I was called to diagnose a potential appendicitis Let me explain why this call has him worried.
  • My opinion can be “YES” or “NO.” The surgeon's opinion can be “YES” or “NO.”The patient's final outcome could be “YES” or “NO.”
    • Me =YES, Surgeon =YES, Patient Outcome =YES.
      • If the patient has appendicitis and there are complications, I will be sued because my name is on the chart.
    • Me =YES, Surgeon =YES, Patient Outcome =NO.
      • The appendix comes out normal. I can be sued for unnecessary surgery, unnecessary hospital admission, picking a "bad surgeon," and for any complications.
    • Me =Yes, Surgeon =NO, Patient Outcome =YES.
      • I can be sued for picking a "dumb" surgeon. Never mind that I may have had no choice at all because this was the ONLY surgeon willing to be part of this patient’s HMO.
    • Me =YES, Surgeon =NO, Patient Outcome =NO.
      • I was wrong; the patient did not have appendicitis. I have NOT committed malpractice, but I was conservative and kept the patient overnight. I will get yelled at by the patient's HMO for causing unnecessary expenses. They keep track of ALL the money I make them spend on health care, and will fire me if I cause them to spend more money than other doctors.
    • Me =NO, Surgeon =YES, Patient Outcome =YES.
      • I was smart enough to call for help, and the surgeon was smart enough to take the patient to the O.R. right away. I'll only get sued if there are complications. Funny thing about this scenario is that the reason I didn't know for sure about the diagnosis is because the HMO refused to approve the C.A.T. scan of the abdomen that I requested to confirm the diagnosis.
    • Me =NO, Surgeon =YES, Patient Outcome =NO
      • We could not get a C.A.T. scan to confirm the diagnosis, so the Surgeon took out the appendix just to make sure we did not miss a bad appendix. But as luck would have it, the appendix was normal. Now I can get sued for complications, picking a "dumb" surgeon, and for unnecessary surgery. I guess that is better than getting sued for missing a bad appendix. Do you think that the HMO will at least forgive the "unnecessary" expenses on this case?
    • Me =NO, Surgeon =NO, Patient Outcome =YES
      • We are in trouble. Neither the surgeon nor I had enough evidence to send this patient home, so we kept the patient overnight. Once again, we could not get a C.A.T. scan. The HMO would not approve it. HMOs don't approve things after 5:00 p.m., on weekends or on holidays because they are not there. If the patient has complications, the argument will be that the delay caused the problems. It does not matter that we had to choose between taking a high risk patient to the O.R. without a C.A.T. scan versus watching the patient overnight.