Demystifying Medicine One Month at a Time

Tag: malpractice

Be Careful What You Wish For

Why our medical malpractice system is superior to not having one.

One of the topics I went to China to discuss was our medical school’s approach to teaching medical ethics.

At Wuhan University they have a first-year course, but I was told by both the school administrators and some of the students that the material is dry and not seen of immediate importance, so students often skip the class.

Here’s how it’s structured: 27 hours of straight lectures.

No case studies, no discussions, simply a professor of policy and administration who talks to them about morality, ethics, and offers only some specifics about clinical medical issues–like end of life or reproductive health.

Try not to be on the receiving end

The faculty deans at Wuhan have accepted the idea that to improve their course, they need to make it more case-based and interactive. To that end, the students want to hear from “real” doctors discussing cases that occur in their clinical practices.

I met several practicing doctors who are interested in helping improve the course. One of them is a cardiologist who became interested in medical ethics because of her own moral distress in dealing with angry families when a patient dies. She had spent two years in the US doing research, so had some frame of reference for how things are done here. “If something bad happens to the patient, the family can always sue. In China, it is not so.”

Instead, the family might openly grieve and become angry and aggressive. She reported that doctors have been attacked by angry family members, and in one instance she knew of, killed.

In her experience, even when a patient (and their family, as surrogate decision makers) had been duly informed about the risks and benefits of the proposed procedure (e.g. cardiac cath), and then consented to it, the family still became irate when the patient died–although this was not an unexpected outcome given the gravity of the clinical situation (an acute heart attack).

A member of one family kicked her, and demanded their money back. This doctor further told me that Chinese families typically demand a refund when a patient dies in a medical setting, and that it is often given as a matter of culture.

She estimated that this occurs about one or two times out of every one hundred patient deaths.

Thus, seeking more education about ethics (and implicitly the topic of patient-doctor-family communication) has become an imperative for her.

Makes you think.

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An additional note: In this superb NY Times article about the paucity of mental health care in China, the writer makes mention of hongbao, the Chinese custom for giving cash-stuffed envelopes to doctors in fields like surgery or cardiology. The article states that doctors can earn one-third of their income from hongbao.

Psychiatrists don’t get hongbao; this is only one of many reasons that Chinese medical students choose not to enter the field.

In America, we have a name for hongbao: it’s called concierge medicine.

Who Sues?

Time to turn our attention to an unpleasant topic: Lawsuits.

Who files them?

Why? And what actually happens?

There have been oceans of ink spilled about medical malpractice. An oversimplification of the various positions on malpractice and malpractice reform goes something like this:

  1. (+) Malpractice suits are good. They keep healthcare professionals and hospitals on their toes; if the threat of a big payout improves safety and quality, then lawsuits provide an important regulatory function. Also, they give the vulnerable patient a chance to rectify an error, a mishap, or an injustice.
  2. (-) Malpractice suits are detrimental. Yes, there are outliers, but 98.5% of medicine is practiced safely and effectively. Bad outcomes happen as part of the natural course of medical practice. As long as patients are informed beforehand about the risks inherent in any medical undertaking, they must understand that there are no guarantees in life.

Here, too, is an oversimplification of the politics of malpractice reform:

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