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« The Necesarean: The Perspective of a Plaintiff's Birth Trauma Attorney | Malpractice 101 (and other scary stories surgeons tell in the dark) »
Monday
Jan102011

Hanging Up My Gloves

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By an anonymous OB-GYN

 

When, as a medical student, I took the plunge into obstetrics, I remember thinking that delivering babies was so much fun that I’d be willing to pay for the privilege.

It was fun for years. I spent my twenties, thirties, forties at it. I sacrificed many a night’s sleep and plenty of my own life on that altar. My own children complained about it. Night call got harder, physically, and the workload, day and night, became ever more demanding. I’d always been in academic medicine, so working harder did not translate into more money. But that was OK too. Still fun. Still it was work that was important and valuable. Still, I thought, I was doing some good for mothers, babies, students, residents. The shape of the job changed over time: there was less time for reading, or writing, or research, or thinking. It got to be all clinical, all the time. We covered more clinics and took more call. Expectations burgeoned like mushrooms after rain. It was no longer enough to be physically present in the hospital: the attending had to come to every delivery, scrub for every case, see every consult, see every patient in triage. Oddly enough, this did not grow us any extra attendings. But it went some distance toward driving out the older, experienced ones.

I got sued. It was traumatic the first time. I got dropped. I tucked my tail and kept going. I got sued some more. Sometimes I got sued for deliveries I didn’t even do, deliveries I wasn’t even in the hospital for. I got dropped some more. Most of these were cases where I didn’t even know there was an unhappy outcome. You brace yourself after the bad shoulder dystocias, or the bad babies, but those aren’t the ones that surprise you. The ones you didn’t see coming are worse. As an attending physician in an academic medical center I have my fingerprints on a lot of patients, one way or another. Did I read a straightforward ultrasound at 18 weeks? Did that patient go on to develop preeclampsia 2 months later and deliver prematurely at some other institution? Could she read my name in her records? Because if so, she could advance a legal theory about my culpability. More calls and more clinical duties cut down on the time I could spend with any given patient, increased the number of patient exposures, forced multi-tasking even when focus would have been best.

It was like dancing through a minefield. You could never tell when something was going to blow your legs out from under you, but it wasn’t any safer to go back. I did my best to keep the mission in mind, but the joy was leaking out of a hundred different punctures. I became wary of patients. I got tired of everybody else’s needs. I tried to dodge the bullets.

This year, the bullet had my name on it. The case blew up out of nowhere, like they do; it was another 24-hour in-house call at the academic medical center. There was nothing memorable about it, at least from the perspective of a few years later. No standout crises that day. But a patient admitted that day delivered the next day, after a second stage I didn’t manage and wasn’t there for. I read that chart through in the lawyer’s office: she rejected the cesarean offered after a few hours of pushing, went on to a spontaneous vaginal delivery. Normal fetal heart rate tracing throughout. Normal cord gases. Lousy Apgars and intracranial hemorrhage. I felt bad for the patient and her baby: she thought it would take about $20 million to raise him.

My lawyer—-strike that, the university’s lawyer—-figured I’d be dropped. I hadn’t written a note, which was unusual, but sometimes you miss one in triage or on the labor floor. The plaintiff’s lawyer started out with a theory about the strip but gave it up. The theory fibrillated a little, eventually settled down, exhausted, on the notion that if any of the attending physicians had personally retrieved the prenatal clinic record over the weekend, the patient should have been offered cesarean at admission—- the same procedure offered, and declined, in labor.

Depositions were duly taken and experts ordered up. A court date was duly scheduled. I arranged coverage for my clinical duties and dreaded the date. A settlement was proposed, rejected, renegotiated. I got a phone call: the university is going to settle, it’s a business decision. One of the seven million dollars in that settlement would be assessed in my name.

My consent was not sought. Settlement was reached over my objection, and I had, by the terms of my employment contract, no right to refuse settlement or go to litigation. No confidentiality agreement was imposed upon me. I asked what would happen if I wrote about the case, and was met by shocked silence…because it’s a shameful thing, a secret we’re supposed to keep in the closet.

I didn’t lose this case: I never had an opportunity to fight it. But there is a record now in the National Practitioners’ Data Bank with my name on it; you could look it up. It will follow me the next time I apply for a medical license, or hospital credentialing. And in the eyes of patients or consumers…well, you know what it means. Those doctors are damaged goods, subprime mortgages, product recalls.

But I know what else it means. It means I’m hanging up my gloves. It means I’m done with delivering babies. Is there an emergency on L&D? Is the department strapped for nighttime coverage? Do you need a senior physician to take a junior one through a breech delivery? Did you call for help with that shoulder dystocia? Sorry, but I already gave.

 

 

 

 

 

 

 

 

 

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Reader Comments (51)

Very sad. The world today is just full of litigation. Didn't get the outcome you wanted? Sue. My friend's dad retired from obstetrics because of this. He was an amazing, wonderful OB for 35 years...and just got tired of getting sued over things that he had no control. Very sad, indeed.

January 11, 2011 | Unregistered CommenterAngela

This is a very important voice to include in our collective conversation. Thank you so much for sharing.

January 11, 2011 | Unregistered CommenterDou-la-la

This is a powerful post for me; I am a birth activist hoping for a someday VBAC, and my husband is a medical student. It's tragic that the medical system doesn't allow OBs to spend time with their patients, to know them personally, to care for them as human beings. So many of the problems in our birthing system have to do with care providers being pressed for time and having too much work to do in too little time. There's a lot else, too, of course, but this would be a great place to start. Is it such a revolutionary idea to pay providers for the time they spend keeping their research current?

January 11, 2011 | Unregistered CommenterLiz

I have heard tons of stuff like this coming from different OBs (and similar stuff from other doctors), and it is so very, very sad. Even those who want to can't provide good care because the cards are stacked against them. So very sad.

January 11, 2011 | Unregistered CommenterDiana J.

This post made me wonder how much of the problem with suits being brought for poor outcomes could be eliminated by better social supports for families with special needs children. While suing is/was a terrible solution, I can imagine it seemed the only option for a mother facing a $20 million dollar burden.

January 11, 2011 | Unregistered CommenterChristie B

Sing it with me, friends; personal responsibility for personal choices.

I am so so so sorry for this OB. And I am sorrier still for the f***ed up system that puts all of us, birthing women and practitioners alike, on the altar of the allmighty dollar.

The system has got to go.

January 11, 2011 | Unregistered CommenterLaureen

Yet another reason we need to make midwifery the standard of care for the majority of pregnant women. Why should an OB *need* to be present for a low risk vaginal delivery? It's ridiculous. OBs need to take time with those higher risk patients who need that specialized care, and they need to take time to keep up on current research, as well as to add to it. This system works for no one.

January 11, 2011 | Unregistered CommenterAmber Bamber

I find it absolutely disgusting how a doctor can be sued for a birth they didn't even attend, or have any part of.

This is why educating yourself as a patient is paramount - but also realizing that no, you are not a doctor. The woman who refused that cesarean, that eventually led to her baby having problems - it was offered to her, but SHE declined. Several times. Where is the personal accountability in admitting that you, as the patient, refused what could possibly have been a life-saving or changing measure? You have the right to refuse, but you should also be willing to accept some responsibility that perhaps your insistence was what led to ultimately bad outcome.

Obviously I think that trial attorneys will press the client into suing - but so can other doctors. While not in obstetrics, my father-in-law was a thorough, well-liked, respected surgeon who had quite a "following" of patients. During one case, he advised a patient how to properly care for a wound to avoid infection, advice they ignored and ultimately suffered for. They saw another physician, who encouraged the patient to sue. I don't doubt that perhaps there were other motivations: my father-in-law was getting older, nearing retirement, and this younger doctor no doubt saw him as the "competition." Even though the patient's negligence was clearly the reason for his problem, another physician stepped in and suddenly there was a case.

It seems that in the case of obstetrics, the only OBs who don't routinely get sued (although I've never looked at any official "data") are the ones who willingly and regularly put patients at greater risk with totally unnecessary procedures. Doctors, and patients, also don't seem to realize, or want to acknowledge, that sometimes things go wrong despite your best efforts, whether they're warranted or not; that no amount of technology is completely fail-safe and that sometimes the things your doctor does to you actually increase your risks (although obviously not the case with this physician). Sometimes people want to point the finger of blame in the opposite direction when really, they should be looking at themselves.

January 11, 2011 | Unregistered CommenterThe Deranged Housewife

Thank you for sharing your story.

January 11, 2011 | Unregistered CommenterMegan

This is so sad. And this is why good medicine is dying. Good medicine means more than just competent care, it means allowing time for a physician/patient relationship. When we expect our physicians to behave like machines, we have to expect them to eventually break down.

January 11, 2011 | Unregistered CommenterErika
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