On Call Dilemma

Once again I had the pleasure of being on call this past weekend and I had an episode which demonstrates the effects of the legal profession on my everyday decisions. A man called me about his 91 year old mother suffering from an ear ache and asked me if I could prescribe medicine for her over the phone. He said it had just snowed heavily and was unable to get his 91 year old mother to the office. I had never seen him or his mother before in the office and was likely a patient of one of the doctors I was covering. Naturally, I felt for his dilemma and would have liked to help his mother but I told him that I could not prescribe any medicines over the phone without first examining her. His options were to go to the emergency room, an urgent center, or wait until the following day when the office would be open and she could be seen. He was not happy with that answer and asked me simply whatever causes ear aches just give her the medicine to treat her to whom I replied it is not that simple and the pain could be due to several causes which are treated differently.

I could have called in an antibiotic or ear drop for her which most likely would have helped but by doing that I have accepted the legal responsibility of treating her which then infers that I know what is wrong with her without ever seeing her. If she had a rarer and more serious cause for the ear pain that went undiagnosed or a delay in diagnosis and I have treated her I am going to get a call from the local lawyer’s office. After he sues me and I show up in court he cross examines me and says “Doctor, you prescribed ear drop A for this 91 year old lady. Can you explain to the jury the results of your physical examination”. Of course, I have no answer and look incompetent. They do not care that it had just snowed and he couldn’t get his elderly mother out, and that I felt badly for their plight. The lawyer continues “Doctor, do you know that because you prescribed ear drop A the patient did not go to the emergency room, the ear pain was actually due to a life threatening infection and she ended up dying after a protracted course of hospitalization and suffering. Obviously, I have no acceptable answer and lose a multi-million award.

Yes, 999 out of 1000 times this would not happen and by calling in the medicine I would have cured her and had a satisfied customer. But because of the one in a thousand where I could have a bad outcome I refuse to prescribe medicines over the phone. I refuse to accept the legal exposure this puts me in. The lawyers, by exploiting the one in a thousand for a jackpot award have made the 999 suffer or be inconvenienced and this is all too often the result of legal actions. One person makes out real big (and the lawyer) while the remaining population ends up suffering for it.

Unfortunately, I have to practice medicine with the fear of being second guessed and a lawsuit around the corner. I am always thinking of the legal repercussions of my actions and with every interaction with a patient my assumption is that their lawyer is in the room or on the phone with us. Not only does this add a tremendous amount of money and stress to the practice, it ultimately gets translated into more inconvenience and expense for the patient. It’s hard to have compassion for this suffering 91 year old lady when no one will show compassion to me for the decisions I make and the factors that led to them.