You are consulted to see a patient for possible surgery. On first meeting, he’s a great guy. But he’s 4+ sick. He had a heart transplant a number of years ago. Diabetes. COPD. And now he has an acute abdomen. He needs immediate attention.
He’s awake, alert, and competent. You’ve discussed the risks, benefits, and options. He is totally aligned with your recommendations.
The patient’s words are: “Doc, I really want to thank you for looking after me. I appreciate you being here for me. I’ve had a number of tough conditions over the years. Just do your best. I understand the risks.”
The patient’s son, at bedside, is also fully supportive, echoing similar comments.
Your patient has one request. “Would you be kind enough to call my other son, who lives 6 hours away, just to let him know what’s going on?”
“Of course.”
Meet Godzilla.
The other son lashes into you – stating that the hospital has been incompetent from day one…all the doctors are just interested in cash…and that you’d better not screw up because he’s an attorney and will personally come after you if there’s a bad outcome.
That was not a positive trust building exercise.
You state you cannot comment on his dad’s past hospital experience as you just met him 30 minutes earlier. But he has a life threatening condition. And there are no good other options.
You hang up while the son is still venting.
Now what do you do?
Your patient is nothing but kind, civil, and appreciative. But, the patient’s lawyer son on the phone might become executor of the estate if your patient dies. And he would conceivably have standing to sue. Whether he would prevail is another matter.
On the other hand, the lawyer son is not your patient.
You’re the one surgeon on call. There’s no option to transfer to another facility. And, anything other than surgery – soon – will likely end in death. And even with surgery, the patient might die or experience a complication.
What do you do?
I’m sure I’ll be accused of lawyer bashing. So be it. This vignette is based on bona fide case.
You treat the patient to the best of your ability, documenting everything in detail. I would also contact the hospital legal department to ensure everything is documented optimally.
In this patient with an acute abdomen, there is a significant risk of death and this needs to be noted.
Consent process with witnesses like usual.
If one decided not to do the case and referred to another, there would be a delay, and if any adverse event occurred, you still could be at fault for delaying care.
In life, there will always be someone like this, however, they are an obstacle that needs to be overcome.
Be careful out there!
You carefully document the consent process having the son present sign as a witness as well as nursing staff. Then you treat the patient. By the given scenario, the patient is competent. You don’t know the mental status of the person on the other end of the telephone. Also, if a suit does ensue, any delay in therapy could provide ammunition for that suit. Not to mention, any delay could result in poor patient outcome. One should never be afraid of what might happen as long as you treat your patient well.
This is precisely the reason I thank my lucky stars that I did NOT choose medicine as a career, but rather got advanced degrees in electrical engineering, where I don’t have people making cheap grabs at my home or my kids’ education every time they have a psychotic whim.
However, as office manager of my husband’s practice, I feel for this physician. We have had a few personal threats like this and in spite of the fact that nothing ever comes of them, it’s a very unsettling and difficult position to be placed into- because if something DID come of even one of them, it could mean certain disaster with absolutely no merit.
Over the years, I have come to the conclusion that, unfortunately, physicians need to become more stoic to this type of bullying. For some reason, there are doctors who are more likely to become recipients of this type of lashing than others. Sometimes the arrogant, less caring doctor is NOT named in the suits- because he/she is not considered a coward or pushover. Gentle, competent, caring docs get abused simply because they are easy targets.
I never realized until I met my husband how much social psychology Darwinism there is in the field of treating patients. One would think that the overall standard of care would protect against this vulnerability, but it does not.
I think that Dr. Troell has hit on the correct solution. The key here is the documentation of the process in detail. You cannot prevent the lawyer son from bringing suit, but you can certainly protect yourself with complete and correct documentation. I would also include a summary of the conversation with the son so that you will have no doubt about what was said should it ever come to litigation.
Every single patient ever treated should be considered to have HIV, hep C and a son who is a personal injury plaintiff attorney. Enough said.
Never deal with relatives who aren’t at bedside. Because they’re not there, they already feel guilty and to alleviate their guilt they look for someone to blame. It only wastes your time and can only lead to no good.
PLease note that if you try to transfer a patient like this and he/she dies in the process or is worse off bc of the transfer, that is a much worse place to be in than the case of this son.
I would find a way to tell the patient that the son was contacted and that the son had not been pleasant and had made some pretty difficult statements. Ask the patient if he wants to know more or if this is what he expected. Ask the “nice son” in more detail how to approach that issue with the father. Then, document on the chart what the not-nice son said and his threats. The latter as a fact on the chart in combination with outlining the risks discussed with the patient and his family should be sufficient.
Lastly, it is possible for any of us to be assaulted by frivolous lawsuits. Fortunately, the vast majority of them go away if we leave them in the hands of excellent lawyers with whom we cooperate fully. They cost us time and cost our malpractice insurers money but our malpractice carrier does not penalize us for a defending rare frivolous threat.
I have dealt with a similar son while caring for an 80 yo woman with multiple medical issues. My response to him was go ahead and take your best shot at me. I will do my best to treat your mother and you can sue any time for reason. But so can I. He took his mother to another
hospital for care. She died about 18 mo later and 18 mo after that he contacted me to tell me that he should have stayed with me and he made a mistake. We do not have to be arrogant but we should not be push overs.
I have long said that it’s not what you do to/for a patient, it’s who they are. We all want patients as thoughtful and understanding as this one. There are some patients who will try to do anything, crooked or not, to continue their lives…and this includes suing you. So it is a risk in this case no matter what happens.
But I have a suggestion: speak with the far away son on speaker phone while you are sitting with the nearby supportive son. He (the nearby son) will also then be in the “chain of command” in passing information on to this other son.
Since there is no way to transfer this patient then it is the surgeon’s duty to operate.
Given that, I would contact the hospital lawyer and maybe even my own carrier to put them on notice and find out if there is anything I can do to protect myself. I would have the man, the son, a nurse sign the consent. I might even insist on a video of the consent.
I would also be sure that I consulted all specialists in advance that are indicated, and document like crazy. Screw the crazy other son. Sometimes you get a bad hand. I would also document the threats.
On a social note. I would have insisted that the son or patient call the other child first and then I would have spoken with him. I would have told him that I will not treat him disrespectfully and will not tolerate it from him. If he persisted, I would have hung up. Further, I would refuse to speak with him in the future. The son at the bedside is capable of communicating.
We as doctors are not obliged to be targets of abuse, and we do not have to speak with every family member. We cannot fear getting sued- we have a duty to perform. Sometimes complications and even a death will occur. We can’t beat statistics.
sek
Document, Document, Document!! and then proceed with treatment.
All of us have had to deal with a lunatic family member at one time or another.
This is a classic no-win situation. At least you have been for-warned. Most doctors have no real warning of an impending suit ahead of time. If surgery is necessary and you have nobody to refer to and time is of the essence, you have no choice but to operate. Many here have already said this.
But you do have another option: The good son vs. the bad son.
The good son may have some ability to deflect the bad son from you. It is worth considering a try: “I just spoke with your brother by phone. He told me that he is very angry at doctors. He already warned me that he may sue me. If you were in my shoes, you certainly would understand that this is ‘distracting’ from your father’s care. An example of this is that I was forced to notify hospital CEO and counsel about your brother, but I had no choice. I can assure you that I will do my very best, and I know everyone here will too. But it does not feel good to be working under a sword of Damocles. If you were in my place you certainly would understand. I certainly wish your Dad the very best and I will pray for him. A lot about his case is out of our hands.”
Who knows. Perhaps an apology will be generated. The good brother is probably already well aware of the bad brother and may have had his own experiences with same. The good brother might even be able to stop the lawsuit, using his own skill in family dynamics, when and if the time comes.
Michael M. Rosenblatt, DPM
Good care and documentation is your best defense. We have unnecessary fear of lawyers. It is very rare to get sued by a lawyer patient or their family member. It’s the personal injury lawyers who are vultures. Most of the law suits I have personally seen are by the patients who are appreciative of care and/or the ones who send a thank you note.
I wish all the MJ posers were this easy. As far as I’m concerned, everyone got the right answer.
JH
I am a bit confused by Nadeem’s post above. It’s not so much that doctors “fear” lawyers, it is rather that the lawyers steal vast amounts of time/energy from doctors, their families and their staffs’. Every doctor who is sued wonders if they will end up going to court, planning and preparing depositions, having staff undergo depositions, etc. This is business as usual for the legal profession. They were trained in Socratic argumentation. Doctors are not.
Then, the doctor always wonders if they will be dropped by their insurance if they reach a “magic number” of claims. I know of several orthopedists who lost their ability to practice privately because of a confluence of “too many” lawsuits against them. I am not in a position to judge whether this was fair or deserved, but it did happen.
Perhaps they went on to join a group practice. I don’t know. But they were out of their practice. That I do know.
As far as suing patients being “appreciative of care, or sending thank you notes,” I have never heard of this occurring in any lawsuit situation. I know that is only one person’s experience, but I consider it unlikely. Since I never had to go to court, I am not an expert on this, but I have never heard of any colleagues facing legal action who had such an experience.
Perhaps Nadeem testifies as a plaintiff’s expert, or is an attorney. But being threatened (on the phone) by a family member who is an attorney has to ring your panic buttons. If it doesn’t, you are ignoring an important message that should be transferred to the hospital CEO.
Michael M. Rosenblatt, DPM
This one is a no-brainer: save a life! The positive rapport developed with the bedside-son is priceless. He knows his brother’s personality, and could be a good source of surgeon-support. In any event, our obligation is to the patient even if he is cantankerous.
Time for tort reform yet? If I were a GS, I doubt I would feel comfortable working for myself. If you work for the VA, you have the best malpractice protection, not to mention generous salary and benefits. I would hope that working for a hospital would provide a GS with better malpractice protection than being alone in the free market.
4. A lawyer’s conduct should conform to the requirements of the law, both in professional service to clients and in the lawyer’s business and personal affairs. A lawyer should use the law’s procedures only for legitimate purposes and not to harass or intimidate others. A lawyer should demonstrate respect for the legal system and for those who serve it, including judges, other lawyers and public officials. While it is a lawyer’s duty, when necessary, to challenge the rectitude of official action, it is also a lawyer’s duty to uphold legal process.
Document everything, do the good job that you know you can do.
After the surgery and recovery, I would file an ethics complaint against the lawyer son. It is time we bite back boys and girls.
You make certain who is the patient’s legal spokesperson, including if patient themselves, then you so note it boldy in the record.
You then see if you live in a state that is out of control with malpractice. If you have the misfortune to live in such a state you then should start the process of relocating out of a state where the malpractice money machine enables looting even from third parties you never had treated directly as a patient.
By restricting communication to one spokesperson you protect privacy and clarify channels of communication. You avoid entrapment into dysfunctional families and engagements with dsyfunctional individuals. If the patient is nasty beyond what you can tolerate…and…it is not an emergency/urgency….then kindly explain to that individual that you just don’t feel comfortable continuing to be their doctor and that perhaps it is best if they seek care from another doctor. Then officially dismiss them within the legal allowable time.