While we were passing gas...

Most colonoscopies are performed with conscious sedation, a pleasant concoction of a pain-killer and a sedative that induces a "twilight-zone" state in the patient. Once they're in that state, we can then do our examinations without causing much if any pain.

Not all patients do well with conscious sedation. Occasionally we call the anesthesiologist in to give industrial strength sedation, inducing a level of sleep that most gastroenterologists feel uncomfortable giving on their own.

During a recent case, the "gas-passer", as anesthesiologists are sometimes called, was in a fairly chatty mood.

"Doc", she said, "have you heard about that lawsuit in Arizona? Some doctor is getting sued because he didn't order a mammogram on a demented nursing home patient. But they're not suing him for malpractice. They're suing him for elder abuse!"

I hadn't heard about the case and still don't know any of the details.

"There is precedent for this kind of stuff," says I. "In California some family members wanted to destroy a physician and make a buck on it because they thought he undermedicated their dying father for pain control. California restricts non-economic losses to a mere $250,000, and of course there would be no way to generate economic losses on such a case, so they sued the doctor claiming elder abuse. The doctor was found guilty and the family was awarded $2,000,000. I doubt the jury realized that such a judgment would not be covered by malpractice insurance because it is a criminal case. The doctor was financially destroyed."

"When will this stop? When will they figure out that they've pushed too far?"

"When we all quit, which we're not likely to do because basically we enjoy the practice of medicine. Besides, we have no other marketable skills, and they know it."

So we don't worry about the simple malpractice case anymore. Instead we worry about being given a felony conviction so lawyers and families can make a buck and destroy us.

One way for us to escape this threat is simply not to see anymore Medicare patients. Because their Medicare reimbursements are slated to go down another 30% over the next few years, more and more doctors are thinking about dropping Medicare. The government has constructed huge barriers to doing this, and traditionally doctors haven't wanted to put themselves in the position where they "won't take care of Grandma".

Still, we live in a free-market society and sometimes the only thing the market understands is that a huge demand for a service or product that is in short supply will ultimately drive costs up and availability down. It seems to me that the only way things will change is when a patient calls 911 because of a medical crisis and is told that the only person they could find to man the emergency room is some third year law student.

In the meantime, I try to take solace in the words of Mother Teresa:

People are often unreasonable, illogical, and self-centered. Forgive them anyway.

If you are kind, people may accuse you of selfish ulterior motives. Be kind anyway.

If you are successful, you will win some false friends and some true enemies. Succeed anyway.

If you are honest and frank, people may cheat you. Be honest and frank anyway.

What you spend years building, someone could destroy overnight. Build anyway.

If you find serenity and happiness, they may be jealous. Be happy anyway.

The good you do today, people will often forget tomorrow. Do good anyway.

Give the world the best you have, and it may never be enough. Give the world the best you've got anyway.

You see, in the final analysis, it is between you and God. It was never between you and them anyway.