Doctor gives patient prophylactic dose of SQ heparin
--> Patient has serious GI bleed
--> Doctor gets sued
--> Doctor is scared and doesn't give any patients SQ heparin anymore
--> Patient gets pulmonary embolism
--> Doctor gets sued
--> You can't win
(No, this hasn't happened to me. Yes, I've seen it happen to multiple doctors.)
What if the doctor is following the hospital or an organization guideline?
ReplyDeleteI can't understand how non med expert can role in medical matters.
I'm a little horrified that a lawsuit would cause a doctor to stop following evidence based medicine....
ReplyDeleteI couldn't have said better!
DeleteThere are risks to anticoagulation though and sometimes it can be a judgment call in certain patients.
DeleteSpeaking as someone who defends malpractice suits: sometimes you do everything right, and you get sued anyway. Frequently a physician does something unquestionably negligent and never gets sued. The link between what you do (or don't do) and being sued is nowhere near as direct as most physicians think.
DeleteYep. Reminds me of this excellent ACP Internist blog post
ReplyDelete( http://blog.acpinternist.org/2013/11/what-do-400000-deaths-from-medical.html )
that details the small decisions doctors make all day long and how things will go wrong at times even with excellent medical judgement.
Good clinical decision-making does not preclude lawsuits. No one told me that during medical school and it has been a hard lesson for me to learn.
Just a quicky anecdote----my husband recently had gall bladder surgery---he is on warfarin/coumadin for his clotting disorder. He went off for surgery. The first day after surgery, they started pushing lovanox and warfarin. He went home from the hospital and was home a week, but didn't feel all that well. On the 7th day home, he started getting intense pain in his abdomen. We went to a local ED---they did a CT scan---his liver was bleeding. He had to be lifeflighted to a major hospital and spent 4 days in ICU. It was a traumatic experience for all. We wish the surgeon had held off on the blood thinners after the surgery for a few days. We don't intend to sue, but it was a very scary experience.
ReplyDeleteI enjoy your blog---and thank you for your work.
Elissa Hock-Wimmer
If your husband had not been anticoagulated and developed a massive PE and died or had a major stroke, you probably wouldn't have been very happy with that outcome either. Patients and families need to understand that following evidence based medicine isn't a magic bullet that prevents all possible complications. Just saying.
DeleteOf course, you are correct. The biggest issue is that when you are having something that is called a "minor" procedure---you don't anticipate that you are going to have internal bleeding and almost bleed to death. More than anything--we were upset that we weren't warned of the possibilities. My husband doctors only at a very famous hospital---and even though we thought the doctors and facility were "invincible"---we know that there are questionable judgements in all facilities---no matter their reputation.
DeleteWe are truly grateful for the medical care that we usually receive and know that there are fabulous care-givers out there. Again---it was mostly a wake-up call for us.
And there's heparin induced thrombocytopenia
ReplyDelete