cats and dogs

For baby boomers, the apex of academic achievement was an MD or JD. Doctors and Lawyers, professionals. Years of study; competition for admission; long apprenticeships leading to the prestige and financial success of a professional career. The reality of the realtionship between MD's and JD's is anything but collegial.

Doctors are trained to work cooperatively, sharing information and insights. From early in our education we are admonished to see one, do one, teach one. The teaching of our students and less experienced colleagues is enshrined in the Hippocratic Oath. One of the greatest joys in being the world's oldest ER doc is the opportunity to share my thirty years of ER experience with my young associates, physician assistants, nurses and EMS personnel.

Lawyers like to refer to each other as brother. They must mean like Cain and Abel. The legal system is adversarial in form. Two attorneys battle over a civil or criminal issue. Although the judiciary process seeks to arrive at "the truth", a good attorney can argue either side of any case.

ER docs interact with the two major branches of the legal profession civil and criminal. I have been a factual witness in many criminal hearings and trials. I have been asked to testify to the injuries suffered by my patients at the hands (feet, elbows, teeth or other parts) of their assailants. Occasionally I have been required to give testimony relevent to the medical condition of an alleged criminal who was treated or examined by me. My experience in emergency medicine has qualified me to give expert opinions as they relate to a criminal procedure. CSI ER DOC.

ER docs get sued for malpractice. This is a fact. Every ER doc gives his or her best efforts to relieve the suffering of our patients. We try to diagnosis and treat our patients competently and compassionately. "To err is human" and ER docs are all too human. We work long hours, manage many patients simultaneously and on occasion miss diagnoses and give inadequate or even harmful treatments.

When a patient is injured by our nonfeasance (missed something) or malfeasance (did something bad) we get served with a complaint. Thus begins the humbling, life altering, and painful journey through our civil court system.

The first step to is notify your insurer. Doctors pay large amounts of money for malpractice insurance premiums. The insurance company assigns a case manager and a defense attorney to guide and represent the doctor in defense of the malpractice action. The next step is the discovery process. Written questions, interrogatories, are submited by the patient's (plaintiff's) attorney. They are answered by the physician and his or her attorney.

The deposition is like the Spanish Inquisition without the religious overtones and no instruments of torture are employed. During the deposition the plaintiff's counsel asks questions of the defendant doctor. This sounds simple and straight forward. It is neither. The plaintiff's attorney asks leading questions, multipart questions and hypothetical questions, all in an attempt to have the doctor hang one's self. By our training, doctors are open, honest and prone to think out loud. Plaintiff's lawyers will use various tactics to exploit this vulnerability.

A good defense attorney is like a guardian angel. Their knowledge, experience and compassion can get even the most timorous doctor through this ordeal relatively unscathed. I have had the good fortune to be represented by remarkably gifted and empathetic defense attorneys in my long career.

Many medical malpractice suits are settled prior to trial. In my state, cases that go to trial are won by the defendant physician 80-90% of the time. There is an alternative to this anachronistic system, mediation or arbitration panels. If a patient feels that he or she was harmed by the care given by a physician, an action would be brought before a panel of experts from the legal, judiciary and medical fields. The evidence would be weighed without the emotional appeal to a jury of laypeople. Financials award, if given, would be determined by actual losses suffered by the patient and their family. Doctors would be more willing to acknowledge errors if such a system was in place.

Patients in the ER are often subjected to potentially dangerous tests and procedures in an attempt by the ER doc to cover his or her ass. Potentially cancerous causing radiation exposures from CAT scans, needle sticks, spinal taps are sometimes done in the name of "defensive medicine".

My saintly wife is a civil litigator, an attorney who represents one side of a civil court case. I sleep with the "enemy". Many of dearest friends are attorneys and even judges. I am priviledged to have many police officers as friends. I do understand the adversarial nature of our judicial system. It may not be perfect, but it is better than any other judicial system on this blue planet.