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So many lawyers, so little time...

"The prospect of hanging focuses the mind wonderfully"--Samuel Johnson

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Location: Louisville, KY, United States

Gastroenterologist, cyclist, cellist, Christian, husband, father, grandfather.

Sunday, January 30, 2005

So many lawyers, so little time

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".

I live in a community which is large enough to be considered a city but small enough not to have any major-league sports teams. As an exercise in pain and penance, I went through the "Attorney" section of the Yellow Pages and marked every lawyer or firm that advertises that they handle medical malpractice cases. There were 53.

Most of the advertisements were fairly tasteful, but there were a few featuring angry looking people who would not rest until the victims had recovered every last nickel they were due. One had a rather flippant "Injured? Call A.K., he'll make them PAY". I wondered if I could sue someone if I stroked out reading this stuff.

Once upon a time I was referred a young man with chest pain. He noted that his chest only hurt when he drank, and when he drank he would down a six-pack in a sitting.

I performed endoscopy on the gentleman and noted that he has some minor changes of inflammation in his esophagus. He also had a small warty growth called a 'squamous papilloma'. These are almost always benign but I removed it to be sure. Subsequent biopsies confirmed my impression.

I met afterwards with the patient and his mother. "I really think you need to cool it with the alcohol", said I. "If I drank as much as you do, my chest would be hurting, too".

There are some days I can get away with this remark, days when I'm radiating warmth and goodness, or when I've been humbled and speak as one pilgrim to another. This was not one of those days. I have no doubt that my demeanor was one of "Gimme a break, it shouldn't take a doctor to tell you that habitually drinking six packs is bad for you; where is your brain?" They meekly considered my council.

Five months later I received a very nice note from his mother. "Would you be willing to write off the balance of my son's bill? He was diagnosed with Hodgkin's Disease and it's almost impossible to pay all his bills".

I gave the note to my billing and collections lady, telling her that as long as it wasn't violating some law it was fine with me. It seemed a good Christian thing to do.

As I reflected on this case, I struck me: of course! A rare but classic presentation of Hodgkins Disease is pain of the lymph glands that occurs whenever the patient drinks. I had heard about this symptom back in 1976 as a medical student, but hadn't ever seen a case. His chest must have been full of diseased glands, and everytime he drank they all hurt. Why didn't I think of that?

Five months after that I received a call from the patient's family doctor. In the letter I had sent to him I had meant to say "The patient has a squamous papilloma, a completely benign lesion with no malignant potential". I missed a one letter typo, and the letter read like this instead: "The patient has a squamous papilloma, a completely benign lesion with a malignant potential". The family had a copy of the records and stumbled upon that sentence.

"Doc, the family is furious with you. They're convinced that you knew he had cancer and just flubbed up the communication out of maliciousness".

"Over a one letter typo concerning a lesion that has absolutely nothing to do with Hodgkins Disease? Have them give me a call and we'll set up a meeting so I can disabuse them of this nonsense".

That's when the requests for records started to come. First was from a midlevel malpractice attorney with a nurse reviewing these records.

The only positive thing I could think of was that the statute of limitations for malpractice in my state is one year, so they had to serve me papers or forget about it forever. Didn't I really foul up? I could have diagnosed Hodgkins Disease when he saw me if only I had remembered that weird symptom. The fact that it wouldn't have affected his outcome didn't make any difference. It never does: what matters is whether the plaintiff can look pitiful in front of a jury and if he has a lawyer clever enough to convince them that it was all my fault.

Five weeks later I get another request for records, this time from one of the most successful and meanest malpractice attorneys in the city. Once again I have the records sent off. This time I was glad that my billing and insurance lady had put the mother's request for a write-off in the patient's chart. I wouldn't seem like such an ogre in front of the jury.

Three more weeks came and went, and no papers were served. Perhaps the mother's letter was enough to scare the sharks away. The only thing I experienced was seven months of feeling dumb and two months of feeling evil. No harm done.

The lawyers would cite this case as a victory of the System. After all, no suit was ever filed, thanks to the conscientious work of the malpractice attorneys. But I wonder just who gave these poor souls the idea of vengeance for profit.


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