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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, July 24, 2005

Smoke 'em out

For the sake of argument, accept the statistic that the number of deaths in America from medical malpractice outnumber the combined deaths from breast, colon and prostate cancer (I don't accept this as a fact, but visit virtually any tort lawyer's website and the figure is taken as God's own Truth). Considering that our medicolegal system sucks off billions of dollars from the delivery of healthcare, and that lawyers currently offer precious little to protect the health of patients prospectively, and that for all the attention the malpractice crisis has gotten we've seen little demonstrable improvement in the overall quality of healthcare over the past thirty years, one might reasonably conclude that, as an organization dedicated to the reduction of medical errors, the American Trial Lawyers Association is a dismal failure.

At my "risk management" seminar I saw one of the most astounding video clips on malpractice I've ever seen. In 2000, a family lost their two year old daughter due to medical negligence at Johns Hopkins University. The mother, in her anguish and while fighting back tears, recited how the university had, through gross miscommunication, more or less executed her little girl.

What made this so astounding was that the mother was delivering this lecture at Johns Hopkins University, to the medical staff.

As the camera panned the very attentive audience, there were few dry eyes to be seen. There were more than a few of us at the seminar who were also fighting back tears.

In every family statement regarding a malpractice lawsuit I've ever heard, the family spokesperson invariably says "It's not about the money (although we expect huge amounts from the trial)" and "We just don't want anyone to suffer like we have (although we aren't about to lift a finger to try to fix whatever situation lead to the tragedy)". Astonishingly, the family of the little girl took a sizable portion of their malpractice award and set up a program at Johns Hopkins to improve medical communication so that no one else might have to suffer the needless loss of a loved one.

Imagine. Taking money awarded because of malpractice and reinvesting it in improving the delivery of healthcare. I had never heard of this before.

Then the vision came: our local, state, and national medical societies appealing to the Trial Lawyers to join us in seeking constructive improvements to the system. "Our lawyer brothers and sisters, join us in improving healthcare in our country. Donate your time AND money for systems review and development. Work with us to make medical errors a thing of the past."

Expecting lawyers to tell us stuff beyond "If you didn't document it, it didn't happen" and "Be nice to your patients, you arrogant bastards" and "Work smarter, not harder" is of course delusional. But it would smoke 'em out and dispel the notion once and for all that what they do is supposed to be in the Public Interest.

Saturday, July 16, 2005

Nasty lawyer tricks

This week I attended my biannual Risk Management Seminar, "risk management" euphemistically referring to malpractice lawsuits and how to avoid them, if possible. Most of these things tend to be dreary affairs, with an insurance representative standing before us and telling us such helpful things as "If you didn't document it, it didn't happen", and "Work smarter, not harder", followed by some sanctimonious defense lawyer assuring us that if it wasn't for HIS hard work we'd all end up in jail.

This seminar was actually quite interesting, for a change; I should be able to milk it for two or three posts without any trouble.

In a civil trial, the opening statements by both the plaintiff's and defense attorneys are made, followed by witnesses called by the plaintiff's attorney. After each witness, the opposing attorney will cross-examine the witness and try to rebut any ugly assertions the witness has made. In the past, more often than not the plaintiff's lawyer will call the accused doctor as his very first witness. It makes sense: pull the doctor up on the stand before he's had a chance to acclimate to a court setting; try to make him look like an idiot, and, failing that, make him lose his cool by badgering him mercilessly, setting him up to appear to be such a jerk that the jury will rule against him even if he were completely innocent.

It turns out that this approach is a thing of the past. Doctor depositions are now videotaped. In the pre-trial preparation, the attorney will put together a Power Point presentation, splicing together any unfortunate statement the doctor may have made and then running very selected portions of the videotape in the plaintiff's attorney's opening statement. That makes sense, too: the lawyer can still badger and harass the doctor during the deposition AND then choose only the worst clips to play for the jury AND it cannot be immediately rebutted in cross-examination because it's just part of the opening statement.

"Docs, we might not be able to get you up on the witness stand to defend yourself for at least three or four days. By then its an uphill battle, no matter how innocent you are."

Those doctors in the audience with Blackberries were pulling up the latest stock-market quotes to see if their portfolios were adequate to allow them to retire. I, however, was glad to see that the Public Interest was in such good hands and was being so well protected.

Wednesday, July 13, 2005

Thermostat wars - a theological perspective

The author of The Da Vinci Code is sympathetic to the concept of the "Divine Feminine", that primordial nurturing force of the universe represented by Venus and Aphrodite and Isis and maybe Mary Magdalene. Towards the end the book, the author makes the plea that our world must once again celebrate the Divine Feminine, that we must become whole and fertile and get in touch with our feminine self and repudiate the evil militarism of our patriarchal society.

If he is speaking metaphorically I can live with that. There's not a one of us who wouldn't benefit from getting away from the TV or office and commune with Mother Nature, enjoying Her splendor by strolling through forests and meadows, watching our furry little friends go hippity-hop down the Bunny Trail, stepping on venomous snakes, being attacked by blood-sucking sand flies, contracting Lyme Disease...whoa, I guess snakes and sand flies must be from the realm of the Masculine. Mother Earth would never treat us like that.

If Dan Brown really believes that there is a Divine Feminine, then all I got to say is this: I sure hope not.

Here I sit in the Ohio Valley, with its heat and humidity, and as I type this I'm wearing a scrub top, and under it, some Patagonia long underwear. I've been in one too many endoscopy rooms where the thermostat has been set down to 62 degrees by some perimenopausal nurse. After a few procedures my fingers grow numb, my core temperature drops to 92 degrees, and I listen to patient after patient compare our room to a walk-in meat locker.

It gets worse. Combine a woman going through menopause with a woman suffering from low thyroid hormone levels and a female Generation X'er who is just plain tired of listening to the old folks complain, and you have Total Primordial Chaos. One turns the thermostat down to 58. The other counters by putting their space heater on their desk and turning it on full blast. One sneaks around the flank and turns the thermostat up to 80, the other gets a minifan and plugs it in, cranking it up while papers and office documents go hurtling through the air.

No, I'm too much of an empiricist to believe in a Mother Goddess. If she really existed, our global warming would end abruptly, our temperatures would go down 5-10 degrees planet wide, we'd have glaciers in Florida and mass extinction everywhere, with only the most cold-resistant life forms surviving. I wouldn't trust Venus with a thermostat. Not until Isis sneaks around to the flank.

Monday, July 11, 2005

Jewish Zen

This is from a post in Free Republic. I've added it to my research on zen.

If there is no self, whose arthritis is this?

Be here now. Be someplace else later. Is that so complicated?

Drink tea and nourish life. With the first sip... joy. With the second... satisfaction. With the third, peace. With the fourth, a danish.

Wherever you go, there you are. Your luggage is another story.

Accept misfortune as a blessing. Do not wish for perfect health or a life without problems. What would you talk about? The journey of a thousand miles begins with a single oy.

There is no escaping karma In a previous life, you never called, you never wrote, you never visited. And whose fault was that?

Zen is not easy. It takes effort to attain nothingness. And then what do you have? Bupkes.

The Tao does not speak. The Tao does not blame. The Tao does not take sides. The Tao has no expectations. The Tao demands nothing of others. The Tao is not Jewish.

Breathe in. Breathe out. Breathe in. Breathe out. Forget this and attaining Enlightenment will be the least of your problems.

Let your mind be as a floating cloud. Let your stillness be as the wooded glen. And sit up straight. You'll never meet the Buddha with such rounded shoulders.

Be patient and achieve all things Be impatient and achieve all things faster.

To Find the Buddha, look within. Deep inside you are ten thousand flowers. Each flower blossoms ten thousand times. Each blossom has ten thousand petals. You might want to see a specialist.

To practice Zen and the art of Jewish motorcycle maintenance, do the following: get rid of the motorcycle. What were you thinking?

Be aware of your body. Be aware of your perceptions. Keep in mind that not every physical sensation is a symptom of a terminal illness.

The Torah says,"Love thy neighbor as thyself." The Buddha says there is no "self." So, maybe you are off the hook.

The Buddha taught that one should practice loving kindness to all sentient beings. Still, would it kill you to find a nice sentient being who happens to be Jewish?

Though only your skin, sinews, and bones remain, though your blood and flesh dry up and wither away, yet shall you meditate and not stir until you have attained full Enlightenment. But, first, a little nosh.

Sunday, July 10, 2005

Why I love one of my daughters more than the other

A long time ago, in the antediluvian era of iron men and wooden ships, when giants walked the halls, I returned to our squalid little home, weak, exhausted (me, not the home), discouraged beyond belief, feeling like two things would never end, one being my medical training, the other being this sentence, wandering about the wilderness like the children of Abraham. I came to rest in my prized Salvation Army easy chair which offered me so much comfort that I came to regard it as a friend and perhaps even a trusted mentor, more of a mentor than those narcistic fascists who ran the training program and kept me in an endless state of torment. There I sat, finally at peace after a brutal 36 hour on-call marathon when you approached. Although you were only 7 months old at the time, you possessed a deviousness far beyond your age, given away by the impish gleam in your eyes as you crawled up to the chair, carelessly knocking over my sun tea and revealing a maliciousness that was both startling and alarming.

As I traveled to Branson, Missouri and back in order to pick up my as of that time unborn son from summer camp, I listened with your mother to the audio version of The DaVinci Code and thought to myself, "Surely I can write pretentious prose about largely fictitious pseudohistorical events, too."; after what seemed like an eternity of internal struggle but in reality represented the time it took your mother to hop out of the car, run into the McDonald's, go to the bathroom (I resolutely refused any liquid refreshment to obviate the need for such activity), and bring back two luscious hot-fudge sundies in which the peanuts had been held (purely for dietetic reasons), I reached this startling conclusion: Just Kidding!

Now get back to your studies and/or go find a job, depending on which one of you reads this.

Saturday, July 09, 2005

The Virgin

My dictum:

Never hang around the doctors lounge if you're already depressed.

My deviant:

Never hang around the doctors lounge even if you're not depressed if 1. they have pizza there and you're on a diet, and 2. there's anyone else there.

"Doctors in this state are freakin' idiots!" proclaims the Virgin, an excellent, personable physician who had the misfortune of wandering, for the very first time, into the gunsights of the malpractice lawyers. "We could have gotten malpractice caps in this state if our lobbying efforts hadn't been so clearly pro-Republican. Now every Democrat in the state torpedoes any effort to clean things up around here, simply because it's the Republicans who introduce the reforms. We'll never get any meaningful tort reform around here."

We will when you and I resign, retire, or move out of this state, I thought.

"For the first time ever I was named in a lawsuit two weeks ago. The noneconomic damages are not terribly high, and I'm willing to take my chances in court with them on that. But they're asking for $5 million in non-economic and punitive damages. If I lose that, I'll be financially destroyed. I'll have to settle with those buttholes because our state medical association didn't have the sense to make tort reform a bipartisan issue."

I felt like a deer seeing it's mother getting blown away by the evil hunters. I certainly could empathize, so I endeavored to say the most encouraging things I could think of: "You arrogant fool! You're getting what you deserve. Just what do you intend to do about all the uninsured people in this country? How are you going to improve quality control? Economic ruin sounds about right for anyone crass enough to try to make money off the sick and dying. Feel free to call me any time. I'll always be here for you."

Tuesday, July 05, 2005

When you come to a fork in the road, take it

This is the beginning of what I think will be a very nice article should I ever actually finish it. If the perfect analgesic/anti-depression drug were available, would you take it? Come to think about it, I believe one could obtain the desired effect by washing down a pack of Peanut M&M's with a can of Miller Lite. But I digress.

Futurists are divided in their visions of what is to become of our culture. One camp sees a dark dystopian landscape, at best resembling the urban overcrowding of Bladerunner, at worst resembling the anarchy of The Road Warrior. The other sees a lighter vision of a world where genetic engineering and pharmaceutics allow the human race to live a peaceful, comfortable but meaningless existence as what was described in Brave New World.

Free of the guiding force of Providence, which fork in the road we travel down will be determined largely by accident. If the Wahabists gain access to the Russian nuclear arsenal or if the dire predictions of global warming prove to be true, we will likely undergo near-extinction, with the unlucky survivors left to fend for themselves amidst the rubble and chaos. If we get lucky and avoid such a cataclysm, I think it is inevitable that our race will do what it can to eliminate all forms of disease, infirmity, pain, and even suffering. Big Pharma and Genetic Industries will lead us to the bliss of the Promised Land.

In this Utopia we'll surely have a drug (Soma?) that will free us from pain and induce a mild euphoria without the troublesome side-effects we see with the opioids we now have. Perhaps the same compound will also keep our seratonin and norepinephrine levels pleasantly and permantently high, rendering depression and neuroasthenia rare if not unheard of.