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I was struck by the amount of care that was seemingly influenced by fear of litigation. An ambulance driver diverted to a closer e/r despite having a physician

I was struck by the amount of care that was seemingly influenced by fear of litigation. An ambulance driver diverted to a closer e/r despite having a physician onboard. A nurse wouldn't sanction ice chips without the admitting physician's chop. Exhausting and time-consuming tests needlessly repeated. I once asked a veterinarian acquaintance of mine why he hadn't become a physician. "Wouldn't you rather drive something fancier than that pickup truck?" I needled, gesturing out the window at his old F150. "Yeah" he replied, "but those guys spend most of their time doing paperwork. I get to practice medicine."

hkmurakami 14y ago
>I once asked a veterinarian acquaintance of mine why he hadn't become a physician. "Wouldn't you rather drive something fancier than that pickup truck?" I needled, gesturing out the window at his old F150. "Yeah" he replied, "but those guys spend most of their time doing paperwork. I get to practice medicine." That is an amazing (albeit gravely unfortunate) quote. I'm going to share it with some friends who are studying to become vets themselves (I hope that's alright with you). Thanks for sharing the anecdote :).
- brown9-2 14y ago
  Unfortunate how? Based on the choice of car?
  - rrouse 14y ago
    Unfortunate that human doctors have to spend so much time doing paperwork
    - ams6110 14y ago
      Not all do. There are a few who have opted out of the insurance-based system. They run cash practices, and from what I've heard are able to spend more time with patients and charge them less because of the breathtaking amount of overhead they've eliminated.
lordlicorice 14y ago
I think it has more to do with bureaucracy than with fear of litigation. In an ecosystem as complicated as medical care, lots of policies and procedures accumulate over time and there's nobody with the authority to cut through the bullshit and redesign the system. I imagine that these policies come about not from lawyers' memos, but from the physicians themselves.
tibbon 14y ago
I've had several conversations with my vet about how his practice is so much smoother because he doesn't have to deal with an insurance industry (both from the sides of patients and a huge malpractice insurance cost) that essentially is just there to screw up everything. Few people attempt multimillion dollar lawsuits against vets because fluffy died from something that was unpreventable, but that's what happens daily in the US. As a patient individually, health insurance is great. But as a system is so horridly broken that it slows stuff down. Also, for anyone reading, getting into Vet school doesn't mean that you're not competitive enough for standard med school; quite the opposite. Getting into vet school is damn hard.
- jamesjguthrie 14y ago
  > Also, for anyone reading, getting into Vet school doesn't mean that you're not competitive enough for standard med school; quite the opposite. Getting into vet school is damn hard. We were always taught in school that becoming an animal doctor requires better qualifications/grades and is harder than becoming a human doctor - presumably as there is more than 2 anatomies one must become an expert of.
  - 13hours 14y ago
    Over here in South Africa, you actually go to med school for a year, and then apply for veterinary medicine. So you have to be the best of the med school applicants to get a place. Hardest course to get admission to of any.
- duck 14y ago
  My great uncle (who is pushing 90) was a vet here in the States, but for the last 50 years has been going to Nepal for six or so months each year to be a regular doctor.
monocle 14y ago
The nurse's action in this situation is more a case of not violating his/her scope of practice. "Ice chips" is actually a specific diet order in the hospital. If a patient gets admitted with a diet order of "NPO", the the patient is not allowed to get anything by mouth ("nil per os") which includes ice chips and oral medications. For the father to expect that the nurse should get his daughter ice chips when she probably had an NPO order is more a sign of his emotional distress during the situation. "I tell her I am the doctor, and I want the patient to have ice chips. I am told I am not the admitting physician and cannot give orders. She ignores my request to show me the location of the ice machine." Though we all can identify with him in this situation, why would we have any expectation that the nurse would violated his/her scope of practice in this situation? The practice of nursing doesn't allow for writing a patient's orders. His story is an example of the problem with the process of dying. All of us are dying. The question is when do you stop trying to extend life? Even a senior gastroenterologist could not help make that decision earlier for his daughter. No one - physician, father, family member - wants to bear that responsibility/guilt. We put that decision upon the person who is close to death, but they never really know how close they are. So what is the medical system supposed to do if a decision is never made? Continue will medical care, which is the most expensive at the end of life.
konstruktor 14y ago
A part of it is probably the litigation-happy culture in the US itself, the other one is laws that don't seem to include palliative care as an essential and non-negotiable responsibility of any medical profession. Would this be the case, the ambulance driver would be liable for driving a moribund patient to an ER instead of a hospice against a doctor's order.
lostlogin 14y ago
Was the Doc in the ambulance? I thought he was in phone contact? But your point remains. Another unfortunate effect of this is that the rest of the world follows the US. The system here in New Zealand, socializes the costs associated with medical mistakes, paying for costs and lost earning for patients. Our system isn't perfect, far from it. But it gets eroded somewhat by the extremely defensive medicine that is practiced in the US that is trickling in here, leading to higher costs and worse practice. Blood test, scan, rescan, more expensive scan. Oh wait, it's just a cough. More tests doesn't equal better care. Each carries its own risks and has a monetary cost.

hkmurakami 14y ago

>I once asked a veterinarian acquaintance of mine why he hadn't become a physician. "Wouldn't you rather drive something fancier than that pickup truck?" I needled, gesturing out the window at his old F150. "Yeah" he replied, "but those guys spend most of their time doing paperwork. I get to practice medicine." That is an amazing (albeit gravely unfortunate) quote. I'm going to share it with some friends who are studying to become vets themselves (I hope that's alright with you). Thanks for sharing the anecdote :).

brown9-2 14y ago
Unfortunate how? Based on the choice of car?
- rrouse 14y ago
  Unfortunate that human doctors have to spend so much time doing paperwork
  - ams6110 14y ago
    Not all do. There are a few who have opted out of the insurance-based system. They run cash practices, and from what I've heard are able to spend more time with patients and charge them less because of the breathtaking amount of overhead they've eliminated.

lordlicorice 14y ago

I think it has more to do with bureaucracy than with fear of litigation. In an ecosystem as complicated as medical care, lots of policies and procedures accumulate over time and there's nobody with the authority to cut through the bullshit and redesign the system. I imagine that these policies come about not from lawyers' memos, but from the physicians themselves.

tibbon 14y ago

I've had several conversations with my vet about how his practice is so much smoother because he doesn't have to deal with an insurance industry (both from the sides of patients and a huge malpractice insurance cost) that essentially is just there to screw up everything. Few people attempt multimillion dollar lawsuits against vets because fluffy died from something that was unpreventable, but that's what happens daily in the US. As a patient individually, health insurance is great. But as a system is so horridly broken that it slows stuff down. Also, for anyone reading, getting into Vet school doesn't mean that you're not competitive enough for standard med school; quite the opposite. Getting into vet school is damn hard.

jamesjguthrie 14y ago
> Also, for anyone reading, getting into Vet school doesn't mean that you're not competitive enough for standard med school; quite the opposite. Getting into vet school is damn hard. We were always taught in school that becoming an animal doctor requires better qualifications/grades and is harder than becoming a human doctor - presumably as there is more than 2 anatomies one must become an expert of.
- 13hours 14y ago
  Over here in South Africa, you actually go to med school for a year, and then apply for veterinary medicine. So you have to be the best of the med school applicants to get a place. Hardest course to get admission to of any.
duck 14y ago
My great uncle (who is pushing 90) was a vet here in the States, but for the last 50 years has been going to Nepal for six or so months each year to be a regular doctor.

monocle 14y ago

The nurse's action in this situation is more a case of not violating his/her scope of practice. "Ice chips" is actually a specific diet order in the hospital. If a patient gets admitted with a diet order of "NPO", the the patient is not allowed to get anything by mouth ("nil per os") which includes ice chips and oral medications. For the father to expect that the nurse should get his daughter ice chips when she probably had an NPO order is more a sign of his emotional distress during the situation. "I tell her I am the doctor, and I want the patient to have ice chips. I am told I am not the admitting physician and cannot give orders. She ignores my request to show me the location of the ice machine." Though we all can identify with him in this situation, why would we have any expectation that the nurse would violated his/her scope of practice in this situation? The practice of nursing doesn't allow for writing a patient's orders. His story is an example of the problem with the process of dying. All of us are dying. The question is when do you stop trying to extend life? Even a senior gastroenterologist could not help make that decision earlier for his daughter. No one - physician, father, family member - wants to bear that responsibility/guilt. We put that decision upon the person who is close to death, but they never really know how close they are. So what is the medical system supposed to do if a decision is never made? Continue will medical care, which is the most expensive at the end of life.

konstruktor 14y ago

A part of it is probably the litigation-happy culture in the US itself, the other one is laws that don't seem to include palliative care as an essential and non-negotiable responsibility of any medical profession. Would this be the case, the ambulance driver would be liable for driving a moribund patient to an ER instead of a hospice against a doctor's order.

lostlogin 14y ago

Was the Doc in the ambulance? I thought he was in phone contact? But your point remains. Another unfortunate effect of this is that the rest of the world follows the US. The system here in New Zealand, socializes the costs associated with medical mistakes, paying for costs and lost earning for patients. Our system isn't perfect, far from it. But it gets eroded somewhat by the extremely defensive medicine that is practiced in the US that is trickling in here, leading to higher costs and worse practice. Blood test, scan, rescan, more expensive scan. Oh wait, it's just a cough. More tests doesn't equal better care. Each carries its own risks and has a monetary cost.