Wednesday, December 4, 2013

Vicious cycle

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.)

10 comments:

  1. What if the doctor is following the hospital or an organization guideline?
    I can't understand how non med expert can role in medical matters.

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  2. I'm a little horrified that a lawsuit would cause a doctor to stop following evidence based medicine....

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    Replies
    1. I couldn't have said better!

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    2. There are risks to anticoagulation though and sometimes it can be a judgment call in certain patients.

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    3. Speaking 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.

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  3. Yep. Reminds me of this excellent ACP Internist blog post
    ( 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.

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  4. 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.

    I enjoy your blog---and thank you for your work.
    Elissa Hock-Wimmer

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    1. 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.

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    2. Of 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.

      We 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.

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  5. And there's heparin induced thrombocytopenia

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