Medical Justice provides consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. We also provide counsel specific to COVID-19. If you are navigating a medico-legal obstacle, visit our booking page to schedule a consultation – or use the tool shared below.
“Can Medical Justice solve my problem?” Click here to review recent consultations…
all. Here’s a sample of typical recent consultation discussions…
- Former employee stole patient list. Now a competitor…
- Patient suing doctor in small claims court…
- Just received board complaint…
- Allegations of sexual harassment by employee…
- Patient filed police complaint doctor inappropriately touched her…
- DEA showed up to my office…
- Patient “extorting” me. “Pay me or I’ll slam you online.”
- My carrier wants me to settle. My case is fully defensible…
- My patient is demanding an unwarranted refund…
- How do I safely terminate doctor-patient relationship?
- How to avoid reporting to Data Bank…
- I want my day in court. But don’t want to risk my nest egg…
- Hospital wants to fire me…
- Sham peer review inappropriately limiting privileges…
- Can I safely use stem cells in my practice?
- Patient’s results are not what was expected…
- Just received request for medical records from an attorney…
- Just received notice of intent to sue…
- Just received summons for meritless case…
- Safely responding to negative online reviews…
We challenge you to supply us with a medico-legal obstacle we haven’t seen before. Know you are in good hands. Schedule your consultation below – or click here to visit our booking page.
Man, the country has gotten so sensitive…
Patients are lashing out online, stating medical practices are “this phobic” and “that phobic.” Racist. Ageist. Ableist. Other “ists.” Some patients have filed lawsuits alleging discrimination. Oh dear.
Let’s start with the basics.
If a physician recommends a procedure, it’s based on two prerequisites.
Is the patient a candidate for the procedure? Meaning, is the risk/benefit ratio reasonable for this patient?
Next, does the doctor have the background, training, and experience to do the procedure well?
They BOTH matter.
If an orthopaedic surgeon, for example, tells a transgender patient with a fibula fracture he does not take care of transgender patients, that likely IS discrimination and actionable in court. To state the obvious, being a transgender patient has minimal if any impact on how to treat a fibula fracture.
In contrast, if a transgender patient requests gender-affirming surgery from a urologist or plastic surgeon, and that specialist has zero background, training, or experience in that specialized domain, and he tells that patient he does not perform such procedures, is that discrimination? Nope. It’s called practicing good medicine. One should be cautious in performing what you are not likely to do well.
If a patient is not a candidate for a specific surgery, say a lumbar fusion, because he has a BMI of 55, and the surgeon tells the patient that much, is that discrimination? No. The decision is based on that surgeon’s perception of risk – in his hands- based on the condition being treated in a specific patient. Individualized medicine.
Some surgeons are comfortable performing high-risk procedures on Jehovah’s Witness patients who refuse transfusions. Most are not.
Neurosurgeons who limit their practices to spinal surgery should not be forced to perform aneurysm clippings. It would not be good for the patient. It would not be good for the surgeon.
One astute plastic surgeon, Dr. Steve Teitelbaum, asked rhetorically:
We are all trained to do facelifts, but some plastic surgeons don’t do facelifts; might a plastic surgeon who referred out a patient requesting a facelift be sued for age discrimination? Some surgeons don’t perform liposuction; might they be sued for discriminating against obese people? Some don’t perform “ethnic” rhinoplasties because they are really difficult to get right; does that mean they are discriminating against “non-Caucasians”? Some don’t do labial reduction surgery – is that discrimination against women? Some don’t do female to male transgender surgery because though the mastectomy is straightforward, it is really tricky to predict the scar and to masculinize the chest. As our attendings told us in residency, “Just because you know how to do it does not mean you should be the one doing it.”
True enough.
Every specialty has a list of procedures where it’s just good medicine to match the right patient with the surgeon’s skill set. Not discrimination. If you can’t perform the procedure well and the patient may be a candidate for that procedure performed by a different doctor, refer the patient.
A “language” detail if your practice does not perform a specific procedure: Give the patient an option. It’s OK to say and write, “I do not have the background, training, or experience to do X. I limit my practice to Y. Nonetheless, Dr. Z does a great job with the procedure you want. We’d be happy to refer you there…”
By the way, when did our population get so sensitive?
What do you think? Let us know your thoughts in the comments below.
Medical Justice provides consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. We also provide counsel specific to COVID-19. If you are navigating a medico-legal obstacle, visit our booking page to schedule a consultation – or use the tool shared below.
“Can Medical Justice solve my problem?” Click here to review recent consultations…
all. Here’s a sample of typical recent consultation discussions…
- Former employee stole patient list. Now a competitor…
- Patient suing doctor in small claims court…
- Just received board complaint…
- Allegations of sexual harassment by employee…
- Patient filed police complaint doctor inappropriately touched her…
- DEA showed up to my office…
- Patient “extorting” me. “Pay me or I’ll slam you online.”
- My carrier wants me to settle. My case is fully defensible…
- My patient is demanding an unwarranted refund…
- How do I safely terminate doctor-patient relationship?
- How to avoid reporting to Data Bank…
- I want my day in court. But don’t want to risk my nest egg…
- Hospital wants to fire me…
- Sham peer review inappropriately limiting privileges…
- Can I safely use stem cells in my practice?
- Patient’s results are not what was expected…
- Just received request for medical records from an attorney…
- Just received notice of intent to sue…
- Just received summons for meritless case…
- Safely responding to negative online reviews…
We challenge you to supply us with a medico-legal obstacle we haven’t seen before. Know you are in good hands. Schedule your consultation below – or click here to visit our booking page.
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Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.
Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.
Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.
In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.
Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. Byrd Adatto was selected as a Best Law Firm in the 2021 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. With decades of combined experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.
Quite agree with all of your suggestions here. I do want to recommend a recent compelling article by Iezzoni et al about physicians’ lack of awareness of ADA requirements. Turns out, we’re pretty clueless. https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.01452
You did touch on this issue almost a year ago (6/19) , but the case on which that column was based has been remanded.
I guess humanist or specialist are the only “ist” descriptors that anyone can accept anymore. Almost all others raise the hackles and make us unwilling to listen further. When we are unable to listen, it is hard to have a conversation. (ref: recent AMA podcast/tweet)
This column is based on what is or may be perceived as discrimination. To a very large extent this is based on the demeanor of the physician involved. In the last few days a retired physician friend of mine went to a major medical center, to see a ophthalmic neurologist. As part of the questioning, the physician asked the retired physician who the president was. My friend thought he was being a bit coy when he said, it depends upon who you ask. Now clearly the neurologist was asking that question in order to do a neurologic assessment. But the neurologist went off on a political tirade that went on for a number of minutes based on friend’s answer. Now my friend’s wife is contemplated a board complaint. This was an unforced error on the part of the neurologist. Has he done this before? Was he just having a bad day? Did he exercise poor judgement? The point is that how a physician responds about procedures that they may or may not do, directly determines whether it is perceived as discriminatory or not. Many physicians continue to have terrible bedside manners and do not know how to win friends and influence people. They think that because of their training and high status that they can act high and mighty. That was definitely a characteristic of physicians a generation past. But I continue to see this in physicians today. They put themselves in harms way of lawsuits because of their demeanor and responses to patient interactions. My prediction would be that if you sent all physicians for a Dale Carnegie course, and they actually learned how to win friends and influence people, you could cut down on lawsuits against physicians, and board actions against physicians by 50%. The situation described in this article is an indictment of technically proficient but inadequately humanistic responses on the part of physicians. The incident that I described with my retired physician friend, is even sadder because this is how a practicing physician treated a retired physician. One day that physician will be retired. Would his future self like to be treated in the same manner he treated my friend?