Thursday, January 20, 2011
There are a lot of things that scare me about my future practice of medicine.  Of these, the general idea of making a mistake is the most terrifying.  I wrote about this in my first post ever, "Getting Used To Failure", where I talked about the difference between bad outcomes and true mistakes.  Part of this fear is linked to the fear that someone will sue us.  This fear, probably more significantly than it should, drives part of what we choose to do in medicine, part of how we treat our patients.
Truely eggregious, intentional, or illegal incidents aside, many many medical malpractice suits are brought because a patient, or a patient's family, are upset with the outcome of a particular course of treatment.  There are five things that must be proven in order for a doctor to be found guilty of medical malpractice: duty, breach of duty, causation, proximate cause, injury.  Basically, they have to prove that the doctor's actions were outside the standard of care for physicians in his field in that instance, and that action resulted in injury that otherwise would NOT have resulted if standard care had been given. 

I could go talk about the way litigation against doctors changes the common practive of medicine from an evidence based one to a defensive one.  Or how devestating it is to be sued when you truly think you did the best you could (I don't know that from first hand experience...).  Or how most suits are brought against a small percentage of physicians.  Medical malpractice is a complicated beast.  And three days of class within the walls of a law school certainly don't qualify me to talk about it.

What I do want to talk about is compensation.  Specifically, the money.  There are two types of compensation that can be given to a plaintiff that wins their case (the following is not official legal lingo.  It's my lingo).  First, there's compensation for economic loss.  This may include lost wages, loss of future earning potential, medical bills, future health care, etc.  If medical malpractice is found, this seems to be reasonable.  For instance, if a surgeon is drunk while performing an appendectomy, and accidentally removes someone's kidneys instead (I really hope this has never happened....), it would be reasonable for the patient to receive money to compensate them for the cost of being on dialysis, the lost wages for spending extra time in the hospital, and even the lost earning potential because they now must got to dialysis three times a week.  Were it not for the neglegence of the doctor, this person would not be on dialysis. 

But then there is the less clearly defined catagory of "pain and suffering".  There has been much debate about whether or not there should be a cap on the awards for pain and suffering.  While the majority of awards are not outlandishly high, some are.  I have reservations about any awards for pain and suffering.  I understand that I've never been in a situation where this would apply to me.  But still, I have an opinion about it. 

The assignment of money for pain and suffering implies that in some way, this money will make up for the pain and suffering of the patient or their family.  It also suggests that the pain and suffering caused by this negligence on the part of the physician is somehow more valuable, or worse, than the pain and suffering experienced by everyone else in the world who experiences pain and suffering.  I don't know that I think money should be paid at all for pain and suffering.  I don't understand what it compensates for.  I am certain that in many instances, the patient experiences pain that they otherwise would not have.  They may have pain for the rest of their life.  But money doesn't fix that, in any way.  The costs associated with medical treatment due to the pain should be covered under economic loss.  But for this person, to gain money due to pain?

I guess I feel like they are looking in the wrong place for resolution of this permanent change in their life.  But no amount of money will make things like they were before.  And that is tragic.  Tragedy happens every day.  A child gets shot in the crossfire of a gang war, and is paralyzed.  The people responsible are held accountable for their actions, sent to jail.  But the kid is still paralyzed.  And that becomes his life.  What is that worth?  And who pays it?  Is it worth less if the kid becomes a world class paraolympian?  Worth more if he wanted to be a basketball player, and now his dreams have to change? 

At the hands of us, or someone else, our life becomes what it is.  And we live it, with the pain and suffering, joy and happiness, and mundane days.  We don't earn for pain and suffering any more than we pay for joy and happiness. 

In these cases, I think that, as society, we recognize someones pain and suffering.  We valiadate it, give them as much support as possible, and recognize that their life will be different.  We understand that we don't understand. 

But I don't think that compensation should be an option.  I don't think we assign a value to the loss of someone's leg, or the value of chronic pain.  The pain and suffering is no different in someone who lost their leg in a car accident caused by snow as in someone who lost in an accident caused by a drunk driver.  Certainly, the punishment for the cause should be different, but should the compensation to the injured? 

I don't think it should.

But that's just me.

What do you think?


About Me

I am a Family Medicine intern at a community hospital in Indiana, navigating the new world of being a physician. I am privileged to work in a field I love, where every day is a new and unpredictable challenge.
I am not only a doctor, but also a cyclist, runner, DIYer in the making, lover of the outdoors, traveler, and human.
Human, MD is a glimpse into the world of a young doctor who is just trying to stay true to herself through the grueling whirlwind of residency.


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