6 ms·

Anatomy of a Tragedy

43 points by devbug 13y ago

lutusp 13y ago
Not to make light of a terrible story, but: "Somewhere in the world is the world's worst doctor. And what's truly terrifying is that someone has an appointment with him tomorrow morning." -- George Carlin
- mikeash 13y ago
  In an ideal world, even the worst doctor in the world would still be pretty good. Of course, here in reality, it seems that about 90% of the population of any profession is basically incompetent, and doctors are no exception.
chiph 13y ago
There will always be bad doctors. What's needed is transparency, but laws such as HIPAA protect them (as well as patient privacy), and many doctors now have you sign a NDA before treatment, to prevent disparaging remarks being posted online.
- saalweachter 13y ago
  Is practicing medicine a right or a privilege? While the "free market solution" of letting patients discover and inform each other which doctors are "bad" and which are "good" certainly requires the free market principle of open information about goods, services, and prices, it also also masks a second assumption, that practicing medicine is a right and that we injure doctors unforgivably by revoking their right to practice it. Practicing medicine is a privilege. We trust these men and women with extraordinary rights, to slice into bodies, dose us with precise amounts of radiation, and prescribe us medicines which in the right dose can kill or cure. If there is evidence that this trust has been betrayed and a doctor is killing us instead of curing us, that privilege should be revoked immediately until we can ascertain the facts of the matter.
  - enoch_r 13y ago
    Libertarians agree with you: practicing medicine isn't my right unless I can find someone willing to pay me to do it. Customers determine whether I get the privilege to sell any good or service. The question is who else should have the ability to make such a decision.
    - RougeFemme 13y ago
      Even if only customers should have the right to make that decision, customers should, in a free market, have access to information that would help them make an informed decision. I think the question in that scenario should be, what information should the customer have access to, who should vet that information and how long should the vetting process take? No, you don't want physicians falsely accused and you don't want information misunderstood, but this doctor should not have been so protected by the system. I'm not in favor of higher malpractice maximums, but some mechanism needs to be in place to "encourage" hospitals and doctors to blow the whistle more loudly and forcefully.
makomk 13y ago
Aren't these Texas laws basically the same as the "reforms" to healthcare that Republicans wanted to roll out nationwidw?
loudin 13y ago
I really wish people talked to others working in the medical industry before jumping to conclusions about medical practices and norms. Surgeons are increasingly portrayed by the media as greedy and worthy of increased oversight. The reality of the situation is that surgeons are just like you and me - in fact probably better than you in me in a lot of ways. The vast majority assume a crushing amount of debt and go through 10+ years of schooling for an intensely demanding job that places them in life-or-death situations on a daily basis. And that's before dealing with the lawsuits, shrinking income due to insurance cheaping out on procedures, and the general distrust from the public. The bottom line is that situations like these are rare. And instituting a system geared towards knee-jerk reactions is going to dramatically affect the ability of good doctors who make genuine mistakes. It's going to scare away intelligent people from the field who want to do good, but would be legitimately afraid of losing their livelihood in a lawsuit or protracted legal process. And it's going to affect the public, who will be likely left with a lower-quality medical system.
- corresation 13y ago
  The bottom line is that situations like these are rare. The article is quite specifically about a rare, incredibly egregious example, and indeed many of the protagonists of the story are countless other medical professionals who wanted this dealt with. I'm not sure what your opposition is about, as you seem to be refuting a position that no one actually holds. It is absolutely outrageous that this was not dealt with earlier, and that is what the story is about. Texas is hardly alone -- here in Ontario it is well known that the same thing happens: grossly incompetent practitioners are protected by a system that other practitioners do not defend and do not want.
dnautics 13y ago
the claim is that 'weakened medical regulation' made it difficult to remove this guy. But don't get things wrong - he WAS removed, after three years. Do we have any evidence to show that 'more robust medical regulation' would have removed him sooner? For example, the Anil Potti case (4 years of practice before removal) https://en.wikipedia.org/wiki/Anil_Potti https://en.wikipedia.org/wiki/Anil_Potti
- jakobe 13y ago
  You are right, that is a rather weak claim in an otherwise very well written article. I especially don't see how higher pain-and-suffering damages would have helped stopping this criminal sooner.
  - dnautics 13y ago
    maybe, maybe, by adding a marginal deterrent for him to become a doctor. Maybe by increasing his malpractice insurance costs (but there would have been no data for him, so it wouldn't have helped, and it would increase malpractice costs for competent brilliant newbie docs)
    - tzs 13y ago
      The pain and suffering damage limit appears to be just one factor of several that worked together in Texas to make it easier for him to get away with his incompetent surgeries. The other factors make it much harder to prove a malpractice case in Texas than in other states, and then the low limit on the damages (which, as the article notes will leave very little for the patient after costs) makes it not worthwhile to pursue the case. If he could have been successfully sued then after his first two or three botched surgeries his insurance rates would probably be through the roof, and the lawsuits would be public making it easier for the public to learn that they should never go to this guy for treatment.
- tzs 13y ago
  Potti was a researcher. His misconduct was faking research. Faking research is something you do in private, with no witnesses other than those helping you fake the research. When fake research gets published, it is generally not immediately evident something is wrong. Eventually someone might notice that the purported experimental data is too ideal to be from a real experiment, or other researchers will fail to replicate the results. The Texas doctor, on the other hand, was a practicing neurosurgeon. Other surgeons were actually witnessing his surgeries and directly observing his incompetence. He was leaving behind a trail of dead and crippled patients at an alarming rate. I don't see how the two are even remotely comparable.
mhb 13y ago
What about the whole rest of society's mechanisms for handling offenses? Couldn't the Texas attorney general have prosecuted him? Did any of the people who knew what was going on appeal to anyone besides the medical board?
bambax 13y ago
A search for "Christopher Duntsch videos" results in those gems from Best Docs Network "which features some of the best doctors in the entire Dallas Fort Worth area that help change people's lives": http://www.youtube.com/watch?v=C542mx2aRJ4#t=1m00s http://www.youtube.com/watch?v=C542mx2aRJ4#t=1m00s http://www.youtube.com/watch?v=DLN6rOPpE5E#t=20m49s http://www.youtube.com/watch?v=DLN6rOPpE5E#t=20m49s In the second video, one of Dr Duntsch's patient calls him "the best doctor [I've] ever had" and the procedure she went through "a miracle". But, curiously, a search for "duntsch" on bestdocsnetwork.com yields no result whatsoever. What's happening here? Who pays for what in these kinds of shows...?
MrBra 13y ago
Crazy crazy story... Thanks for posting/writing this and for putting accent on such a dramatic case and such a sick malfunctioning system which, of course. is the result of category self protectionism. And I say this while feeling great respect and admiration for medicine and for what it takes to become a doctor.
pvaldes 13y ago
Anatomy of a paralell trial to me.
mnaqvi 13y ago
Why can't the public access this information freely? http://www.npdb-hipdb.hrsa.gov/footer/publicInformation.jsp http://www.npdb-hipdb.hrsa.gov/footer/publicInformation.jsp

43 points by devbug 13y ago

Not to make light of a terrible story, but: "Somewhere in the world is the world's worst doctor. And what's truly terrifying is that someone has an appointment with him tomorrow morning." -- George Carlin

mikeash 13y ago
In an ideal world, even the worst doctor in the world would still be pretty good. Of course, here in reality, it seems that about 90% of the population of any profession is basically incompetent, and doctors are no exception.

chiph 13y ago

There will always be bad doctors. What's needed is transparency, but laws such as HIPAA protect them (as well as patient privacy), and many doctors now have you sign a NDA before treatment, to prevent disparaging remarks being posted online.

saalweachter 13y ago
Is practicing medicine a right or a privilege? While the "free market solution" of letting patients discover and inform each other which doctors are "bad" and which are "good" certainly requires the free market principle of open information about goods, services, and prices, it also also masks a second assumption, that practicing medicine is a right and that we injure doctors unforgivably by revoking their right to practice it. Practicing medicine is a privilege. We trust these men and women with extraordinary rights, to slice into bodies, dose us with precise amounts of radiation, and prescribe us medicines which in the right dose can kill or cure. If there is evidence that this trust has been betrayed and a doctor is killing us instead of curing us, that privilege should be revoked immediately until we can ascertain the facts of the matter.
- enoch_r 13y ago
  Libertarians agree with you: practicing medicine isn't my right unless I can find someone willing to pay me to do it. Customers determine whether I get the privilege to sell any good or service. The question is who else should have the ability to make such a decision.
  - RougeFemme 13y ago
    Even if only customers should have the right to make that decision, customers should, in a free market, have access to information that would help them make an informed decision. I think the question in that scenario should be, what information should the customer have access to, who should vet that information and how long should the vetting process take? No, you don't want physicians falsely accused and you don't want information misunderstood, but this doctor should not have been so protected by the system. I'm not in favor of higher malpractice maximums, but some mechanism needs to be in place to "encourage" hospitals and doctors to blow the whistle more loudly and forcefully.

makomk 13y ago

Aren't these Texas laws basically the same as the "reforms" to healthcare that Republicans wanted to roll out nationwidw?

loudin 13y ago

I really wish people talked to others working in the medical industry before jumping to conclusions about medical practices and norms. Surgeons are increasingly portrayed by the media as greedy and worthy of increased oversight. The reality of the situation is that surgeons are just like you and me - in fact probably better than you in me in a lot of ways. The vast majority assume a crushing amount of debt and go through 10+ years of schooling for an intensely demanding job that places them in life-or-death situations on a daily basis. And that's before dealing with the lawsuits, shrinking income due to insurance cheaping out on procedures, and the general distrust from the public. The bottom line is that situations like these are rare. And instituting a system geared towards knee-jerk reactions is going to dramatically affect the ability of good doctors who make genuine mistakes. It's going to scare away intelligent people from the field who want to do good, but would be legitimately afraid of losing their livelihood in a lawsuit or protracted legal process. And it's going to affect the public, who will be likely left with a lower-quality medical system.

corresation 13y ago
The bottom line is that situations like these are rare. The article is quite specifically about a rare, incredibly egregious example, and indeed many of the protagonists of the story are countless other medical professionals who wanted this dealt with. I'm not sure what your opposition is about, as you seem to be refuting a position that no one actually holds. It is absolutely outrageous that this was not dealt with earlier, and that is what the story is about. Texas is hardly alone -- here in Ontario it is well known that the same thing happens: grossly incompetent practitioners are protected by a system that other practitioners do not defend and do not want.

dnautics 13y ago

the claim is that 'weakened medical regulation' made it difficult to remove this guy. But don't get things wrong - he WAS removed, after three years. Do we have any evidence to show that 'more robust medical regulation' would have removed him sooner? For example, the Anil Potti case (4 years of practice before removal) https://en.wikipedia.org/wiki/Anil_Potti https://en.wikipedia.org/wiki/Anil_Potti

jakobe 13y ago
You are right, that is a rather weak claim in an otherwise very well written article. I especially don't see how higher pain-and-suffering damages would have helped stopping this criminal sooner.
- dnautics 13y ago
  maybe, maybe, by adding a marginal deterrent for him to become a doctor. Maybe by increasing his malpractice insurance costs (but there would have been no data for him, so it wouldn't have helped, and it would increase malpractice costs for competent brilliant newbie docs)
  - tzs 13y ago
    The pain and suffering damage limit appears to be just one factor of several that worked together in Texas to make it easier for him to get away with his incompetent surgeries. The other factors make it much harder to prove a malpractice case in Texas than in other states, and then the low limit on the damages (which, as the article notes will leave very little for the patient after costs) makes it not worthwhile to pursue the case. If he could have been successfully sued then after his first two or three botched surgeries his insurance rates would probably be through the roof, and the lawsuits would be public making it easier for the public to learn that they should never go to this guy for treatment.
tzs 13y ago
Potti was a researcher. His misconduct was faking research. Faking research is something you do in private, with no witnesses other than those helping you fake the research. When fake research gets published, it is generally not immediately evident something is wrong. Eventually someone might notice that the purported experimental data is too ideal to be from a real experiment, or other researchers will fail to replicate the results. The Texas doctor, on the other hand, was a practicing neurosurgeon. Other surgeons were actually witnessing his surgeries and directly observing his incompetence. He was leaving behind a trail of dead and crippled patients at an alarming rate. I don't see how the two are even remotely comparable.

mhb 13y ago

What about the whole rest of society's mechanisms for handling offenses? Couldn't the Texas attorney general have prosecuted him? Did any of the people who knew what was going on appeal to anyone besides the medical board?

bambax 13y ago

A search for "Christopher Duntsch videos" results in those gems from Best Docs Network "which features some of the best doctors in the entire Dallas Fort Worth area that help change people's lives": http://www.youtube.com/watch?v=C542mx2aRJ4#t=1m00s http://www.youtube.com/watch?v=C542mx2aRJ4#t=1m00s http://www.youtube.com/watch?v=DLN6rOPpE5E#t=20m49s http://www.youtube.com/watch?v=DLN6rOPpE5E#t=20m49s In the second video, one of Dr Duntsch's patient calls him "the best doctor [I've] ever had" and the procedure she went through "a miracle". But, curiously, a search for "duntsch" on bestdocsnetwork.com yields no result whatsoever. What's happening here? Who pays for what in these kinds of shows...?

MrBra 13y ago

Crazy crazy story... Thanks for posting/writing this and for putting accent on such a dramatic case and such a sick malfunctioning system which, of course. is the result of category self protectionism. And I say this while feeling great respect and admiration for medicine and for what it takes to become a doctor.

pvaldes 13y ago

Anatomy of a paralell trial to me.

mnaqvi 13y ago

Why can't the public access this information freely? http://www.npdb-hipdb.hrsa.gov/footer/publicInformation.jsp http://www.npdb-hipdb.hrsa.gov/footer/publicInformation.jsp