explain this away genius:
Medicine on Trial.
With the recent heated discussions on this board about the current medico-legal climate in the US, I though this article from the January issue of JAMA, and the replies published this week in the same journal, may be of interest to residents, students, and the odd lawyer here.
Merenstein, a family doc currently with the Johns Hopkins Hospital, was sued in 2002 for failure to order a PSA on a middle-aged patient who subsequently was found to have the most aggressive form of the cancer. Merenstein was a resident when he saw the patient.
The facts of the case appear to be as follows:
1.The patient, an educated 53 yr old, was seen by Merenstein for the first time in his resident clinic.
2.The patient had never had a PSA level evaluated before this visit.
3.Dr. Merenstein had a detailed discussion with the patient on the evidence for prostate ca screening, and the risks and benefits involved. He fully documented this discussion. The patient was encouraged to think about whether or not, having considered all the available information, he would like the test.
4.The reason Dr. Merenstein took his approach, instead of simply ordering the test, is that research has shown that the benefits of prostate screening is not a straight-forward, black-and-white issue (owing mainly to the high false positive rate and relatively low specificity of PSA). Because the evidence for the benefits of screening are not clear, the recommended approach is to discuss the issues with the patient and have the patient make an informed decision.
5.The patient never returned to Merenstein?s clinic for f/u.
6.The patient was later seen by an older FP who, disregarding the evidence, simply ordered the test.
7.The patient unfortunately turned out to thave the ca.
8.He sued Merenstein and the residency program.
9.At some point during the trial, Merenstein was ?exonerated?, but his program was found liable for US$1 million dollars.
This case was interesting to me because:
a.The doctor who practiced good medicine was sued ? precisely for practicing good medicine.
b.The plaintiff counsel held up bad medicine as the standard of care.
c.Incredibly (at least to anyone who is in medicine) plaintiff counsel actually attacked Evidence Based Medicine itself ? labelling it as a ?cost saving method?. He apparently even urged the jury to return a verdict to teach residency programs not to ever put residents on the street who practiced EBM. (!!!!)
d.To anyone with even a modicum of any medical knowledge, with any appreciation at all of medical science, this is the most absurd, insulting, and unimaginably stupid thing one could ever counsel. I think it is like saying that law schools should never let their graduates have any knowledge of the Constitution, because the Constitution is a tool to put people in jail.
e.The Jury, of course, agreed with counsel for Plaintiff.
f.The Jury were reported to say: "we had a hard time accepting that ignorance of PSA results was preferable to knowledge?, and "in the end the physician should recommend to the patient to get the PSA", thereby completely demonstrating that they had completely no clue.
It is cases like this which lead physicians to:
1.Believe that the law is destroying Medicine
2.Believe that med-mal lawyers are the scum of the earth
3.Believe that medicine is simply too complicated today for ignorant lay juries to judge medical cases entirely on their own
4.Practice bad medicine out of fear of being sued (ie. basically stop thinking, and just order every imaginable test under the sun)
Medicine on Trial.
With the recent heated discussions on this board about the current medico-legal climate in the US, I though this article from the January issue of JAMA, and the replies published this week in the same journal, may be of interest to residents, students, and the odd lawyer here.
Merenstein, a family doc currently with the Johns Hopkins Hospital, was sued in 2002 for failure to order a PSA on a middle-aged patient who subsequently was found to have the most aggressive form of the cancer. Merenstein was a resident when he saw the patient.
The facts of the case appear to be as follows:
1.The patient, an educated 53 yr old, was seen by Merenstein for the first time in his resident clinic.
2.The patient had never had a PSA level evaluated before this visit.
3.Dr. Merenstein had a detailed discussion with the patient on the evidence for prostate ca screening, and the risks and benefits involved. He fully documented this discussion. The patient was encouraged to think about whether or not, having considered all the available information, he would like the test.
4.The reason Dr. Merenstein took his approach, instead of simply ordering the test, is that research has shown that the benefits of prostate screening is not a straight-forward, black-and-white issue (owing mainly to the high false positive rate and relatively low specificity of PSA). Because the evidence for the benefits of screening are not clear, the recommended approach is to discuss the issues with the patient and have the patient make an informed decision.
5.The patient never returned to Merenstein?s clinic for f/u.
6.The patient was later seen by an older FP who, disregarding the evidence, simply ordered the test.
7.The patient unfortunately turned out to thave the ca.
8.He sued Merenstein and the residency program.
9.At some point during the trial, Merenstein was ?exonerated?, but his program was found liable for US$1 million dollars.
This case was interesting to me because:
a.The doctor who practiced good medicine was sued ? precisely for practicing good medicine.
b.The plaintiff counsel held up bad medicine as the standard of care.
c.Incredibly (at least to anyone who is in medicine) plaintiff counsel actually attacked Evidence Based Medicine itself ? labelling it as a ?cost saving method?. He apparently even urged the jury to return a verdict to teach residency programs not to ever put residents on the street who practiced EBM. (!!!!)
d.To anyone with even a modicum of any medical knowledge, with any appreciation at all of medical science, this is the most absurd, insulting, and unimaginably stupid thing one could ever counsel. I think it is like saying that law schools should never let their graduates have any knowledge of the Constitution, because the Constitution is a tool to put people in jail.
e.The Jury, of course, agreed with counsel for Plaintiff.
f.The Jury were reported to say: "we had a hard time accepting that ignorance of PSA results was preferable to knowledge?, and "in the end the physician should recommend to the patient to get the PSA", thereby completely demonstrating that they had completely no clue.
It is cases like this which lead physicians to:
1.Believe that the law is destroying Medicine
2.Believe that med-mal lawyers are the scum of the earth
3.Believe that medicine is simply too complicated today for ignorant lay juries to judge medical cases entirely on their own
4.Practice bad medicine out of fear of being sued (ie. basically stop thinking, and just order every imaginable test under the sun)
