Doctors in Hot Water

Doctors are increasingly in “Hot Water.” But this may not be their fault. Let me tell you about an actual case that recently happened in a hospital.

Dr Canfield, a surgeon, had an unexpected finding during an operation. It was a challenge in which he had not had a great deal of experience. He wasn’t quite sure if an alternative approach to the intended operation might be better. So he did the unusual and obtained in intra-operative surgical consultation from a colleague. It took a great degree of courage for a surgeon to do this during an operation. Maybe he should have expected the unexpected, but such is the nature of medicine and surgery. Many surgeons would just have proceeded and no one would have known the difference. Thus the patient received the benefit of the consultative opinion, did well postoperatively and was discharged.

Several days later, two of Dr Canfield’s colleagues in the same specialty took him aside and told him that he should resign his surgical privileges within 24 hours, or they would “drag him through the mud.” He was directed to meet with the physician health committee in the medical staff lounge immediately after office hours at 6 p.m., or they would report him to the Medical Board.

When he arrived in the staff lounge, he met one of his colleagues who pledged to be his friend and see him through the confrontation. On entering the medical staff lounge, he found himself surrounded by four other colleagues in his specialty, as well as a psychiatrist who was present in order to make it look like they were interested in his emotional health. He was given the same ultimatum to resign within 24 hours or they would use his medical records against him and he would lose hospital practice privileges, an action that would then be reviewed by the state medical board. Ultimately, the result could be loss of his medical license. He would then be reported to the National Data Bank, that attorney David Gallie has called a permanent tomb for physicians, not necessarily just bad doctors.

Professor John H Fielder, PhD, writes about a disturbing trend in medicine today which he calls “Abusive Peer Review.” He cites examples in Astoria, Oregon, Oakridge, Tennessee, and Sacramento where Peer Review, which is supposed to monitor quality of care, is being used to eliminate doctors in competition. He cites reports that estimate that up to 70% of Peer Review may have nothing to do with quality of care, the very thing it was designed to do, and instead is used for economic reasons.

So if your doctor disappears from his or her practice, there is a chance that, even though he was a good doctor, he didn’t have the political savvy to survive the political onslaught of unscrupulous doctors and hospitals.

A Doctor Goes to Jail

At the beginning of 2001, one of our doctors went to jail. It may have had nothing to do with the practice of medicine, but rather with law. Although there may be information that wasn’t available in the papers or in the facts as he discussed them, it is important for us to understand them. Many doctors could go to jail while practicing good medicine.

This doctor had a large convalescent hospital practice. He would see these patients once a month. Many of his patients were unable to communicate with him, and the examinations were unchanged for months and sometimes year. The important thing for him to do every month was to review the medical record to see what was going on and to discuss the patient with the nurse for any problems that weren’t recorded. Then as he walked around the hospital ward, his examination was focused on the primary area of disease or new items the nurse brought to his attention. These patients did not need a detailed examination on a monthly basis.

A nurse noted the lack of significant examination and reported him. Many physicians with similar practices have told me they practice the same way. In fact, most family physicians stated that this is how they practice office medicine. Only the required examination, based on the patient’s complaint, is all that there is time to do. Hence, he was within the community standard of care.

In the old days from which this physician came, a doctor would charge a fee commensurate with the degree of detail of the examination. However, at this time, there are thousands of numbered codes, each representing a certain type of detail. Unfortunately, there was no number that correctly identified the type of evaluation that he did. He, therefore, used a numbered code that he felt was close to what he did. He unfortunately chose a number that reflected a degree of examination that he didn’t perform, unbeknownst to him. Therefore, he was indicted and sentence for not following the letter of the law. Physicians don’t make good lawyers. They don’t think in legalistic terms. It has been estimated that perhaps half of all physicians breaks rules of which they are totally unaware.

As lawyers in practice and lawyers in congress control more and more of what physicians do, and put doctors in legal straight jackets, we will find physicians fending for themselves to the detriment of their patients. When doctors become lawyers and business people, then who will we have as our doctors? Then we as patients soon won’t have any body on our side. We must act before it’s too late.

Disabled Doctors

Doctors were once among the most dependable workers in America. However, they have been leaving their jobs in sharply rising numbers to collect disability benefits. In some instances, they are earning more on disability than in working, according to insurance executives. Insurance analysts believe that declining morale is a key factor in the growth of disability claims.

Surgeons have been encouraged to continue practicing despite arthritis and other ailments. They formerly ranked with lawyers, accountants, and architects in occupations most favored for disability coverage. Now they rank toward the bottom of the professional hierarchy, below shipping clerks, steel mill superintendents and traveling salesmen.

For years, physicians have vented anger and frustration about the changing rules of their profession. Many complain they are working harder for less money, are under increased stress and are having their medical judgment questioned by HMOs. Adding to their indignity, many critics dismiss their complaints as the whining of a spoiled elite.

Disability carriers are experiencing a drain on their earnings as doctors are incurring disability claims at about twice the number expected from all occupations. They are no longer clamoring for doctor business.

But the real question remains. Why are we allowing others to destroy our profession? To what organization are we paying our dues to be our watchdog? Maybe we need a different watchdog.

Hazards of Hospitalization

The Harris poll rated health care settings as slightly more dangerous than airplanes and the workplace and slightly safer than nuclear power plants. Many were speaking from personal experience. The results reflected that 40 percent of US adults have been involved personally or through a friend or relative with a medical accident or mistake while in a hospital as a patient. This is supported by the results of Lucian Leape, MD, of the Institute for Health Care Improvement at the Harvard School of Public Health, which says that errors or accidents may harm up to 20 percent of hospitalized patients. This totals a staggering three million separate incidents a year at a total annual cost of $200 billion.

The best way to avert errors when you are admitted to the hospital can be summarized in two words: Speak Up!

It may be a cliché that health care should be collaboration between patient and doctor–but it’s no where truer than in a hospital. Many people are intimidated by complex hospital routines that they stay out of the way. But any doctor or nurse will tell you: The hospital is one place where it definitely pays to be involved and assertive. Ask questions about any thing you don’t understand. Be polite, be pleasant, and be persistent. Try to understand the purpose and schedule of every medication or test you are given. Drug allergies may have been missed. Have personnel identify themselves before you take your medicine or are wheeled off for a test that you haven’t been expecting. Always ask what it’s for. If you’re too shy, recruit a friend or relative to be your advocate who will ask the questions for you.

Remember the organ removed or the amputated leg can never be restored. The life that is lost can never be reclaimed.

Veterans Hospitals

Here’s an interesting and true story I know you will enjoy.

Joel D Wallach, DVM, MD, nominee for the 1991 Nobel Prize in Medicine, mentioned in an address that hundreds of thousands of patients lose their lives unnecessarily in hospitals. He then stated that we have two “opportunities” to give our lives for our country – once on the battlefield and once in a [government] VA hospital.

He wasn’t kidding. A VA doctor tells the true story. One day during rounds, the nursing assistant complained that a patient was not swallowing. The food just keeps running down his mouth onto his shirt. The doctor looked closely at the patient and noted that he was dead.

Now isn’t that something. Not only can you give your life in the VA hospital, but after you’ve given your life, the staff doesn’t even know that you’re dead.

As is well known, the government itself is a welfare system. It is the only employer that can employ the totally incompetent.

Or from another angle, while we’re debating physician-assisted suicide, why don’t we just allow people to get admitted to a VA hospital who want to die. Then nobody will know the difference.