Playing Defense| June 26, 2019
Trust your doctor. But only believe in Hashem
id you hear what happened to Dr. T.?”
I had barely made it into the department and already I was hearing rumors.
“No, what? Is he okay?”
“He’s okay,” Dr. Dan told me, then hesitated. “Well, sort of. I mean, he’s okay… but he lost a patient.”
I winced. “Ouch, that hurts.”
“No, it gets better. I mean worse. She died two days after he saw her.”
Just then Dr. T. appeared at the end of the hallway. Dr. Dan stopped talking. I squinted. He did look bad.
I waited until Dr. T. disappeared behind a curtain before asking.
Doctor T. had been on shift when Mary came in. She had arrived at the hospital on her own two feet, accompanied by her sister and complaining of chest pain. Immediately, Dr T. ordered an EKG (it was normal), bloodwork (troponin levels were okay) and took a full medical history (no history of heart disease). A CT scan turned up no blood clots. Really, Mary seemed to be fine. After a thorough workup, he sent her home.
She was back 48 hours later. This time she was brought in on a stretcher, lights flashing and sirens sobbing, in cardiac arrest.
She didn’t make it.
Dr T. was devastated. “I checked everything,” he muttered, shocked. “I ruled everything out. She definitely wasn’t having a heart attack!”
Western medicine is not a very forgiving climate for doctors nowadays. You see the billboards everywhere: Personal injury lawyers. Medical malpractice suit. Did your doctor harm you? The message: Doctors are evil. They’re not careful. They don’t care about you, only about making money. Call this lawyer or that practice (who clearly cares only about you and not about making money), and we’ll make sure to punish those evil doctors and get you the restitution you deserve.
Fun fact: The first medical malpractice suit in the US was filed in 1794 – four years before George Washington was inaugurated. The plaintiff, who claimed his wife had died due to the incompetence of the surgeon, was awarded 40 English pounds. Now, in 2019, medical malpractice insurance is anywhere from $30k for a general practitioner to $300,000 for some specialties. Damages awarded run into millions of dollars. Everyone knows they can sue their doctor.
All this creates an adversarial relationship between you and your doctor. And when there’s an adversarial relationship, everyone loses.
Patients are conditioned to distrust their doctors. They don’t feel safe and it’s hard to feel reassured.
Doctors are conditioned to distrust their patients. They’re forced to focus not only on what’s best for the patient, but also on how to protect themselves from litigation. They’re forced to be super cautious, overqualify every statement, and order every test available to explore the remotest possibilities.
No patient wants to undergo extra tests.
Even the cost of care is unnecessarily increased, which hurts everyone.
It’s called defensive medicine. Patients are afraid to trust their doctors, doctors are afraid to trust their own judgment. VIP syndrome, where VIPs counterintuitively get worse care because you’re afraid of their power — afraid to do something invasive or make a decision — has spread to every patient.
Did your doctor harm you? Did this horrible drug cause terrible side effects? The message is that doctors are evil and out to hurt people.
This might come as a surprise, but doctors really care about their patients. They want to help them get better. Losing a patient affects them deeply. The term “second victim syndrome” was coined to describe the status of the doctor or nurse in the case of medical error. The patient is the obvious victim — but the “second victim” is the medical professional who handled the case. It affects the doctor — we think about it, rehash it, question ourselves over and over.
Dr. T. took it really bad. He’d wake up in middle of the night, reviewing the case in his mind. What did I miss, what did I miss? What could I have done differently? When I saw him on shift, he looked haggard. He ran extra tests on every patient, checked them twice, didn’t trust his own judgment. It was uncomfortable for him at the hospital too — his colleagues were asking questions, he had to appear before a peer review board.
Eventually, he asked the family to agree to an autopsy.
At the hospital, we were floored. No one was blaming Dr. T. (besides himself). The notes from Mary’s first visit were impeccable: The doctor had followed every protocol, run every test, checked every possibility, and everything had come back clear. It’s terrible to lose a patient, we all understood how he felt — but an autopsy?
Two months later the autopsy report came back. Cause of death: drug overdose.
Drug overdose. Now the family hemmed and hawed. Had they known Mary was using? Well, not really, maybe, sometimes. Why hadn’t they reported it to the doctor? Well, you know, it was awkward, and all the tests showed she was fine. (That was because they were the wrong kinds of tests after all.) Could Mary have been saved, had we known? That’s a tough question to think about. Maybe, the family admitted, it had been a mistake not to mention it.
Not every case ends this way. Not every case gets autopsied, not every case gets closure. Some deaths really are due to medical error. Doctors, like patients, are human. Doctors, like patients, will make mistakes.
That’s not to say we should accept negligence. We shouldn’t accept errors as inevitable or stop trying to avoid them.
But as believing Jews, we also shouldn’t think we are more powerful than we are.
Not everything is identifiable. Not everything is preventable. People die.
But unlike what your lawyer wants to you believe, doctors mean well, they work hard. They care about you and want you to get better.
Trust your doctor. But only believe in Hashem.
All names and identifying details have been changed. Patient profiles may be based on composite cases.
(Originally featured in Mishpacha, Issue 766)
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