Medical Malpractice--One Doctor’s Personal Experiences
This item was posted on RiskList by Anne Kramer at Anderson, Kill & Olick, highly regarded as one of America’s premier policyholder counsel firms. It is reproduced here with Anne’s kind permission.

Subject: RE: Your Med Mal post on risk list

I sent the BW article [MedProLaw.org poster’s note: BW is Business Week] article to a friend who is a family practitioner and OEM in the midwest. Some of you might be interested in his response:



Ann,
Definitely fascinating. It's something that I got turned onto during my residency by some very smart people. We were looking at a lot of obstetrical practices like once-a-C-section-always-a-C-section, that turns out to be one guy's opinion.

My personal crusade has been in the area of low back pain. I had a classic operable case of disc herniation but I tried to make my own treatment decisions based on science. It was difficult at times to delay likely certain relief (surgery) with the knowledge that studies showed that without surgery I was likely to have an identical outcome as those who had surgery -- just later. I also knew that surgery wasn't going to assure that I would regain strength in my right leg any more than time would. As it turned out I had a nearly perfect outcome (95% return of strength and sensation) and I avoided unnecessary surgery. The surgeon I consulted with was really amenable to this wait-and-see approach. He was willing to see the science as it is without coloring it by other external factors like the next boat payment. Seeing me in obvious pain he kept holding the surgery out for me, "We can make that better if you want to go for it." I kept declining. Opting to continue waiting because after the first two weeks I was improving. Slowly, way too slowly, but, improving none the less.
I continue to be startled at the behavior of physician-scientists (as Flexner saw us). Turning instantly to the most recent 'gorillacillin' instead of what the science indicates is both effective and cost-effective. They routinely use an $80.00 course of therapy where a $6.00 course would work as well. I was seeing some skin abscesses at the clinic. Out of curiosity I started doing cultures of the pus. An aside: the cure for abscesses is opening them and allowing them to drain -- no antibiotics necessary. So, all of these are community acquired infections -- no one coming out of nursing homes, hospitals, prisons, etc. To date I've cultured about 150. All of the Staph. aureus (the vast majority of the bugs causing infections) but one were resistant to methicillin (so called methicillin-resistant Staph. aureus -- MRSA). So, gently, I started letting it be known among local physicians this little fact. The assumption I made was that this finding is a direct result of over-use of antibiotics in the community. I am not sure how it started: patient expectation driving physician behavior or the other way around but most patients expect an antibiotic even when I tell them they have a 'cold' or a viral infection. An aside: Here, I work in a community where about half of the patients I see either smoke or are exposed to the smoking of their parents and they 'need' antibiotics. Oh, how I must bite my tongue so often. As it turns out, all of these MRSA are susceptible to another low cost and common antibiotic so if someone waits too long and becomes septic with infection there will be a ready, cheap cure available.
As I look up I'm thinking this is far more than you might have wanted but what can I say?