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The Burden of Success — in Real Life and on Television


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The Burden of Success — in Real Life and on Television

By Hiller B. Zobel

Related to: Diagnosis, Emergency Medicine

The most sincere compliment a doctor can receive comes, paradoxically, in the form of a lawsuit. Of course, I'm not referring to a claim for amputating the wrong limb, or prescribing a dose ten times the normal. Such egregious cases generally settle even before litigation.

I'm thinking of a much more common scenario. The patient has presented at the emergency department (ED) with a cut on his leg that shows signs of serious infection: plainly visible red streaks, swollen inguinal lymph nodes, elevated fever, and odorous thick yellow discharge. His wife says he was chopping brush four days before, nicked his calf, slapped on a large band-aid and kept working. Within a day or so, the wound began to drip pus, but the patient insisted it was "just a scratch," and rejected any suggestion that he see a doctor. The condition worsened to its present nadir, and here he is.

The ED team immediately starts intensive treatment: debridement, antibiotics, IV drips, and everything else that good medicine would counsel. Unfortunately, the infection has progressed too far—despite the heroic efforts, within 36 hours the patient dies.

Most physicians—and, perhaps, most laypersons—would say that the man waited too long, the disease had too great a head start, and only a miracle could have saved the patient. Indeed, many non-medical people would say something like, “He brought this on himself.”

Nonetheless, a few months later, the widow sues the ED doc, the hospital, and virtually everyone else who had any contact with the patient, even though no doctor or nurse caused the death.

A psychiatrist might opine that the widow is suing because she cannot accept that her late husband’s machismo (or her own failure to insist that he seek medical care) effectively killed him. The suit is her way of shifting blame.

Perhaps, instead, we might assign blame to another physician: Gregory House, MD. After all, he and other television health care professionals never meet an insoluble medical problem. Why should real-life docs be any different?

Beyond that, modern medicine does boast (and boast of) a remarkable success rate—at least lay people, reading the ads for (among others) hospitals and practitioners, regard cure as a virtual certainty. Any imperfect outcome, therefore, must indicate physician error.

As doctors have to realize, in medicine as in sports, financial advising, or gourmet restaurants, excellence invokes an unreasonable expectation of invariable perfection.

Hiller B. Zobel, a retired associate justice of the Massachusetts Superior Court, is the author (with Stephen N. Rous, M.D.) of Doctors and the Law (W.W. Norton 1993).

November 1, 2010
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