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Catastrophizing the Practice of Medicine

Got an email from one of the 4 people who follow this blog and this doctor said that after practicing for 30 years he’s just realizing that maybe he’s meant to practice medicine. Imposter syndrome aside and looking past any potential catastrophe we imagine, there is the part where you get paid to care about another human being.

Maybe the caring is in a way nobody ever cared about you or it’s the way you wanted to care about the people you love but were afraid to express.

I am afraid to express my love to my partner many times because I don’t want to come across as weak, needy, or maybe even admit to myself how good I have it because what if one day someone just sucks this right out of my life?

Defensive Medicine

Hi, I’m Dr. Mo, and I practice defensive medicine. So much so that I’m reading your chart before I walk into the room and already thinking about what I’m gonna document to make that lawyer’s life hell when they come for me.

Even worse, I believe that this defensive practice since 2009 has somehow protected me.

The reason I’ve not been sued is because my documentation is the tits! I always list a broad differential and what I’ve ruled out, I tuck the patient in, arrange all sorts of follow-up, and have 10 lines of generic sentences meant to protect me from a lawsuit.

If this were true, it still wouldn’t justify carrying this much baggage around. I’ve been thinking about getting sued on at least a daily basis since 2012 – that’s 4,500 thoughts of getting sued without getting sued. That’s just so sad. A moment of silence for my sanity.

I’ve treated patients as a liability, standing between me and my paycheck and me and my sanity. It’s their existence against mine, their ear itching chief complaint against my ACH deposit.

Catastrophizing Medicine

Can I get sued? Yes. Medicine is a risky business.

Can I decrease the chance of getting sued? Yes.

Can I prevent getting sued? No.

Am I a bad person if I get sued? No.

Would a medical malpractice suit ruin my life? No.

Will I be destitute and have my loved ones leave me? No.

Will it be hell going through a malpractice case? It doesn’t have to.

Confronting Past Fears

I don’t even know how I ended up here. I never got sued. I got some accusations in residency. There was 30s woman who claimed I did my bimanual pelvic exam inappropriately … with my nurse and a medical student present.

I remember there was a nurse who’d keep grabbing my crotch and being unbelievably inappropriate. I reported her to my attending and then to my residency director and everyone said just suck it up. Maybe that left me feeling powerless? Who knows.

I have all sorts of narratives to catastrophize the practice of medicine, healthcare, health reform, medical entities, etc. I don’t think there is anything wrong with having an eye on how things are but I’ve internalized these now and they completely overshadow my patient visits.

I Don’t Have to Be Perfect

I don’t expect much of the dude sweeping the streets here in Downtown Long Beach. Sometimes he’s listening to music, talking to someone on his wired headphones, or smoking a cigarette.

Deifying Doctors

But a doctor, a surgeon, we expect the world of these people. We revere them and deify them. I still get a little tickle near my colon when the doctor first comes in, and that’s before the rectal exam. I’m in awe that this person is a doctor.

I expect myself to be perfect, to say nothing wrong, and to do nothing wrong. If I do something wrong, it should be something really minor. And if I do make a mistake, it’s my fault.

Incidents Are Impossible to Avoid

Accident vs. incident. An accident has such heavy baggage with it. The accident at work is the mistake I made, the error in clinical judgement that led to an outcome.

However, incidents will happen and can probably be prevented in the future. We cannot avoid incidents, but we can learn from them, adjust, improve, and take better care of patients.

Unrealistic Expectations Are Unrealistic

But here I am, sitting on my throne; no, I cannot miss an important diagnosis. I cannot miss septic arthritis, Steven Johnson Syndrome, or confuse the PNA for the PE (that’s pulmonary embolism, for the orthos—oh, and pneumonia, which is an infection of the lung).

To be perfect, I have to be a machine, and to be a machine means I cannot be a caring human being in the presence of another. This means that when I get my next gout flare in my jaw, there won’t be a caring doctor sitting across from me.

What’s Worse Than Getting Sued

What’s worse than getting sued is making myself and my patients suffer daily for no sensible reason – it’s not like me stressing about getting sued can prevent me from getting sued. To carry around all that anger, angst, frustration, fear, and misery while missing out on living life.

If I am going to practice medicine from now until I die, I need to get through it with my emotions intact. Being a doctor is hard enough; no way you can bring this kind of baggage along for the ride.

Burning Out

Though yoga has been proven to be curative for burnout it’s still a good thing to avoid. When I go through my day to day expecting perfection and hoping that nothing ever goes wrong then I place an immense load on myself.

How can a physician not burn out? But would a malpractice suit add to the burnout? Maybe. Yes, it probably could. But lawsuits aren’t easy to prevent. Harm, yes, that can be reduced and that’s what most of us are already doing.

Hating Medicine

If you don’t want to hate medicine or learn how to unhate it then the practice itself has to mean something to you that’s unique to you.

Perhaps you care about how many good surgical outcomes you have or how many patients praise your bedside manner.

To not hate medicine, you must love yourself for exactly how you are now—right now. Even if you’re overbilling Medicare, flirting with patients, or performing surgeries that don’t need to be done, you have to first love yourself so that you can prevent hating yourself and medicine.

Once you accomplish that, you can then, from a place of warm fuzziness, try to figure out why you are doing what you shouldn’t be doing.

A Lawsuit Isn’t the End of the World

If other doctors before me have survived getting sued, I can, too.

My tip for other doctors is that you have to have someone in your corner to talk with. My wife was wonderful. Unfortunately, getting sued is just a part of doing business in medicine. It doesn’t mean you’re a bad doctor; it’s just your turn.

Dr. Wuest

“It was a difficult case and I wasn’t at all sure the jury would understand the complexities. But the jury was wonderful. After the 3-week trial, it took the jury less than an hour to find that I wasn’t liable. I totally believe in the jury system. It’s the fairest thing in our democratic society.”

Dr. Anonymous

“I had no way of telling what the jurors were thinking. The jury began deliberating but didn’t reach a verdict that first day. Was that a good sign or a bad one? I had no idea. Fortunately, the jury came back the next day and found that I wasn’t liable. I felt relief that this ordeal was over but was still upset that I lost so much time out of my life over this.”

Dr. Onyewu

I never link to Medscape, but I had no choice here. The article talks about how betrayed these doctors felt when they found out they were sued. Almost all were convinced that they were doing everything right for the patient and that, therefore, they shouldn’t be sued.

We think that about major diseases — I ate and exercised so well, how could I have gotten cancer, a heart attack, stroke, or MS?

More than any other culture, we have a major blame problem. Everything has to have a root cause, and the individual is at fault. If they just didn’t do something, then the bad outcome would have been avoided.

The thing is, the world doesn’t work like that. Bad shit will happen for no good reason, the same way good shit happens to shitty people for no good reason.

Forgiving Yourself Now – Before Something Bad Happens

If you can’t do it, then I can do it for you: I, Dr. Mo, hereby forgive you for anything wrong you do in medicine. For any sepsis you miss in an elderly patient, any bad surgical outcome, any missed strokes or heart attacks, or any missed aortic dissections.

You are forgiven because you are human. And you are forgiven because you never practice medicine on your own. There are 1,001 moving parts over which you have very little control.

I catastrophize medicine because I think that I cannot live with myself should something bad happen – if I get sued, lose my medical license (again), kill a patient, miss something big, etc.

Are You Gonna Be Okay?

If you never could practice medicine, would you be okay?

If you got sued and lost all the money you had, could you be okay?

What if you had to serve 5 years in jail for involuntary manslaughter, could you be okay?

Of course, we could. Millions of people before us have gone through such events, and thousands have come out just fine or even better.

It’s an unpleasant thought because we compare it to who we are now and how we are living. We compare the bad outcome to the ideal life we hope to live in the future; the boats, vacations, sports cars, plastic surgeries, and the grandkids getting married.

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