PreMDpilot

Meet the Medical Malpractice Lawyer

I really love the highlight of cases on the side. It shows them ranked by monetary awards. Slightly slicker version of an ambulance chaser saying, "have you been injured in an auto accident."

Let's examine the article shall we:

As many as 98,000 people die each year as a result of medical errors. (Institute of Medicine, National Academy of Science To Error is Human: Building a Safer Health System (National Academy Press, 1999).

Yet, a study by the Harvard Medical Practice Study Group determined that for every eight potential medical malpractice claims, only one claim was actually filed (Harvard Medical Practice Study Group, Patients, Doctors, and Lawyers: Medical Injury, Malpractice Litigation, and Patient Compensation in New York (Harvard University, 1990).

Studies of the pervasive problem of medical errors have also found that an estimated 3 to 4 percent of hospitalized patients received the wrong drug, dose or treatment, and that such mistakes are implicated in the death of one in 10 of these victims. (Washington Post, February 18, 2003; Page HE01)

First, look at the title of the study (To Error is Human). These people have twisted the intent of this study around for their own purposes. Let's also examine the error statistics. They say that 3-4% of hospital patients receive the wrong drug and 1:10 of these victims dies. So that's an error rate that leads to catastrophic failure of 0.3%. Most businesses would kill to have an error rate that low, and with something as complicated as medicine, it's a very impressive error rate. It's tough to compare, but aviation fares about the same. Aviation has an accident rate of 0.272 per 100,000 departures And medicine is quite a bit more complicated and more prone to error than aviation.

In response to the medical problems, some politicians advocate weakening the civil justice system, so that it is harder to bring suit to hold people medical professionals accountable, or to create artificial one-size-fits-all limits on jury awards. This, of course, will harm public safety, serve to further injure the most seriously harmed in our society, and runs contrary to the concept of taking responsibility for ones actions.

I'm all about holding people accountable for their actions, but you have to realize that errors are going to happen because medicine is a human endeavour. That error rate will drop to zero as soon as we know everything about the human body and can put it all in a computer, but until then, we're stuck with doctors. I bet the legal profession has a much higher error rate which results in many innocent people going to jail, but no one is going to prosecute them for that. The problem with medical malpractice is that it is causing systemic problems in the medical system. It is raising costs for everyone. It actually promotes secrecy and cover-ups, because the consequences of honesty are so severe. It sucks time and resources from an already strained system, and most importantly it affects the way doctor's care for their patients. Uneccessary tests are ordered and performed, thereby increasing the risk to the patient, just so the doctors can cover their butts. I don't care how many studies this guy can quote about how malpractice isn't raising insurance premiums, you can talk to any doctor in any hospital and they will tell you the reality of the tests that they order.

It's time to step back and acknowledge how complicated medicine really is, and accept some of the risks inherent with that complexity. I know I'm going to make mistakes. I have made mistakes (some big, some small) in everything I have ever tried to do. It's how human beings learn. I generally don't repeat mistakes but I am constantly coming up with new ways to screw up. I have good intentions and I'm willing to go to the ends of Earth to correct my mistakes, but it's kinda hard to correct death. Most physicians are just like everyone else except trial lawyers like this one hold them to a much higher standard...perfection.

These are the kind of flashpoints that cause wars.

I would say that I don't really understand why Iran is doing this except after I think about it, there really aren't any repercussions that can hurt them too badly. Let's examine the consequences of a war with Iran. Instead of just invading all willy-nilly and worry about the consequences 4 years later.

Let's say this incident does spark a retaliatory attack from either Britain or America. That attack can come in several forms. The first and easiest option would be airstikes. This would damage some Iranian infrastructure and maybe hamper their nuclear efforts if we could hit those targets. It would also unite Iranians and most of the Arab world against the Western world. Muslims will see this as another attack by a Christian nation on a Muslim nation and then we will have a true clash of civilizations. It will strengthen Iranian resolve and, most importantly, it will destroy any chance we have at making Iraq stable.

The second option would be a naval blockade and economic sanctions. Sanctions are already being talked about and implemented because of the nuclear stuff, but this would try to step them up with the addition of a naval blockade to turn up the pressure. This is a slightly more diplomatic option, but will still result in all the above consequences if we have to end up attacking the Iranian Navy.

The third and absolute worst option would be full-on invasion. The U.S. is having enough trouble occupying Iraq, and while even a small contingent of the U.S. military could utterly wreck the Iranians, the question then becomes, "now what?" We have invaded another country, which will greet us with the exact opposite of open arms. Our troops will be in a shooting gallery all the way into and out of Tehran. We will lose lots of good people. There is no way we could ever sustain an invasion of Iran.

Basically, if we attack Iran or retaliate with military force, then we lose lots of options in the Middle East. Iran knows this, and feels free to try and push its boundaries outward. I can't say I blame it's leaders for not going along with what we want them to do. We would do the same thing in their situation. I blame President George W. Bush for tying our hands and enabling Iran.

I would like to highlight two abuses of the USA Patriot Act

#1: FBI Abuses National Security Letters

#2 Justice Department Abuses Power to Appoint US Attorneys

How many more are lurking below the radar? The Patriot Act was one step closer on the slippery slope to a police state. One more step and the terrorists win.

Had to exercise my better judgement today. Due to inclement weather, I haven't been able to get my paraglider out for a while now. I've been feeling the itch, but haven't been able to get off the ground. All that was going to change yesterday when I went out and met my instructors and hiked up the hill. It was later in the evening, and the wind was coming down the hill as we started to hike up. It is impossible to take off with any kind of wind coming down the hill because the wing will want to travel faster than you can run and you will probably crash. I was feeling optimistic that the winds would change and I would get a takeoff.

We waited for 10 minutes and the wind finally died. My one of my instructors took off and I watched as he ran halfway down the hill because there was no wind at all. We waited for a few more minutes and finally the wind switched again and my other two instructors took off. One of them dropped their carrying bag though, so I had to retrieve that, and by the time I got my lines untangled, clipped in, and got everything stowed. The wind had switched to going down the hill again. And now it was a little stronger. A small gust actually blew my wing toward me as I waited. The sun set and the shadows started to deepen as I sat up there waiting to go. The wind would die down, but never completely went away. It started to get dark, and I had a decision to make. Do I keep waiting, or do I pack up and start to head down now? I waited a few more minutes and then decided that it was too dark out and that if something went wrong, I was liable to hurt myself.

Of course, as soon as I unclipped and started to hike down, the wind switched one more time and was blowing in my face. I don't know why I don't have any luck with wind. It just never seems to cooperate with me. I was glad that my judgement didn't fail me though and I didn't try a takeoff with a tailwind. I'm still here to write about using my judgement. I'll get up there eventually.

I have never had a cavity in my life.

I received amazing dental care when I was a child. I know this because I never brushed my teeth when I was little and, despite my best efforts, never developed a cavity. Sometime around middle school I realized that people don't like to be around you when you don't brush your teeth. So I reluctantly started brushing every morning. It wasn't until I went to the dentist some years later and had a conversation about how cavities actually develop that I started the sterling dental habits that I employ now. I brush, floss and use mouthwash every morning when I wake up and usually brush before I go to bed. I have been doing this for a number of years and have also been receiving checkups yearly from a dentist both my parents and I trust deeply. Every time I visit him, he looks in my mouth and says "This mouth isn't going to make me any money."

When I got the job I am currently working, it came with the nice little benefit of Dental Insurance. I have to pay about $10 a month for it, but that's worth it. My old dentist wasn't covered by the insurance so I went online and looked for a new dentist. There was one in
town close to where I lived and I got an appointment pretty easily. I arrived at the office and waited for a few minutes until the receptionist called me back and the dental hygienist went to work on my mouth. I have to say that this was a wonderful experience as she had the most beautiful big blue eyes. I got lost in them as she cranked and scraped and grineded on my teeth.

Then the dentist came in. He was a younger guy with a beard and an friendly air to him. He proceeded to look in my mouth and poked at my teeth like dentists do. He kept rattling off numbers to the receptionist, and as he continued to poke around, I started to get a little nervous. He then took a camera and took a couple pictures of my teeth. After he was all done, I sat up and he told me the verdict. Apparently there are seven cavities in there that all need to be drilled and have a filling put in. At first I was incredulous. Seven! I've never had a cavity in my life and all of a sudden I have seven! Then I became suspicious. I started to question him thoroughly about the work that needed to be done and had him justify each procedure. I also asked him about the dangers and possible side-effects of the drilling he was proposing. He answered my questions calmly and showed me the pictures. I had no idea what I was looking at, but there might've been something there. After the Q and A session I scheduled an appointment to have the first cavity filled.

I was still suspicious though and decided to get a second opinion from my old dentist. It was a miracle that I got in within a week, AND on my day off, as he is very popular and busy. I asked the previous dentist for copies of the X-rays and he provided them. My suspicions were fueled even more when I looked at the copies of the X-rays and they were grainy and mis-colored. I brought those to my old dentist and he informed me that he was unable to diagnose anything with such poor quality X-rays and that I would need to redo them. So I got some new X-rays and waited for my old dentist to look at them. I had also brought the bill that the new dentist had proposed and when my old dentist walked into the room, he was angry.

"There is no way you need all this work," he said emphatically. He then proceeded to show me the new X-rays and the portions where the new dentist proposed to drill. There were no shadows that indicated decay, and nothing to indicate the major surgery the new dentist was proposing. My old dentist then proceeded to look in my mouth and found only one area that I needed to have a filling in before I head off to Chicago. He then looked at the bill and explained some rather suspicious billing arrangements that looked like the new dentist was trying to double-bill for the same tooth. I was angry at the new dentist, but relieved that I made the smart play and dodged an expensive bullet. I scheduled with my old dentist to have my tooth filled and went home indignant.

I guess what pisses me off the most about this is not the fact that the dentist tried to rip me off. There are all kinds of people who try to rip you off. I have had especially bad luck with auto mechanics in the past, but I don't really get that upset as it's easy to find another mechanic. I guess I thought dentists were supposed to be above such things. After all, they are granted the title of "doctor" and make more money than most physicians. I am also pissed off because this is not some auto part that is easily replaced or fixed if I get ripped off. This is my health that we are talking about. He was going to drill into my teeth unnecessarily with all the associated risks that procedure entails just because he wanted to make more money. He didn't want to actually help me, he just wanted to make money. That's what pisses me off the most.

Doctors are imbued with a great trust in our society. We trust them with some of our deepest and most embarrassing secrets, and we trust that they are going to act in our best interests, not in theirs. We trust that they do what do because they primarily want to help people, and money is a secondary consideration. This has been an important object lesson for me. I vowed when I walked out of my old dentist's office that I would never put financial concerns above what is best for my patients. I will treat each and every one like they are my family every time I walk in the room. I won't consider what is best for my practice, or for the hospital, or for the HMO, but only for my patients. I know this will be difficult as the other pressures are tremendous, but it's important to maintain that trust. Because if it breaks down, even once, it casts a lasting cloud of suspicion over the entire community and leaves deep scars in the patients.

This was a good weekend. Exhausting, but good.

I leisurely rolled out of bed on Saturday and prepped to go skiing. I usually don't go skiing by myself, but since I have discovered the joys of skiing with my MP3 player, I have taken to going more and more often. I know it's a little more dangerous, but I'm a good skier and I've never ran into anyone, so I figure I'm safe. I gathered all my stuff, burned a couple of CD's full of NPR and music and slowly started driving to the mountains. Usually I hate getting stuck in traffic, but the NPR shows made it go surprisingly fast. I arrived at the resort just in time to get the last slot before they closed the public parking lot. I spent the afternoon getting soaked by the large, flakes that were dumping from the sky and listening to country music as I flew down on my tele skis.

I also got the opportunity to ride a snowcat for the first time. The resort I was skiing at offers a free Cat ride to folks who don't mind the fifteen minute hike after the ride. The hike wasn't bad except the visibility was terrible and it was at 13,000 ft. I was huffing and puffing. I was thinking this had better be worth it, and as I proceeded down the run, I hit about 15 rocks. Now thoroughly tired, wet, and pissed off, and thinking about taking my skis off and walking, I skied onto the best powder of the day. It was deep and soft and unskied, and I was jumping for joy the whole way down. It was so worth it. My skis don't think so as they are now gouged with huge scars, but that can be fixed.

After skiing, I hung out at Walmart until my girlfriend finished up skiing with her friends. Hanging out at the McDonalds of a Walmart gives one a new perspective on the America that we live in. I sat there and read Time magazine as all assortments of languages swirled around me. This week's Time is an especially good read. My girlfriend finally called as I fell asleep with my face in my fries, and we went to dinner. Sitting by the fire, dining and chatting with a beautiful girl is a hell of a way to finish up a ski day.

After that, I went home and freshened up and then met a few friends out for some Salsa dancing. I'm still not good, but I can feel the improvement in just a couple of months. Then I met back up with my girlfriend again for drinks and more dancing. This was very fun, as it is always amusing to watch my girlfriend get drunk.

The next day was a full day of Ultimate Frisbee. For those of you who have never seen or played a game of Ultimate. It's basically like football with a frisbee and without the hitting. I fell in love with the sport in college. It's got the athleticism and grace of soccer, with the teamwork and strategy all its own. It's also got a very strong tradition of sportsmanship and there are no referees. Players are expected to call fouls themselves and this leads to some disputes, but overall the game is full of teamwork and good sportsmanship. It's called the "spirit of the game," and people will be ruthlessly heckled if they don't pay attention to it.

We won out first game easily, and then moved on to the Green Machine. There were a couple of assholes on this team, which always throws me off because I don't expect it from Ultimate players. I had a disdainful opinion of the team as a whole, but knew that they were good because assholes tend to be competitive. They also don't do well if they are losing and you can get them mad. We lost the first few points and then started to gain traction. We traded points until halftime when they were in the lead 7-6. We lost the first point after half and then we took over. We scored five unanswered points and took the game 13-10 in the end. It was especially gratifying because they were getting really angry, and this lead to all kinds of mistakes and yelling. Meanwhile, our team never got discouraged even when we were down. We stayed positive, laughed and cracked jokes and had fun with it. That's the spirit that I liked to see.

The final game was tough because our opponent had all kinds of good players from outside the league. We traded points all game and ended up losing by a score of 12-13. Even though we lost, it didn't feel like a loss, mostly because none of us had expected to make it that far. We had a unimpressive record during the season, and were slated to face the top seed. After we beat them, it didn't really seemed like the finals mattered. We joked and had fun and when we lost, nobody really seemed to care. We were still smiling and laughing, and that is the essence of a great team.

So after a day of telemark skiing, and 5 hours of ultimate frisbee, I dragged my tired butt to my girlfriend's house, showered and went on a picnic with her and her friends. And as I sat there looking at this beautiful, blue sky and watching the sunset, I realized that it was a good weekend. Exhausting, but good.

Money is not often talked about in our society. It's an incredibly rude question to ask someone how much they make. The nice thing about a blog is that I don't have to worry about that. That being said, let's talk about money.

Med school, just like everything else in the medical world, is really, ridiculously expensive. There are a number of ways to offset the expense, but most students are relying on the fact that they are going to make enough money when they graduate to pay off the hundreds of thousands of dollars they accrue in school. I don't know what the national statistics are, but let's examine my case and what it's going to take for me to go to med school.

My school's annual tuition is $36,600. That's about par for the course for a private medical school. State schools can be quite a bit cheaper depending on the amount of funding provided by the state legislature. So taken out to four years: 4 x $36600 = $146,400. There are also school fees in the amount of 2,652/year. Take that for four years and you have a total of $157,008

That's just for four years of school. Now let's add in books and living expenses. I spend about $1200/month for everything I need. I have kept track of how much I spend for the last two years and 1200 is a pretty good estimate. This might drop a little during clinical years as I won't have much time, but still gotta pay rent and food. So $1200/month x 12 months/year x 4 years = 57600. That's a grand total of $214,608.

Now comes the real baby killer...the juice. People don't just hand you money with the expectation that you will pay them back and everything will be Even Steven. The juice is runnin' from the very first day. There are Federal Subsidized loans where interest doesn't start accruing until you graduate, but that's based on financial need and has a maximum amount of 8,500/year. So let's assume that I get all 8,500 each year (yeah right) and don't have to start paying until residency. We can subtract that from the total so $214608 - $34000 = $180608. This is the number that does have interest running on it. So if we add in four years of interest at 6.8% we get $209,730. Now we have to add the subsidized loans back in for a grand total of:

(drumroll please)

Taking the Temperature of the Rightosphere

I linked to this through Poliblog. Most of the responses are a little right of what I expected. The answer that shocked me the most was question 4.

4) Do you think mankind is the primary cause of global warming?

Yes (0) -- 0%
No (59) -- 100%

Umm...wow. That's pretty amazing. I guess what I don't understand is if these guys think that global warming isn't caused by humans, then what IS causing it? What is causing all these glaciers to melt? What is causing the seasons to change. What is causing to apparent uptick of unusual weather phenomena that we have been seeing for the last five years. I've lived in this area of the nation for more than twenty years and I have never seen a winter like this one. It's just weird.

But that is all just anecdotal evidence. What I trust even more than that is the cadre of scientists that say global warming is happening and it's caused by humans. Why is it hard to believe people who have spent their entire lives studying the earth's climate, but easy to believe people who have studied outer space or biology or physics? We all accept the theory of relativity, or the central dogma of biology, or that we are a tiny part of a much vaster universe, but we can't accept it when the leading scientists say we are causing global warming. That's just arrogant not to mention stupid.

Just one more reason conservatives piss me off.