According to the study, the main reason doctors operate on family members is their belief that they are the most qualified person for the job. “In my opinion, I can do just as good plastic surgery when it comes to breasts, tummy tucks, and body work as anybody in the country.
After giving birth to their children, she wanted to restore her breasts to what they were before breastfeeding and tone up her body. He says he feels secure in his decision to operate on family because the procedures he’s performing are elective, done only on healthy people, and very rarely go off-course.
Dr. Gary Link, a New York City facial plastic surgeon, says he only recently gave in to his wife’s repeated requests for Botox (“the idea of causing her any discomfort just doesn’t sit well with me”) but would never do the neck lift his mom is “begging” him for. If your spouse is bleeding on the operating table in real time, your judgment is definitely going to be clouded,” he says, adding that there’s no single surgeon so talented that no one else comes close.
Dr. Holstein agrees and says his wife is required to sit in the same waiting room as everyone else, sign the same liability paperwork, and come in for the same follow-up appointments. My manager researched information available and found it was illegal, but we both thought there was something not right about this situation.
But an easy way to find out is to check with your facility risk manager or ethics committee. Rather than trying to guess and relying on your own research, use the experts at your disposal.
He is the author of “In Stitches,” a humorous memoir about growing up Asian American and becoming a doctor. Then imagine that your grandson gets into a terrible car accident and suffers serious internal injuries.
This was a dilemma that a colleague of mine encountered several years ago. Not wanting to put Joey’s life into another surgeon’s hands, Dr. Sanders decided to operate on his grandson himself.
A 1991 study published in the New England Journal of Medicine found that 99% of the 465 physicians surveyed received requests from family members for medical advice, diagnosis and treatment. The American Medical Association’s Code of Medical Ethics: Opinion 8.19 states that “physicians generally should not treat themselves or members of their immediate families.” The American College of Physicians Ethics Manual states that “physicians should avoid treating themselves, close friends, or members of their own family.” William Beaumont Hospital, where I operate and act as associate professor of surgery, forbids surgeons from operating on family members.
As physicians, we are taught to hold the doctor–patient relationship sacred and to keep a proper professional boundary between us and our patients. I react very differently when one of my children gets hurt than I do when I see an injured patient in my office.
I know of many male plastic surgeons who have performed breast augmentations, tummy tucks, and facelifts on their wives. Third, and most disturbing, some plastic surgeons use their spouses as living billboards for their work.
To them, there is no better advertisement than showing off their fifty-year-old spouse who now kind of resembles Pam Anderson. Full disclosure: Other than removing a mole or two, I’ve never operated on my wife and I never will.
It’s likely fine for the doctor in your family to fill your cavity or administer a flu shot; it’s too risky for a parent to perform a craniectomy on their child or a spouse to come up with a cancer treatment plan for their partner. Treating oneself or a member of one’s own family poses several challenges for physicians, including concerns about professional objectivity, patient autonomy, and informed consent.
When the patient is an immediate family member, the physician’s personal feelings may unduly influence his or her professional medical judgment. Or the physician may fail to probe sensitive areas when taking the medical history or to perform intimate parts of the physical examination.
Similarly, patients may feel uncomfortable receiving care from a family member. A patient may be reluctant to disclose sensitive information or undergo an intimate examination when the physician is an immediate family member.
This discomfort may particularly be the case when the patient is a minor child, who may not feel free to refuse care from a parent. (e) Avoid providing sensitive or intimate care especially for a minor patient who is uncomfortable being treated by a family member.
AMA Principles of Medical Ethics: I, II, IV Read more opinions about this topic It’s likely fine for the doctor in your family to fill your cavity or administer a flu shot; it’s too risky for a parent to perform a craniectomy on their child or a spouse to come up with a cancer treatment plan for their partner.
At the private practice outside Los Angeles where Kiss works, three patients have had confirmed cases of COVID-19 since the pandemic began. She knows it could be devastating if she infects her family, even though children generally experience milder symptoms than adults.
Dr. Iran Altaba of Bremerton, Washington, said she worries “every single day” about bringing the COVID-19 virus home to her family. “I’ve been hugging them a lot,” the 45-year-old pediatrician said in a phone interview, as she cuddled one of her four children on her lap.
Altaba said she first realized she’d need N95 masks and gowns after hearing about a COVID-19 death about 30 miles away in Kirkland last month. She figured she could reuse the mask if she sprayed it down with a little isopropyl alcohol and also protected herself with gloves, goggles and a jacket instead of a gown.
So that’s what she did, visiting symptomatic patients in their cars to reduce the risk of spreading the virus in her office and the need for more protective equipment for other staffers. In the March 19 letter to Congress, about 50 other physicians described similar experiences and fears for their families, with their names excluded to protect them from possible retaliation from employers.
They said the current system, which requires requests from local, state and territorial authorities, “may create delays that could cause significant harm to the health and welfare of the public.” At this point, Sabra said, the federal government should not be keeping any part of the stockpile for a rainy day.
With medical malpractice insurance premiums rising sharply across the nation and at least a dozen states facing an insurance crisis, physicians and policymakers are debating vigorously how best to respond. Tort reforms that would cap awards are among the proposals and have proven effective at moderating premiums in several states.
But while physicians await legislative action or an upturn in the economy to soften the impact of insurance hikes, there is something doctors can do: better manage risk.
Risk management involves more than just reading a journal article, listening to a lecture or filling out a workbook. A while back, I was involved in the care of a four-year-old boy who was admitted with status asthmatics.
The child bounced back, fortunately, as children often do, and within three days he was home. The following week at grand rounds, the senior resident presented the case.
I opened the question and answer session that followed by asking the group, “How did we fail this boy?” A long silence ensued. Finally, a first-year resident raised her hand and offered, “Well, he shouldn’t have been in status asthmatics in the first place.” And that’s the answer.
One of the things physicians need to ask whenever a patient is admitted to the hospital is “How did the outpatient management fail?” In this instance, should we have spent more time with the child’s mother, emphasizing how important certain environmental changes were for her son? Develop a routine of reviewing the sequence of care for unexpected or unwanted outcomes.
A frequent reason for a failure or delay in diagnosis of breast cancer is excessive reliance on a falsely negative mammogram. Diagnosis may mean simply following the patient for a month and determining whether the lump resolves with the next menses; or it may require needle aspiration; or it may need excisional biopsy.
The classic story of the failed hand off is the Friday night catastrophe that occurs while the patient’s usual doctor has gone away for the weekend and the covering physician is inadequately informed and has no prior relationship with the patient. Developing a routine of signing out pregnant patients, especially those near term or with problems, can go a long way toward reducing the risk of a failed hand off.
Sign-out need not be in person; voicemail systems and electronic methods can facilitate such communication. Patients with wrist “sprains” and snuffbox tenderness should be assumed to have particular, or scaphoid, fractures until proven otherwise.
Another situation to watch for is the patient with a popliteal fossa injury, usually resulting from impacting the knee against the dashboard during a car crash. Check and document that the patient’s distal circulation is intact with palpable pedal pulses.
Popliteal artery embarrassment can easily go unrecognized, and the limb is placed in jeopardy. I try to follow the rule of three: If I haven’t figured out and corrected a patient’s problem within three visits, I enlist someone to help me.
Because it’s as good a number as any, and it keeps me from temporizing forever while the patient continues to have problems. In primary care, it can be a challenge to diagnose vague symptoms for early-stage disease at the first visit.
Although this may sound basic, the best way to prevent these types of injuries is to be prepared physically, mentally and emotionally for the procedure. Distractions such as pressing personal problems might be good reasons to reschedule or have another physician perform the procedure.
If failure to obtain informed consent is the only allegation a plaintiff makes, it usually suggests a weak case on the merits, and the physician has a good chance of winning the claim. The first malpractice case recorded in the United States was Cross v Gather, a 1794 Connecticut case in which a man sued his doctor over his wives death following surgery.
Since only appeals court decisions are usually recorded, the first malpractice case may well have occurred before the founding of the country. Historical accounts from the Civil War era document instances of surgeons refusing to do certain procedures because of concerns about being sued.
In every jurisdiction, a lawyer is able to file a medical malpractice suit only with a statement from an expert that negligence occurred. A General Accounting Office report showed that less than 10 percent of the time does the plaintiff have an injury that would be regarded as insignificant.
Whether the bad outcome was the result of doctors negligence may be debatable, but medical malpractice suits for frivolous reasons are uncommon. Perhaps the most powerful predictor of the likelihood of being sued is how well the doctor relates to patients.
In 2000, defendants won 62 percent of all medical malpractice cases brought before a jury. Developing a risk-management style of practice involves four Cs: compassion, communication, competence and charting.
Our practice sends three dunning letters to patients who don’t pay. Stay away from those kinds of games because no one wins except plaintiff’s lawyers who seek to divide and conquer.
Instead, be honest and open yet discreet with communications, not only with colleagues but with patients and staff as well. Flow sheets, protocols and other tools can reduce the chance that important factors are overlooked.
The greatest charting mistake physicians make is that they fail to note what is important. I recall one instance where I dictated a history and physical for a patient with chest pain admitted ruling out myocardial infarction, and the transcriptionist clocked me at 250 words a minute with gusts up to 350.
This can happen to anyone, and courts will forgive such clerical mistakes so long as they are detected and corrected. I was once an expert witness in the case of a pediatrician caring for a child with H. flu meningitis.
The care the pediatrician provided was excellent, but the patient had a terrible outcome and his family sued the physician. Because one normal white blood cell count result had not been incorporated into the patient’s chart, the physician got nervous and rewrote the entire two years of well-child and other visits to include this white count.
The plaintiff’s lawyer obtained the original records and saw they were all written, without a single error, in the same colored ink. The physician had a perfectly defensible case but panicked and ruined her credibility.
Recording errors, when they occur, are best managed by a single strike through line that is initialed, dated, timed and identified as an “error.” More extensive or significant errors (e.g., “wrong patient”) may require more detailed explanation. For example, avoid adjectives such as “drunk and obnoxious’ to describe a difficult patient.
Instead, use more diplomatic language: “Patient is combative; ethanol-like odor noted.” In this case, the patient may be in a state of diabetic ketoacidosis, not alcoholic intoxication, and our description of early impressions will be less likely to haunt us later should our care be challenged as inattentive. The point here is not to sidestep the truth but to choose language that is descriptive, objective and respectful.
Some physicians actually believe that illegible notes are a good way to prevent lawsuits because they hide any evidence of wrongdoing. Years later, when the case finally gets to the jury, the medical record can be the doctor’s best, and often only, friend as memories fade over time.
Legible and logical notes detailing thoughtful care provide the best malpractice defense. Best is to use an electronic medical record system (it brings a wealth of information to the point of care); next best is to have notes dictated and transcribed.