"?
those doctor should be punished.
If a Doctor screws up, it will change(or take) someones life. That is why they are punished heavily. Are there situations where a lawsuit is unreasonable? yes, but that is no reason to not hold Doctors liable when they are incompetant.
As child, my doctor saved a mans ability to walk by using an emergency procedure that was still in trial. If he had not done it, them man would not of walked ever again.
The man sued for malpractice. they settled out of court, but I hope there is a special place in Hell for that guy.
what we need is a way to judge what happened, and deal with in approprietly.
Re:I know the author... (Score:2)
(by the way - industry best practices now call for the surgical attending to mark the limb to be removed prior to operation. It's sad that it took until the mid-90's for this practice to become widespread)
Malpractice suits and our litigous society make it really hard to seperate the unavoidable mistakes from incompetence or genuine wrongdoing. Juries are often swayed by 'professional' medical witnesses who make their living testifying in court against defendents.
Flesh Mechanics. (Score:2)
Flesh mechanics. Some of them know WTF they are doing and some of them, like we used to say of all obstetricians, only need to know how to 'Catch!'.
And you are a bucket of loosely organized uncooperative parts.
Our health is in our hands, not our doctor's (Score:2, Interesting)
Finally I visited one doctor who told me I needed to drink more water, have a humidifier in my room, and change my diet to largely plant based. In a few days my kidney problems ceased without any drug or surgical interventions.
Over the years since then, I've read, and noticed that the majority of health problems can be easily solved by the patient themselves. Just a little research from your local bookstore, or even the net can go a long way.
Doctors should really only be used to help diagnose your symptoms, and to treat those problems that you cannot yourself.
Instead, many of us see the latest drugs on TV and rush in to the doctor wanting him/her to prescribe them. All drugs are toxic and most have unintended side effects and consequences. If you dont believe me, check out side effects for a few popularly prescribed drugs that patients could easily be solving in more natural ways:
Zocor - http://www.medications.com/index.php?act=se&drug=Z ocor [medications.com]
Yasmin - http://www.medications.com/index.php?act=se&drug=Y asmin [medications.com]
Paxil - http://www.medications.com/index.php?act=se&drug=P axil [medications.com]
Levaquin - http://www.medications.com/index.php?act=se&drug=L evaquin [medications.com]
Sure, drugs have their place in certain circumstances, but doctors being in thrall of the pharmaceutical industry really set themselves up for lawsuits from uninformed patients who sometimes pressure them, and many times, medications are seen as the easy way out to shup-up a complaining patient and move on to the other one.
Fellow slashdotters who are ill, should talk to their doctors, and research natural alternatives from a variety of sources before submitting to surgery and medications. And if surgery and medications are unavoidable, get second and third opinions for convention and alternative physicians. You can save your life that way. Check out sites that expose certain health myths, such as The Physicians Committee for Responsible Medicine [pcrm.org] for more information.
My $0.02 worth (Score:3, Insightful)
1. My father was killed by a doctor. He had an aneurism behind his right knee he did not know about. He went to change a tire on my mom's car and when he squatted down his entire leg from the knee down turned white. He stood back up immediate, went inside, got my mom, and they went to the hospital. The surgeon on duty said he knew exactly where the problem was, didn't wait for x-rays, and operated in the groin section. First indication of a bad doctor. My mom, like my dad, believed doctors were gods. When the aneurism was not found they put my dad in Intensive Care (IC or ICU) and did the x-rays. Then the doctor botched the job by sewing my dad's main artery almost shut. He got gangrene and a blood clot detached. He had a stroke and died. My mom never sued. This is why I do not trust doctors and I always get three or four opinions. It is expensive but it is worth it. I don't want to wind up like my dad.
2. I have phlebitis. Major phlebitis. I, luckily, found a competent doctor who put me in the hospital. My blood was so thick they couldn't get any out to test how quickly it would coagulate. They thought I was going to die but I didn't. This was after seeing three other doctors.
3. A while later I was put on something called hydrochlorothiazide or HCT. It is a diuretic and has some other side effects. If you go to the Food and Drug Administration's website [google.com] you can read up on just how bad this drug is if you get on it's bad side. One of those is that it makes you a bit dizzy as well as complacent. My great doctor I'd found turned out to like to fondle his male patients. I found another doctor.
4. The new doctor decided that since I am fairly well read and can think for myself that she would rather I just died - and told me to my face. She is no longer with the clinic I go to.
5. The next doctor I had I'd gone to twice when my leg with the phlebitis swelled back up. This was great cause for alarm with me. The doctor sent me to get a Venogram (sp?) done. The tests were inconclusive so he said "Take two aspirin and call me in the morning." (Honest to god! He actually said this to me!) I reminded him that I could not take aspirin since I am on Coumadin (a blood thinner) and I would die of internal bleeding (which he should have known about). He changed it to Tylenol. He's not working at the clinic any longer either.
My current doctor has been my doctor for the past two years and we have gotten along well.
Enough stories - here are my thoughts:
1. Doctors should have access to several databases. These should have diseases, muscle, nerve, bone, viruses, medicines, and other categories which I am probably leaving out.
1a. The databases should have symptoms, causes, effects, treatments, and most importantly, side effects, problems, reactions, and any other bad things that can happen from doing whatever it takes to fix the problem.
2. A drug interaction database. So doctors can know exactly what might interact with what and how to treat the problems that occur. (With hyperlinks to relevant information so they can verify the information for themselves if they need to do so.)
3. A database with methodologies on how to improve the human body so they don't have to just push pills on everyone. This should be open to the public as well (readonly status of course) so people can get on-line and find out how to keep themselves healthy.
4. Now, the important part: Make this available via wireless PDA to the doctor no matter where he is. So they can just plug in what is wrong and the AI breaks things down into percent chances (%c) of what is the matter. The reason this is so important is because I have seen (and I am sure so many others have) that your doctor only kind of knows you. If they are seeing over a hundred people a month they can not keep straight who's problems belong to whom. But a computer can. And it can recall that information and it can help the doctor to make the decisions he/she needs to make in order to help you out.
And that is the real problem here. Doctors become overwhelmed. Open your eyes and look at them. They are still doing everything with paper and pencil. Many times they can't even read their own writing. And charts? Do they have a nice bar chart that shows them how you are improving? No. They have to look at a bunch of separate papers, correlate all of that information into something useful, and then make a decision based on that information. If you think that's easy to do then have someone take twenty sheets of paper, write random numbers on them, shuffle them together, read each sheet of paper and add the numbers together in your head as you are going from one page to the next. Guaranteed that around pages eleven or twelve you will begin loosing what the number was because you also have to turn the pages, do the math, and continue going. But a PDA could do it in a few milli-seconds. Now try doing it with blood pressure, chloresterol, and other vital statistics. It's not possible. So they generalize. So long as you are up and breathing then you must be doing well. Here's a few pills, talk to you later.
It needs to stop. People cry "No! No! No! I don't want my personal information in a database!" Too bad - it already is there. What you should be crying about is the lack of proper security. We have credit cards - why not medical cards which have all of your information on the card? Can someone say flexible-CDs? Even if the card is only used as a key so only you can unlock the information - that would still be a great leap forwards for everyone. You go in, give them your card, your information is downloaded to their system, and your current information is available to the doctor. No more paying $50.00 or more to have your records transferred from place to place. Just so long as it is secure I'm all for it. Or put my information on a CD, have a good container for it (aluminum maybe?) and allow me to carry it from one place to the other. Or maybe we could go to memory sticks? These 256mb [pcmall.com] or more secure digital cards may just be the answer. Again - you carry it with you and the label says it all. "Medical Information"
Something to think about.
My Girl Friend'S Decision Not To Be A Doctor (Score:2)
My mate is currently attending a four year university with a direction in biology and chemistry. She has considered directions such as pharmaceutical industry work, chemistry related product development, research, and anywhere in related fields of biology and chemistry.
One thing that she has said that she would like to do, but will not do, is be any sort of general practitioner of medicine -- that is, be a doctor. She references her previous experiences when following around a doctor at work in a hospital. While the idea of helping people and practicing upon the human system, which she likes a lot, is positive, the surrounding circumstances that doctors are put under are totally negative.
This negativity comes from the long hours of required work (don't work 12+ hours a day = get fired), the average pay in comparison with the work output required, the possibility of being sued out of existence (unless you practice in California), and most of all, the treatment decision making process is put into the hands of "Heath Medical Operators" (HMO) and other individuals who have no medical qualification to be making such decisions.
You get to work with the patient, make a decision about their condition, make a recommendation for treatment, and then someone out of state by means of fax, eMail, or phone (who was probably selling insurance or flipping burgers in their previous job) gets to tell you what to do -- with an absolute underlying interest in their own companies's profits rather than the patient's health.
The system of government and corporate intervention in it's attempt to force down costs for those who need medical attention has had the exact effect that one would expect it to -- pay less, get less. The quality of care that a doctor can give is greatly diminished because of the terrible American health system.
The result is that she has no intentions of going into the field of being a doctor. This perspective that she has is not a rare one, and individuals in the general populous are also understanding that being a doctor is a bad job because of the insane work requirements and terrible politics involved.
Who would want to be a doctor in the United States?
Nobody.
I suspect this is going to be a problem for a long time.
Re:My Girl Friend'S Decision Not To Be A Doctor (Score:2)
I think that many many professions, medicine being one of them, need similar rules as airline pilots; there are laws about how many hours you can fly, how much rest you need between each flight, etc etc.
90 hour work weeks? That's insane! I don't want a sleep-deprived, annoyed doctor tinkering with my innards!
Misunderstandings.... (Score:4, Informative)
Salaries
The average physician makes about $150,000 per year. I know that seems like a lot. But think about this. The average physician has $150,000 in educational debt after they finish residency.....that's when they turn 30! So, you're thirty, have tons of debt, no savings, and you are just starting.
How does one determine how much a person should earn anyway? It seems to me there are 4 factors that SHOULD govern this process.
1. Physical exertion
2. Level of training/education
3. Level of responsibility
4. Contribution to society
It seems to me that for a physician 2-4 are very high.
Lastly, I can't stress this enough. PHYSICIANS ARE NOT INTO MEDICINE FOR THE MONEY!!!!! I couldn't have made it through medical school and residency if money was my motivation. Almost all physicians due this for some higher/noble purpose of helping others. It was that reason that let me get through not seeing my wife and new daughter in residency. It was that higher purpose that allowed me to be worked like a slave.
Responsibility
Bad things happend....that's life. I know that everyone has a story about a relative or friend that had a bad experience in medicine. Why do people automatically start looking for someone to blame? Doctors are able to predict a lot of things with the human body. There are a lot of things they cannot. There is a saying in medicine:it's half preventing fires and half putting them out. Unexpected things crop up all the time....it's unavoidable. Yes, sentinnel type of events like amputating the wrong leg have blame, but most bad things that happen could not have been predicted by anyone.
Flesh Mechanics
I hate this comparison. Why? Because it implies that the human body is just as simple as a car engine. It implies that every body is the same. Imagine you are a mechanic. You know that the car you are working on has an engine, electrical system, and exhaust. Now imagine that you kind of know how everything is connected but aren't sure because no 2 cars are the same. That's the way people are. EVERYONE is different. Reactions to medications are different....both good and bad. Reactions to surgery are different....both good and bad. All physicians have are statistics on how these things affect MOST people....not all. Ever hear of the uncertainty principle? Well, it's present in every aspect of medicine and no amount of research, knowledge or training will change that.
Many people have a problem with personal responsibility. It's your God given right to smoke, drink and do drugs. It's your God given right to drive without a seatbelt and participate in unprotected sex. But how do these behaviors magically become the doctors fault? A good example is the lawsuit against the tobacco industry. Yes, they hid research that suggested nicotine was addictive. Yes, they did not tell the public that tobacco was bad for you. There is one person that did.....the Surgeon General of the United States.....back in the 70's. So, it seems to me that if you started smoking after the 1970's, you knew the facts and CHOSE to ignore them. Why should you be entitled to any of that settlement. Yes, THEY were wrong but YOU made the choice and now have to live with that choice.
Physician Intentions
I know I touched on this earlier, but I cannot emphasize this enough. Every single doctor that I know (including myself) is in this field for the most noble reason I can think of....to help people. Most of us try to educate our patients so they can make informed decisions.....and they are YOUR decision. The "paternalistic model"(doing what the doctor says) of physician interaction ended in the 70's. We now live in a world where medical information is easily accessible by the public...and this is a good thing. What is frustrating is when the doctors information conflicts with the patient. I know many people feel this is just the doctor being arrogant because they "know best." Medicine rarely changes the way it treats a patient based on one study. Not all studies are good ones. All studies have limitations. Physicians know this and merely want to better educate you.
Litigation
This is a difficult topic....simply because I don't know the answer. Suing a doctor into oblivion isn't the answer. What does that get you? You have then successfully punished a doctor for all eternity and ruined his/her career and livelyhood (docs have families too) despite all the good he/she has done because of something he/she may not have done wrong. That hardly seems fair.
I have made mistakes.....none of which hurt anyone...but mistakes that I lost sleep over...not because I might get sued, but because something bad might have happend to a fellow human being.
I would also like to flip the coin here. Let's assume that I see you as a patient. Let's assume that you see me over the course of your life, follow my advice, and I treat appropriately your diseases appropriately. Let's say that all of that care EXTENDS your life by 10 years (I'm being conservative). How much is 10 years of your life worth? It seems to me that if you can sue me for taking 10 years of your life away for millions of dollars, why wouldn't giving you 10 years of life be worth millions of dollars? I am not trying to suggest that I bill that amount....that would be ridiculous.....I merely want to illustrate the point that legal action settlement are a little over the top.
Thanks for reading.....I just want everyone to know that the great majority of physicians care about you and about what you think.
Re:Misunderstandings.... (Score:2)
1. I know of *no* doctor who is in medicine 'for the money', and I know quite a few doctors. If their intention was to join a profession for wealth, they'd have become lawyers (and even that is by no means guaranteed these days).
2. The average age you enter the workforce (your first year of Residency) is 28. You start at around $40,000 for three or more years (average residency is four years). The average debt burden for Residents is around $100,000. Residents in NY are so poor they qualify for food stamps. The average work-week is around 90 hours. Hospitals are resisting changes to reduce this to 80hrs/wk because it would cost them more money.
3. Once you're done with Residency, you can expect an average salary of around $150,000. Again, not a good situation to be in if you're 'in it for the money'. Which is why I have yet to meet a doctor who is.
4. Everyone is different. To compare doctors to mechanics is to demonstrate a lack of understanding of the field. Wacky shit happens *all the time* to people, for no discernable reason. Really. Sometimes it's good shit, sometimes it's bad shit, but the one constant of medicine is Urea Happens.
5. There are bad doctors. But there are also good doctors who make mistakes. If every doctor was ruined (financially, professionally) every time they made a mistake that hurt someone, there would be no doctors. I'm not over-stating. The good to society provided by one average doctor over the course of their career vastly outweighs the mistakes they commit - yet it only takes one mistake to remove that doctor from medicine. Is that fair?
Yes, the genuinely incompetent doctors should be removed from practice, but that's not what's happening at the moment - people sue over the slightest of things, any time they get an unfavorable outcome, regardless of fault, and often win. This hurts the good doctors and makes access to healthcare more expensive for all of us. OB/GYN is particularly vulnerable right now, with good doctors (industry-leading doctors) leaving the profession in droves just because they can't afford the malpractice insurance. That's not right.
Re:Misunderstandings.... (Score:2)
Studies have shown that, in general, whether or not a doctor wins or loses a lawsuit has nothing to do with whether or not a mistake was made. The only significant determinant in the outcome of a lawsuit and the amount of damages is the severity of the patient's outcome.
Stop and think about that for a moment. A physician can make a correct diagnosis, prescribe the right treatment, and follow-up correctly, but the thing that'll make up the jury's mind is how bad the patient looks when they see him/her. If the jury sees somebody who has suffered greatly, they look for someone to pin the blame on, and the only person presented to them is usually the treating physician. By default, the doctor must be guilty/liable.
Apply that to your own jobs and see how you'd feel about working in that kind of environment. Most of you are techies, coders, etc. Suppose that you wrote a database program which worked perfectly (ha!). Then due to some hardware problem, it blows up and tons of data is lost, pensioners don't get their checks, convicted murderers get released into the public, whatever. If it worked the same way as in med-mal litigation, you'd probably lose and get sued for millions of dollars of damages to countless plaintiffs.
Malpractice insurance costs have risen dramatically in the last two years, to the point where some states are in a physician shortage crisis, because they've driven out all the doctors who used to live there. I practice in Florida, and we're quickly running out of obstetricians to deliver babies because they can't afford the insurance costs. The costs of insurance for our group (not OB/Gyn thankfully) have more than doubled in the last two years, but it's been worse for some other specialties.
When I moved here, I rented a place from an anesthesiologist who was in the process of moving to another state. Why? Malpractice insurance costs and the legally hostile work environment.
For those that stay, that means that there's even more work to go around, but less pay since the Medicare/Medicaid have cut reimbursements by at least 3-4% for all specialties (on top of increasing malpractice insurance costs), some specialties much higher. This country is driving physicians out of needy areas, and if things keep going this way they'll start driving physicians out of medicine entirely.
So next time you work like hell to avoid your duty to serve on a jury, think carefully about the people you're leaving behind on the juries. Before medicine, I myself served as a jury member in a med-mal case, and found that the people that serve on juries (even in San Francisco) are cows, easily swayed by the glib words of the plaintiff's attorney. If you won't serve as the voice of reason on a jury, don't expect to see any rationality in the outcomes, and don't complain about the high cost of medical care.
Re:A surgical resident? (Score:4, Interesting)
Back when I was in patient care, I really liked working with third- and fourth-year residents. They have a tremendous amount of knowledge but most of them haven't developed the arrogance and/or cynicism that a lot of docs get after a few years. I'd say an experience resident is in a better position to critique the medical field than just about anyone else, to tell the truth. The same is true in other biological fields (medicine is applied biology.) I'm in research these days, and let me tell you, it's the senior postdocs who really know what the hell is going on.
Re:A surgical resident? (Score:2)
I think the original point still applies. Yes, a postdoc or a resident is more familiar with academia but it IS THEIR LIFE. So in my opinion when I read something negative from them about it, to me it smacks of using controversy to gain notoriety (we all know that fame or infamy are both self serving in todays society) the more known you are the better your odds in life.
Re:A surgical resident? (Score:2)
Bear in mind that he works about 100 hour weeks (there's a big fuss going on now trying to get them down to 80 hours a week, averaged over four weeks). So really it's the equivilent of TEN years of 'regular' work experience. Plus he's surrounded by some of the best people in his chosen profession.
He is not an 'academic' by any stretch of the imagination. Frankly, I'm surprised he found the time to write for the New Yorker - I think he just doesn't sleep. But then, surgeons are weird.
Re:A surgical resident? (Score:2)
If you understood me to be calling him an academic, then I miscommunicated. I was agreeing with another poster who compared a surgeon writing about the med. profession to an academic writing about academia. I was stating that I did (and do) agree with the comparison.Sorry for the mix up.
Re: If "It's the legal system", then ... (Score:1)
A system where "people [don't] sure because they can['t]", and if a doctor is negligent with the life and well-being of your child/parent/spouse, there's no recourse?
Do you know of any examples where a competent doctor was successfully sued for a legit mistake, as opposed to gross malpractice, or are you just talking out your ass?
Re:It's the legal system (Score:2)
Re:It's the legal system (Score:2)
Oh. Oh, I see. Running away, eh? You yellow bastards! Come back here and take what's coming to you! I'll bite your legs off!
Re:It's the legal system (Score:1)
It's apmutate
and WTF
Re:It's the legal system (Score:2)
Re:It's the legal system (Score:2, Funny)
Hot Coffee = $200k, malicious action was $2.7M (Score:1, Informative)
http://www.citizen.org/congress/civjus/tort/
Legal Myths: The McDonald's "Hot Coffee" Case
In 1994 Stella Liebeck, a 79-year old retired sales clerk, bought a 49-cent cup of coffee from a drive- through McDonald's in Albuquerque, New Mexico. She was in the passenger seat of a car driven by her grandson. Ms. Liebeck placed the cup between her legs and removed the lid to add cream and sugar when the hot coffee spilled out on her lap causing third-degree burns on her groin, inner thighs and buttocks.
This infamous case has become a leading rallying point for those advocating restrictions on the ability of consumers to use the U.S. civil justice system to hold corporations accountable for the injuries they cause. A New Mexico jury awarded Ms. Liebeck $160,000 in compensatory damages and $2.7 million in punitive damages and in an instant, the media and legal community were up in arms. Newspaper headlines such as "Hot cup of coffee costs $2.9 million," or "Coffee Spill Burns Woman; Jury Awards $2.9 Million" painted the picture of a "runaway jury," an unreasonable award and a perverted system of justice. However, both the media and those who want to take away consumers' legal rights conveniently overlooked the facts of the case, creating a "legal myth" or a poster-case for corporate entities with a vested interest in limiting the legal rights of consumers.
The Facts A detailed look at the facts of this case reveal that in light of McDonalds' actions, the awards were justified:
By its own corporate standards, McDonald's sells coffee at 180 to 190 degrees Fahrenheit. A scientist testifying for McDonald's argued that any coffee hotter than 130 degrees could produce third degree burns. Likewise, a scientist testifying on behalf of Ms. Liebeck noted that it takes less than three seconds to produce a third degree burn at 190 degrees.
During trial, McDonald's admitted that it had known about the risk of serious burns from its coffee for more than 10 years. From 1982 to 1992, McDonald's received at least 700 reports of burns from scalding coffee; some of the injured were children and infants. Many customers received severe burns to the genital area, perineum, inner thighs and buttocks. In addition, many of these claims were settled for up to $500,000.
Witnesses for McDonald's testified that consumers were not aware of the extent of danger from coffee spills served at the company's required temperature. McDonald's admitted it did not warn customers and could offer no explanation as to why it did not.
As a result of her injuries, Ms. Liebeck spent eight days in a hospital. In that time she underwent expensive treatments for third-degree burns including debridement (removal of dead tissue) and skin grafting. The burns left her scarred and disabled for more than two years. Before a suit was ever filed, Liebeck informed McDonald's about her injuries and asked for compensation for her medical bills, which totaled almost $11,000. McDonald's countered with a ludicrously low $800 offer.
McDonald's had several other chances to settle the case before trial: At one point, Liebeck's attorney offered to settle for $300,000. In addition, days before the trial, the judge ordered both sides into a mediated settlement conference where the mediator, a retired judge, recommended that McDonald's settle for $225,000. McDonald's refused all attempts to settle the case.
The Findings The jury found that Ms. Liebeck suffered $200,000 in compensatory damages for her medical costs and disability. The award was reduced to $160,000 since the jury determined that 20 percent of the fault for the injury belonged with Ms. Liebeck for spilling the coffee.
Based on its finding that McDonald's had engaged in willful, reckless, malicious or wanton conduct, the jury then awarded $2.7 million in punitive damages; essential to the size of the award was the fact that at the time McDonald's made $1.35 million in coffee sales daily.
Since the purposes of awarding punitive damages are to punish the person or company doing the wrongful act and to discourage him and others from similar conduct in the future, the degree of punishment or deterrence resulting from a judgment is in proportion to the wealth of the guilty person. Punitive damages are supposed to be large enough to send a message to the wrongdoer; limited punitive awards when applied to wealthy corporations, means the signal they are designed to send will not be heard. The trial court refused to grant McDonald's a retrial, finding that its behavior was "callous." The judge, however, announced in open court a few days after the trial that he would reduce the punitive damages award to $480,000. Both sides appealed the decision.
Before the appeals could be heard the parties reached an out-of-court agreement for an undisclosed amount of money. As part of this settlement, McDonald's demanded that no one could release the details of the case.
Based on the facts, Corporate America's and much of the media's trivial portrayal of the case is deceptive and disgraceful. They have painted a misleading picture of a "legal horror story" when in fact, the case demonstrates a legal system that punishes corporations for misconduct and protects consumers who may be victims of their wrongdoing.
11/30/99NOTES (The nature of the private settlement and lack of public court documents resulted in the use of primarily newspaper sources.)
Re:It's the legal system (Score:1)
What the book says about anesthesiologists (Score:2)
Surgeons do dumb things, and all the surgeons get together in conferences about the dumb things and critique each other in a kind of Quality Circle, and nothing changes -- the advice is "Don't do dumb things." Nothing changes.
This engineer dude looks at how anesthesiologists kill patients. Well, they get the tube down the "wrong throat" -- not much we can do about that, but if we can monitor blood O2 level (see if fingernails are turning blue with a photocell), we can warn of this condition. We can also put a limit on the O2 dial that it gives at least some O2 at minimum; we can standardize the dials to min O2 and max O2 is the same on all machines (so much for all this whining in the Linux world about the need to "customize" every last UI).
Turns out anesthesia is killing only a 10th the patients it did 10 years ago. All from looking at where the fsckups are taking place and standardizing the "user interface" to anesthesia machines. All of the critiquing and peer evals the surgeons are doing is pissing in the wind by comparison.