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My first lawsuit – part 2

** This follows from the previous blog post**

A week later a 10 pound package came for me in the mail – it was a copy of the patient’s entire medical record. It took me almost an hour to find the part that had to do with the paralysis event, but as I read through the chart I saw my note and then gasped.

My note was simple: it documented my physical exam findings, the time I first found him paralyzed, the time I called the surgical team, the time it took them to get to the patient’s room. It was all clearly written and nicely documented. But the entry just above mine was from a nurse who had apparently turned the patient earlier that morning to wash his posterior. She noted that the patient was having some neck pain afterwards and that she had given him some Tylenol.

Then came my note.

And then came another note from the nurse, dated 3 months after the incident, and labeled “addendum:”

“Paged Dr. Jones to evaluate patient with complaint of inability to move lower extremities. Dr. Jones responded that she would examine him after rounds. I told Dr. Jones that it was an emergency but she said the patient would need to wait.”

I was horrified. That’s not at all what happened – the nurse was clearly afraid that she would be held responsible since she was the one who had moved the patient earlier that morning, possibly displacing his (recently operated upon) spine and causing a bleed. She obviously wrote the note to make it look as if the irreversible paralysis was due to the slowness of my response.

And so I felt helpless and very afraid – is this what will end my medical career? I thought about all my years of training, how careful I always tried to be, how much I cared for my patients – and would it all end with this insanity?

As it turned out, I had to prepare for a deposition. I studied every angle of the case, read every piece of the chart, sweated it out for many weeks. And then I got another call from the lawyer one day: “They’re settling out of court. You don’t have to come in. Just forget about it.”

I was relieved, but angry. I also felt very sorry for the patient. But most of all I wondered about the legalities of practicing medicine – how vulnerable we docs are, how a complication can be seen as malpractice… and how another healthcare professional can be so damaging. Sometimes practicing medicine scares me – lives are at stake, and even the best intentions can lead to life-altering events.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

My first lawsuit – part 1

An attorney from the hospital where I used to work called me out of the blue. He asked me if I remembered a Mr. So and So. “I’m not sure,” I said uneasily. “The name does sound familiar.”

Slowly the case came flooding back to me. I was on call on a weekend covering the neurosurgical step down unit. A nurse paged me to tell me that someone couldn’t move his legs. I asked if it was a new problem. “Yes, he could move them just this morning.”

I ran to the patient’s room and found an anxious appearing, young obese man lying flat in bed with a neck brace on. He had recently had a cervical laminectomy (a neck spine procedure). “I can’t move” he said, a bead of sweat trickling off his brow. “Can you feel anything?” I asked.

“Nothing below my neck.”

I took my metal tuning fork out of my coat pocket and pressed it firmly on his toe nail bed to see if he’d withdraw from pain. Not a flinch. My heart started racing. This is a surgical emergency.

I called the neurosurgery team and told them about the sudden paralysis. They arrived on the floor in under a minute, confirmed the diagnosis, grabbed the chart and took the patient to the O.R. immediately.

Hours later I heard that the man had had a rare complication of neck surgery – a small arterial hemorrhage that rapidly compressed the spinal cord. The surgeons evacuated the blood immediately – though it was anyone’s guess if the man would fully recover.

And apparently he didn’t. Four years later he was suing the hospital for malpractice, and I was named in the lawsuit.

“But I didn’t do anything wrong,” I told the attorney.

“Well, you’d better read the record,” he said ominously.

**See my next post for the end of the story!**

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Why are hospitals so ugly?

I used to believe, quite naively, that hospitals were depressing places simply because no one had noted the connection between environment and recovery. It seemed that white walls, antiseptic scents, and cork boards were somehow required of hospitals – and no one had bothered to imagine anything different.

I thought that the solution was fairly simple – get some creative minds to come in and make recommendations for change. So one day I called the chair of the department of interior design at Parsons School of Design and asked whether she might send her students to my hospital to consider how to improve our situation. She was intrigued with the idea – and we soon had an entire team of bright young designers measuring the floors and windows, considering the limitations of our square footage, and getting to work on some dramatic proposals for exciting change.

Several months later the Parsons students made a presentation to our hospital’s executive team, and this was met with great enthusiasm. We all thought that we were on the verge of an exciting breakthrough for patient wellness. But alas, in the end not a single design suggestion was implemented as our administrators told us that there was no money available for environmental improvements.

I found out much later that our acting CEO was making about ½ million dollars per year in salary at the time. All the while the poor patients had to recover in a grim void of sensory stimulation.

There is ugliness in hospitals – and it runs deeper than the white walls. As with many sectors, money is the deciding factor regarding whether or not something gets done. I think that hospitals should take a hard look at their white walls, and the white linings of their executive pockets and ask themselves whom they were built to serve.


This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Who is the best doctor?

I recently spoke to Dr. Jorge Mestman about the issue of finding a good doctor. I asked him if consumer ratings of physicians would help patients find their way to better care and he responded with a resounding “no.” I was somewhat taken aback and asked why he felt that way. What he said was surprising (this is not actually a direct quote, I’m summarizing):

“The best doctor is YOUR doctor. Over time a physician develops a relationship with a patient and an understanding of their issues that is very valuable. The problem with seeing a specialist is that they have no baseline to compare you to – they may make recommendations based on their best analysis of the situation at that point in time. But they can be wrong.

Also, physicians – like any human being – have different skills and styles. Some are great listeners and excel in empathy, others have a ‘tough love’ approach, still others are research oriented and like to delve into the ‘nitty gritty.’ How can one person’s rating capture all of that? Most physicians are good people with good clinical skills. The right one is the one that you like. Also, it’s simply not possible for a few highly rated physicians to care for vast numbers of patients. If people limited themselves to only seeing certain physicians (who got high ratings), they’d be turned away due to the over-demand.”

What do you think of Dr. Mestman’s analysis?

Val Jones is a licensed practitioner of Rehabilitation Medicine and Senior Medical Director of Revolution Health’s portal. No information in this blog is intended to diagnose or treat any condition. The opinions expressed here are Val’s and do not necessarily reflect those of Revolution Health.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Staying alive linked to staying in school?

So it seems that people who stay in school longer, live longer.  But not for the reasons you might expect – it’s not because privileged kids are more likely to stay in school and also happen to get better healthcare.  It seems that school teaches kids two things beyond the books: 1) discipline – the ability to delay gratification and 2) social networking skills.  These two lessons go a long way to keeping people healthier long term.

Come to think of it, this makes a lot of sense – if a person can learn to avoid fast food for the “higher call” of health, they may live longer.  If a person is well integrated in a social network, they’re more likely to seek out medical assistance earlier on – and have caring friends and family spur them on towards regular check ups, taking their meds, etc.

Now, I don’t know what YOU were doing in junior high and high school – but apparently the first hints of your discipline and networking skills were learned there.   Although the research described in the NY Times article only made a link between total years in school, and total years of life – I wonder if your high school’s  “expert networkers” – you know them, the ever-annoying popular kids – will fare best of all in the health arena?

Better go to your high school reunion to find out!


This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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