Hanging Up My Gloves
Monday, January 10, 2011 at 10:07PM
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.
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.
This is a very important voice to include in our collective conversation. Thank you so much for sharing.
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?
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.
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.
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.
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.
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.
Thank you for sharing your story.
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.
Erika wrote: "When we expect our physicians to behave like machines, we have to expect them to eventually break down."
I think you're onto something there. We are all responsible for creating a system that places unrealistically high expectations on human beings.
"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."
There's no evidence in this blog post that this is the case though. FHR tracings were normal throughout. Unless there was some other indication that the baby was compromised during the second stage, and the mother felt like she could go on and push the baby out, why is it then her fault? Sometimes shit happens. And it doesn't have to be anyone's fault.
WOW! That is so sad. I am sorry that this person had to go through all of this. We need to change things in this country, it's out of control
Thank you, Anonymous, for your perspective. It is appreciated!
I do have a few questions. If it's so common for doctors to get sued, then doesn't having settlements on your record become non-remarkable? I am not contesting that it would make someone less competitive, but in light of the overwhelming need for doctors, isn't it likely that finding work is not going to be out of the question, barring loss of a medical license, should Anonymous decide that all the other hassles are worth it?
What would Anonymous recommend in terms of changes to the system? We cannot bar patients from suing, because of course there is some real malpractice that needs addressing. Nor can doctors perform major surgery on every pregnant woman and still be responsible physicians. It seems therefore that change needs to happen at an institutional level--but what kinds of changes?
I like that we are approaching the problems of obstetric care through the financial end first; we talk a lot about the clinical and personal here, but this is definitely one of the missing pieces.
One thing that drives me crazy about modern obstetrical practice is the lack of continuity of care. It's ridiculous that doctors see so many patients they have never seen before and in the 5 minutes they have to assess them it is impossible to do a thorough job. It's not the fault of the doctors, but the fault of the system.
It seems to me that the hospital hung this OB out to dry. They did not support the OB and they settled essentially making the OB at fault. They are more concerned with image and the almighty dollar then with the employees. I think we need to start with the top (insurance companies and hospitals, ACOG, and those opposed to a midwife led model of care) and work our way down.
Thank you for this. Part of my journey in healing from the wrong that was done to me through an unnecesarean is realizing the pressure being put on our care providers. Especially those who work in hospitals. It is unbelievable. What do we expect to happen? I was a school teacher for 4 years. There were teachers who didn't stay after school to plan or participate in programs. There were teachers who relied on the TV for their content. Then, there were those who were there rain or shine, planning, trying their best to improve their skills. What happened? They all got paid the same, and often times those who were trying the hardest suffered burn-out quicker. The malpractice suit threat alone can cause doctors to second guess nature and rely on the skills they learned in surgery to save them furture trouble. They have families after all. They are human after all. It is a broken system, where yes... there are plenty of care providers to blame for procedures we did not need. But, there are also those that wish they could act in other ways. Those who are not at fault, but just happen to work within this broken system. It is in need of reform - desparately. For the good of all of us in this field - mothers to doctors.
Amber,
My bad - I misread the part about several hours of pushing as declining the cesarean several times. However, this relates to the second half of my post - that we can't rely on technology all the time to "ensure" good outcomes. It's unfortunate that the legal system thinks that's possible - and makes a case against the OB as a result.
Kate, I agree with your comment.
The world today is just full of litigation. Didn't get the outcome you wanted? Sue.
That's not what I got from this at all. I am not getting "I made a choice but the doctors should have FORCED me to make another choice, so I'm suing them." And we truly do not know the whole story. Not saying that Anon OB is at fault, but as he/she said, he/she wasn't even at the birth itself. We don't know exactly what happened and on what basis the suit was filed. And true or not, it had to be filed on some basis-- not just "my baby isn't perfect."
What I am getting is what Kate is getting at. It's less the suit(s) itself and more the way it was handled by the lawyers and organizations on Anon OB's side. That system is clearly broken. In more ways than one.
Furthermore... I have always seen-- counterintuitively to the way most OBs seem to practice-- that it is the docs who DON'T perform a million unnecessary "just in case" procedures who are less likely to be sued. It's the docs who are respectful of patients, who give them options, inform them well and let them make decisions in most cases-- who act like human beings-- who are less likely to be sued. Of course, less likely means less likely-- no doubt there are some fantastic docs who have been sued more than once. But on average, NOT essentially guaranteeing a healthy baby "if you do what I say" and stripping women of agency... has better outcomes.
Christie B - I agree with you. That is exactly what I was thinking. From my own experience, raising a child with special needs/ complex medical conditions is very expensive and exhausting. I can see where, if there is a possiblity to sue someone, you would want to in order to have the resources for a better quality of life with your child. I can't say I blame anyone for trying to recoop those costs by whatever means possible. In our current US system, medical care is considered a personal responsibility and in a lot of cases that's an unrealistic burden, which leads to these kinds of suits. All the litigation increases costs, which then makes it seem too expensive to push for universal access to care. There wouldn't be any tangible damages to sue for if health care weren't a comodity.
I am a member of an online forum for families of kids with the same condition as my son, who are mostly in the UK. I'm always shocked to see how different their experiences are. They are struggling with the emotions but not the constant financial stress. For example, I would guess most moms in countries with universal healthcare are not working during their child's heart transplant, to avoid getting fired and losing health coverage.
I just feel like caring for those with the occassional poor neonatal outcomes were considered a public responsibility, it would eliminate a lot of the need to figure out these costs through the court system.