Salieri undergoes colonoscopy

About ten or twenty years ago the New England Journal of Medicine published an article written by an anonymous Midwestern family physician. In this article the author reviewed what he regarded as the biggest mistakes and professional blunders of his career. Sharing this type of information almost never happens in medicine, not your worst nightmares with your very best friend (who just might turn out to be a referring physician). The author clearly wanted to perform a very public mea culpa and clear his conscience of cases that had haunted him. The cases he described weren't the wanton negligent "Oops, I amputated the wrong leg because I operated when I was slobbering drunk" type of thing. What happened in all these cases was he either didn't know about something or he didn't recognize it. I thought it was a very noble gesture.

A lot of other doctors didn't share my opinion. In the letters to the editor section in the next week's issue, one specialist after another sounded off on the family doctor's obvious incompetence. The orthopedic surgeon belittled him for misdiagnosing an anterior compartment syndrome; a cardiologist barraged him for mishandling an obvious case of torsades de pointes arrhythmia; the obstetrician condemned him for incorrectly calculating fetal viability and, in effect, performing an inadvertent abortion of a perfectly viable fetus.

It became clear the standard of care established by the letter writers required that the family doctor should be capable of passing virtually all the subspecialty board tests before it was safe to allow him to practice on the general public. I concluded that it was a pretty good idea not to share your misadventures with anyone but your wife and your priest (the added benefit is that neither of these parties can be legally questioned by the plaitiff's attorney).

It is in this context that I will try to share, in an impressionistic way, my experiences with the American medicolegal community. I hope to capture the conflict between at least three forces warring within the physician: the overwhelming sense of injustice that malpractice claims incite; the realization that life isn't fair, that's the way it is, don't take it personally, and get over it; and the nagging sense of dread that you really did screw up and that someone suffered grievously because of what you did or didn't do.

My disclaimer is that I have of course changed enough details of the occurrences to maintain confidentiality, but not enough so that the basic truth of the occurrences is obscured. In the finest tradition of northeast mainstream media journalism, you might say that these stories are "fake but accurate".