Writing Contest - Honorable Mention
A Medical Education
By Matt Anderson, M.D.
My medical assistant saw him first. He strode down my clinic hallway as I was about to enter the next exam room, a tall man with a paunch wearing a sheriff’s deputy uniform, no smile.
Are you Dr. Matthew Anderson?” he asked, uncomfortably crowding my personal space.
“I am,” I replied, fearful of what an officer of the law would want with me.
“You’ve been served,” he stated flatly as he handed me an over-stuffed envelope, then left.
Served? Served! As I opened the envelope, the realization hit me like a heavyweight blow to the stomach. I was being sued. This could not be! I was eight years out of residency, board-certified, and current on all the best practices of obstetrics and gynecology, my specialty. My training and skills had me convinced I was the least likely OB/GYN doctor to be sued. Not only that, my patients loved me!
But there it was. The words on the “Petition at Law” stung. My hands shook as I read.
Joshua Bailey,* minor child of Christine Bailey* ... vs. Matthew Anderson, M.D. Come now the Plaintiffs...
What language was this?
Failed to provide ...
Failed? I didn’t fail.
Care and treatment rendered was below the standard of care ...
My care was excellent! How could she say that?
Negligence was a proximate cause of the injury ...
I was not negligent!
Wherefore, Plaintiffs pray for money damages ...
Money damages! I could hardly breathe.
“You have three in rooms and more waiting,” my medical assistant reminded me. “Are you OK, or do you want to reschedule?”
I finished the morning in a daze, then called my medical malpractice insurance company. The receptionist was professional and sympathetic. She connected me to a claims representative who had me read the petition and told me to fax a copy of it to her. She would send it to an attorney who would respond within 10 days. “Don’t talk to anyone about this—anyone,” she counseled. “Fax me a complete copy of the chart. Don’t write anything in it. And don’t worry.”
I struggled through the rest of the day, my mind a jumble of thoughts, none of them positive. I was mad. Kübler-Ross was wrong. Anger was my first and abiding emotion. I pulled my patient’s chart and scrutinized every word. I reviewed her care in my mind, every encounter, every visit, everything I had done and why.
Ignoring my insurance company’s admonition to tell no one, I told my wife everything. Our clinic was also named in the suit, so I shared what had happened with my partners. They had been peripherally involved in the patient’s care but were not involved in the offending incident. Still, all the reassurance and support from my wife, my partners, my claims representative, and eventually my attorney did not prevent a cloud of depression from enveloping me.
Over the next three years, the case wound its way through the legal system, never out of my thoughts, the wound reopened each time I received a mailing or phone call regarding it. I learned as much as I could about civil actions. Words like “discovery,” “deposition,” and “interrogatories” became part of my vocabulary.
I attended the deposition of my former patient and quietly, painfully endured listening to her side of the story. The opposing attorney grilled me during my deposition, asking the same questions over and over, each time with a slightly different twist in order to get his desired answer.
I watched as the attorneys, mine and hers, chatted about kids, family, and fishing trips before and after the depositions. They were friends! This case that pierced me to my very core, this lawsuit that exploded my world wounding me and those closest to me, this accusation that so tormented my psyche was just another day at the office for them.
I’ve heard many physicians over the years refer to the legal process as a game. It’s definitely not a game. I listened to an expert witness from the other side state the case against me with seemingly unquestionable authority and certainty. He had no doubt about where I had gone wrong. He dismissed my bedside clinical judgment and thoughtful determinations. In his opinion, I had judged poorly, determined improperly, and completely mishandled her care. The bad result proved his contentions. And I should be made to pay.
The case settled one week prior to trial three years after I was served, much to my relief. Tears flowed easily the day I got the news.
It was Socrates who said, “The unexamined life is not worth living for man.” My unexamined medical life, my arrogance, needed serious examination.
When I was just out of residency, I believed I knew all the right answers, all the right procedures, all the right techniques and treatments. I had attended risk-management seminars. I practiced good communication and documentation, had good relationships with my patients, followed best practices, stayed current on my specialty, and treated colleagues and co-workers with respect.
I thought, or at least hoped, I was sue-proof.
But such was not the case. I was sued. As a result, I developed a greater respect for medicine and appreciated that the journey from point A to point B in medicine is not always a straight line. Each doctor, each patient, each illness, and each crisis has a uniqueness that defies clean algorithms. I realized variations in care occurred frequently and often with good reason. I slowly learned humility.
In my arrogant days prior to the lawsuit, when the right answers came easily, I was critical whenever I was reviewing my peers for utilization or quality. I excused no deviation from my own perception of good medicine.
Now, when I see the same bravado, the same over-confidence, the same critical attitude, and the same intolerance of practice styles and variations in care in younger physicians, I try to tell them that medicine remains an art and that “best practices” come and go. I remind them that they were not at the bedside and that the attending doctor had no intention of harming the patient and no benefit of hindsight. I tell them to always be honest when reviewing a chart but to cut other physicians some slack whenever possible.
I tell them that all the best practices and all the risk-management protocols in the world may not protect them if they get a bad result. It happened to me. And I tell them they may want another doctor to give them the benefit of the doubt if, one day, an official-looking person intrudes on their routine day, hands them an over-stuffed envelope, and utters the words, “You’ve been served.”
Matt Anderson is an ob/gyn physician at Fairview Lakes Clinic in Wyoming, Minnesota. He likes to use his writing to influence and persuade. His reason for writing this piece, he says, was “not to give a morbid, voyeuristic view into the troubled psyche of one traumatized by a lawsuit, but rather to plead for tolerance for clinical judgment.”