Kevin MD called it “Black Wednesday”.
I had both openly (in the comments on his blog) and privately (via unsolicited e-mail) counseled Flea that what he was doing was very dangerous (I thought it better to keep a diary on the trial and publish later) . . . and that if he had not told his attorney about his blog, he needed to do so. The attorney was, after all, contracted by his insurance carrier . . . and the carrier could dump him if what he was doing increased his risk at trial.
Subsequently, Flea’s entire blog came down (a wise decision on his part, albeit a HUGE loss for the rest of us). It's not rocket science what probably happened.
Hat tip to Kevin: A number of medical bloggers have commented on these unhappy developments. There has been much wailing and gnashing of teeth.
I have noted in the past that most medical bloggers do so anonymously. Provided they change the names and blur the locations in order to protect both the innocent and the guilty (not to mention, dodge those snarled privacy laws) . . . and as long as they don’t tell too many people who they really are . . . they generally can get away with discussing their days . . . their patients . . . their opinions . . . with the wit and wisdom and insight that can only be borne of the experience of actually being a doctor.
The public really needs to hear this stuff. In this era of “Walmart medicine” and a "me-me-me-now-now-now" society that expects the state-of-the-art best (not to mention good outcomes no matter what) for next to nothing (and OBTW, society's members will sue the doctor's pants off if they don't get it), this kind of thing needs to be part of the discourse.
Alas, in reading some of the higher-traffic medical blogs (that do not moderate comments), you can see that there are many people out there who get their jollies (often anonymously) by dissing these doctor-bloggers. Many of the bile-spewing commentators on these blogs are obviously lawyers . . . or patients angry with a physician (for whatever reason) and taking it out on the doctor-blogger. The one-upmanship factor is very high. Trashing a doctor is almost like a sport.
I’ve had my share of it on the local scene. As I said in my Ode to Flea last week (before he needed an ode): Greensboro, N.C. is unusual in that it has two area doctor-bloggers (Hi Joe!)who choose not to cloak themselves in anonymity. It is an incredible community resource and it takes considerable courage (if I do say so myself) to do this . . . to open one's heart and soul and psyche up to the ether. But it does not appear to be appreciated AT ALL. It’s the reason I moderate comments here.
These medical blogs all make for really good reading. What makes them good is that the content is so REAL. You can find the totality of the physician experience in the blogosphere (I mean really, who could make up my story of public-service woe in Asheboro?). And some of the stuff you read is even more whacked-out than what you see on “ER”, “House” and “Grey’s Anatomy” (shows I universally hate because they are about as fake as it gets).
I, on the other hand, am in the blogosphere for unique reasons. I want justice . . . a justice that was denied by liars and cheats. Therefore, I sign my name. As things have evolved over the last two years, I’ve worried about a lot of things related to this blog (I'm fairly certain it's cost me job assignments within daily driving distance of home), but being “outed” is not one of them.
I’m feeling a lot of solidarity with Flea. I cannot imagine how disappointed he must be. He loved to write about medicine and his experiences (good and bad) . . . and it showed.
With that in mind, in an effort to encourage him to keep the faith, I recently shared with Flea some of what I’m about to share here. As clouds loom over the medical blogosphere, and people bow to fear & uncertainty, it’s time to blog it. What are all those cliches? "Honesty is the best policy" . . . "Lead by example" . . . "Just do it."
Ooh-rah!
I am not the best Pediatrician in the world. I am not the smartest, or the most articulate, or the most technically-gifted, or the most dedicated. But I believe I am a good Pediatrician. I love what I do, and regard it as a calling. I care about my patients and doing a good job . . . both for the patient and whoever I may be working for.
But as an "ordinary" Pediatrician with sixteen years in the "real world" workforce (much of it "corporate" and/or "non-profit"), I have some horrific stories to tell. I've seen a lot of bad behavior on the part of doctors, lawyers, administrators/executives, AND patients. Medicine is a whacked-out mess. It's certainly not the time for doctors to be hiding under rocks or mincing words about it. Besides, I’ve already been thrown out of my hometown (for doing the right thing by a very sick baby), and was called a “liar” (for telling the truth to the government I served . . . a government that then ignored me . . . like it has ignored so many others . . . and treated me like a disease).
Nothing much scares me anymore. And where medicine is concerned, my only choices are to speak out or walk away.
Plus, it's not like I have a "Marcus Welby" image to protect. Bob Morrison and Steve Eblin took care of that:(
So here goes (and even now I'm still keeping it vague - no names - no location):
A couple of years ago, while on one of my thirty-some locum tenens assignments in several states (since being booted out of my hometown for saving the aforementioned baby’s life), I was sued for malpractice. I was one of several physicians named in a complaint alleging “negligence” in a baby’s death (the doctors sued included an "on-call" physician who answered the phone when it rang and who gave reasonable advice). It's a matter of public record. I violate no laws by discussing the case.
These are the facts: A baby (less than a year of age/older than six months) was discovered unresponsive at home while sleeping with its Mother. EMS was called. Subsequent resuscitative efforts in the ER were unsuccessful.
This happened two days after I had seen the child in an urgent care setting (on a weekend evening). At the time I saw the child, the baby’s exam was “without focus”, and the history (as provided by the parents) was unremarkable. The clinical picture was consistent with a self-limited viral illness. No tests were done as the baby was in no distress whatsoever and did not appear "toxic". The child was sent home in the care of the family. The family was given detailed follow-up instructions, and told to return if the symptoms changed or worsened. It was a fairly standard encounter.
When informed of the child’s death, I felt like I had been kicked in the gut. For a brief time, I wallowed in self-recrimination and doubt and nearly non-stop second-guessing of my own medical judgment. Those were some pretty dark days as I beat myself up. I lost sleep. My neuralgia raged under the stress.
I've since been told my reaction was normal.
I was informed that the chart was peer-reviewed and no discrepancies or deficiencies in care were identified.
A child’s sudden unexplained death at home . . . shortly after being seen by a physician . . . is every Pediatrician’s worst nightmare. As a physician, when something like this happens, you immediately forget about all the many thousands of babies and children you have helped . . . and obsess about the one that "slipped through your fingers". I think it’s the reason so many doctors (including frankly, some Pediatricians) are terrified of taking care of sick babies, and literally run from them.
When I finally got my hands on copies of the baby's medical record, I poured over the chart . . . trying to figure out what exactly had happened.
If it was my fault, I wanted to KNOW.
But in terms of answers, there was not a lot to find in the record of the encounter. My hand-writing (unlike many doctors) is impeccable (printing, not cursive) and very easy to read. The questions I asked, as well as the exam I performed and the instructions I gave for follow-up were thorough and well-documented. Everything I did was completely within accepted clinical guidelines.
The “code” two days later was straightforward and very professionally handled.
Immediate cultures and toxicology studies were all unremarkable. The post-mortem exam revealed several non-specific internal/microscopic/hematologic findings, but nothing came together to point to a definite cause of death. The medical examiner was stumped.
In other words, nothing popped up out of the chart to slap me in the face and tell me (or anybody else) exactly WHY this baby died.
Compounding my angst was that, instead of the usual four to six weeks to get final post-mortem results, it took SIX MONTHS for whole teams of pathologists to say that they could not determine a definitive cause of death. As a physician, it was a horrible position to be in.
I imagine the family didn't appreciate the delays either. And I worried about that. Every day that passed with no answers about the hows or whys of the child's death certainly jet-fueled their grief, frustration, distrust and anger.
When the final path reports came back with nothing upon which to hang a hat or point a finger . . . and no real answers, I knew then that I would get sued.
Sure enough, six months later (like clockwork) I did . . . along with nearly every other MD & institution that had contact with the child prior to presenting to the ER dead on arrival.
But a funny thing happened on the way to the Courthouse. As the case evolved, and I got to review more and more of the child's medical record (previously unavailable to me - as an urgent care clinic is not a "medical home"), my feelings of angst and self-recrimination slowly resolved. I felt great sympathy for the family (that I never saw or spoke to after the encounter), but short of being psychic or having a crystal ball, it was fairly clear that there was nothing I should have done differently during that urgent care visit. Given the information that I had, this child's presentation and exam was like thousands of other children I'd seen and made the same diagnosis who went home and got better.
I mean how could I be expected (in that short encounter) to have "prevented" anything, if the gurus and specialists (after months of examination) could not tell me what it was I was supposed to have prevented?
And here's a cautionary note for those who think doing more tests will protect a physician from a malpractice action: In this particular case, had I done more tests, I might have been led down the path of a misdiagnosis (and taken "action" that would not have prevented the "bad outcome"). By following fever protocols and not muddling the diagnostic water with antibiotics or other medications, (legally speaking) I did myself a favor.
I did no harm.
Let me pause here to say that I am not going to discuss this case in any more detail. You see, I may be "out" but as far as I know, the case still plods on. Other (very good) doctors remain in the line of fire. I still may get subpoenaed as a “witness”. Having reviewed the records (including EMS & police reports/interviews) I can make an educated guess now about what I think may have happened, and I will express my opinion if I’m ever asked to do so in deposition.
I had a great insurance company. They contracted a wonderful medical defense lawyer who made it her business to know the case backwards and forwards . . . and who also actually listened to me (by my experience, a rarity in the practice of law). She was an aggressive advocate, and did not play the “collegial” (aka “billable hours”) game . . . i.e. allowing the case to drag out while accommodating a plaintiffs' attorney who regularly missed filing & discovery deadlines.
The complaint against me was dismissed at summary judgment a little over a year after it was filed.
Malpractice litigation is nothing if not a battle of experts second-guessing the doctors involved. But after being given plenty of time and several opportunities to do so, the plaintiffs did not produce an expert who could/would testify that I was negligent or failed to meet universal standards of pediatric care.
Assuming a doctor is not just a money-grubbing jerk (and there are, unfortunately plenty of them out there), in addition to the completely normal reaction that I described earlier, when your average honest/good doctor gets sued, he/she is horribly isolated. If you follow the lawyer’s advice, you can’t discuss the case in any detail with colleagues or friends or family (never mind that the case, once filed, is public record and the people suing you are often making awful claims against your character and competence). In fact, in some states, you can’t even discuss the case with your co-defendants without all the lawyers being present.
All this cloak & dagger stuff makes trying to figure out what really happened (which is what many plaintiffs say they’re in it for . . . “it’s not the money”) much harder. And it strips the doctor of normal coping mechanisms and puts him/her in a pressure cooker . . . even as he/she moves on with day-to-day life (and taking care of other patients) with this awful cloud of dread hovering overhead . . . sometimes for years and years.
Flea expressed this beautifully on several occasions. Unfortunately, I cannot provide the links now.
In my case, the sense of isolation was compounded by a life spent living on the road/in hotel rooms, and the lingering bitterness about what was done to me in a North Carolina mill town called Asheboro . . . where down is up and black is white . . . and nobody anywhere gives a damn. I felt like I simply couldn’t catch a break from our whacked-out legal system.
On the other hand, maybe I did. My malpractice case only lasted a year and was quickly dismissed. I've been told I was "lucky".
In fact, although I could have done without it (and I certainly wish the child had not died) I am not completely ungrateful for the experience (one that, if you put any stock in statistics, I can expect to repeat at least one or two more times in my career . . . assuming I stay in medicine). I can now speak about malpractice tort reform with some knowledge and authority. This very bad experience was, in its way, a "rare learning opportunity".
Every time I moved on to a new assignment, or applied for privileges at a hospital there were forms to fill out. And while the lawsuit was in play, I had to check the dreaded box that I was actively involved in malpractice litigation. I also had to submit an "explanation of litigation" (I still do . . . even though the case against me was dismissed). It's like a giant scarlett letter following me around.
Of course, after what Randolph Hospital did to me, I'm used to that.
I told only a handful of people close to me about the lawsuit. Like most doctors accused of malpractice, I was embarrased and did not want it to be "common knowledge". I worried about what parents might think of me . . . if they would trust me or like me. The interesting thing was that I discovered that several of my friends (all of them wonderful doctors) were going through . . . or had gone through the same thing.
I think, for most doctors, being sued for malpractice alters the way you practice . . . as well as the way you interact with patients. For a time, it gives you a bit of a bunker mentality and hardens the heart. For instance, you find yourself ordering more tests (that you don’t need to) . . . and keeping patients/their problems at arms length.
It takes a little while to find your balance . . . and your joy . . . again.
This is part of the reason I found Flea’s outlet so wonderfully refreshing. He had found a way to express his feelings AND pump up the public discourse on an issue that is in dire need of reform WHILE remaining anonymous (trouble was, he was giving away too many clues). And, in the face of everything, he was still so fricking optimistic.
If medicine is to survive, doctors are going to have to figure out how to (1) do a better/more responsible job of medical peer review & policing our own, and (2) reform a warped and broken medicolegal system. There is a reason I will never ever vote for John Edwards.
Notice I said that doctors are going to have to find a way. Because it's for damned sure the lawyers and politicians are not going to do it for us. And if anyone in medicine reading this thinks that they will, I'd like to have some of what you're smoking.
Unlike Flea, my attorney knew about my blogging from day one. I made it clear that I could not/would not stop. But I did make an informed decision not to get anywhere near the case in my blogging discourse while it was in play. You see, I knew the plaintiffs' attorneys were watching (more on that in just a second). Even after it was all over (and I was free to comment), I still kept my silence . . . in deference to the doctors still involved.
I had planned to continue that silence . . . until Flea shut down.
I speak out now because I’ve felt Fat Doctor’s (and Flea’s) pain. Of course, given what happened in Asheboro, I know something of the threats and intimidation of employers. But what I really want to share is an accounting of a lawyer's attempt to intimidate me by using my blog:
The plaintiffs’ attorney in this case apparently “Googled” me (I’m not sure if this was before or after he filed the lawsuit). And let’s just say I “own” my name online. My blog profile and website must have popped up real quick . . . my profile is now "number one" on a simple name search for "Dr. Mary Johnson".
I'm not sure how the many hundreds of other Dr. Mary Johnsons in the USA feel about that.
At one point, the plaintiffs' attorney postured that he was going to use the blog against me in deposition (specifically the fact that I had been fired by a hospital-owned practice). After all, hospital executives always act nobly and never make mistakes. The clear implication/threat was that he could use the information provided in the blog to “prove” that I was a “bad” doctor.
I guess I was supposed to cower in terror . . . as so many doctors do when lawyers flex their muscles.
But I didn't. I guess my reaction to the threat was atypical (maybe because I've been threatened by a lot of blow-hard lawyers).
First, what happened in Asheboro was/is irrelevant to this case . . . except that I make my living on the road (friends joke that I have "commitment issues") because of what Bob Morrison and Steven Eblin did.
Second, I would not mind at all being asked under Oath/on the record about what happened to me in Asheboro . . . about being threatened for expressing disenchantment with pediatric quality-of-care issues at my hometown hospital . . . and about being fired for ignoring executives’ threats against my livelihood in order to save a baby’s life.
But here's the thing about that (and this was pointed out to plaintiffs' counsel): I’m not sure that putting my blog "on trial" (or trying to capitalize on what happened after I answered a nurse's desperate phone call about a patient not even my own) would have helped make his case that I don’t care about my patients.
Third, (as I have blogged) I know something of malpractice . . . of suffering genuine harm due to a medical procedure. So he could feel free to ask me about being the victim of surgical malpractice (at the same "care you can trust" hospital that fired me) . . . not once but twice . . . malpractice that required surgical intervention to repair . . . both times.
Before my last ENT surgery, I spent many a night totally alone in a darkened hotel room cradling my aching/pounding/burning face & head, with tears silently streaming down my face because it hurt so bad.
Of course, the tears made it worse. But I didn't want any part of the powerful drugs that could make it go away. I took nothing stronger than high-dose Motrin. I did not want to be "fuzzy" or risk addiction. Because of my outspoken criticism of Randolph Hospital, the NC legal system, the NC Medical Society, the NC Medical Board, and privacy & confidentiality laws (that hinder patient care more than help, and throw due process for doctors out the window), I have a target on my back and I know it (it's not my "imagination" . . . many, many people have expressed concern about this). I was not going to give the NC Medical Board an opportunity to screw me. So I sucked it up and dealt with it. You could say I suffered for my art.
The plaintiffs' lawyer could then ask me why I did not sue for malpractice. There's no good/short answer. Bad things happen. Perhaps I am sick and tired of manipulative/dishonest/greedy lawyers. Maybe I've come to understand that "legal ethics" in the great state of North Carolina is a contradiction in terms. Or maybe it's because (having that "inside knowledge" of the system) I understand that malpractice litigation is not like playing the lottery . . . most of the time making your case is a hard go. "Jackpot" verdicts and settlements are rare. Maybe it's because playing the "victim" is so completely contrary to my nature . . . despite the fact that I've had to do it for nearly ten years.
Or maybe I understand (contrary to popular belief fueled by TV shows) that the legal system is far from noble and rarely "fixes" anything.
So I really do feel Flea’s pain. And I feel the oppression in the medical blogosphere right now. But I think we’ll be okay. And my man Flea will be back. I know it in my bones.
Finally, I thought I’d offer two more things on this post:
First, as an update on the progress of Part Two of “Why I Blog” (which I started writing after getting Flea’s tag), I am waiting very patiently on a small-town-hospital and our state Medical Board to do what needs to be done in order to protect patients (i.e. the Medical Board's JOB) before I publish. Regular readers might remember those two paragraphs I deleted (for publication on the blog) in a letter that I sent to the Medical Board, NC Attorney General and several NC Legislative Committees this past February. Well, while all the "honorables" were all sitting around whistleing Dixie (pretending I do not exist) there has been a new development relevant to those deleted paragraphs.
It's not a nice development. An infant died. It is my very strong, "expert" opinion, the death could have been prevented if the NC Medical Board had acted on a problem that was reported last year. The is one life that should have not slipped through anyone's fingers.
I feel very, very strongly that the Medical Board has no excuse. The lawyers who run the Medical Board completely blew me off (much like they let me swing nine years ago).
Our systems of medical and legal oversight are simply not working. And the "high & mighties" in Raleigh and Washington are sitting on their hands letting doctors (and patients) rot.
Second, I wanted to say this: I’ve been sued for “malpractice” and I’ve been sued for “libel”. Both cases were without merit. Both cases were dismissed in my favor. In the second instance I was "awarded" a paltry punitive damages settlement (as it turned out, far less than I should have gotten . . . given the information that I now know two “non-profit” hospital executives brazenly lied about and withheld).
Because they lied (repeatedly) and were not held accountable, I was not able to get back up on my feet in Asheboro. I can go anywhere, and work everywhere but home. And it is amazing to me that many of the "giants" in Asheboro and at Randolph Hospital are not concerned at all about the fact that what they did to a home-grown Pediatrician speaks volumes about what they are . . . and about what this town really is.
And herein lies the lesson for people who value character and integrity (and it should explain why I've fought so hard for vindication): As bad as getting sued for "malpractice" was (and it was way-bad), getting sued for “libel” was far worse.
You see, getting sued for “malpractice” was about what I do.
Getting sued for “libel” was about what I am.
Author's note: This post is dedicated to Flea.
*Comments on this post are closed. E-mails are welcome.*
Monday Morning Update: More from the medical blogosphere.
