“I’m a lawyer with medical training,” the patient said matter-of-factly. “We will know if you do something wrong.”
I met this man during my family medicine clerkship as a third year medical student. He was a 50-year old “lawyer” who showed up two hours before his appointment, and in the waiting room, threatened to sue the office. The medical assistants reported they got warning phone calls from other clinics that he had tried to sue at least six doctors in the surrounding area, and that he’d actually taken a couple of them to court.
If you want a sure-fire way to unite physicians across specialty, it would be reform of medical malpractice. This is a topic of constant angst for physicians who pay malpractice insurance premiums and take CME courses in “controllable risks” to avoid mistakes that could get them sued. Malpractice changes doctors’ practices, too–one family physician I met stopped doing deliveries after a case of shoulder dystocia where she had to go to court and see the little girl staring at her as the case dragged on for eight years.
Don’t get me wrong, medical malpractice is necessary. There have to be checks and balances in the system, and there has to be a way for patients and families to at least get financial compensation when bad care happens. See “50 Shades of Malpractice” for examples of the bizarre or all-too-familiar stories that led to successful suits against doctors.
But often, “suing the doctor” is borne out of anger and unrealistic expectations. We, doctors, have to do the medico-legal tango and stay on our toes because we are afraid of having to bear the consequences of those feelings.
Back to the patient above. His story spun out of control as we tried to take a medical history: he had been training to be a priest and he had been living at his aunt’s house as part of her will but lost ownership because according to him, the state manipulated his mother with Alzheimer’s disease into believing that he was committing elder abuse. He lived in a car for several years, refusing to go to a homeless shelter because, he said, if he did he would not be able to recoup as much in damages when his countersuit for his aunt’s house went through.
He lived off a nearby university law library where he had essentially self-educated himself in the law. He proudly claimed to have put a law firm out of business by exposing their mistakes, told my attending physician what he HAD to do, and quizzed him on medication side effects, nodding and saying “Very good” when my attending listed the correct ones.
Despite his claims that he was a medical professional, he had raging type 2 diabetes with an A1C around 12%. My attending wrote him prescriptions for diabetes meds, but an hour after the visit, the patient called back to say that he didn’t think the prescription was written correctly and that he would only be satisfied if my attending wrote it in front of him.
Needless to say, the patient was very carefully, and totally legally, fired from the practice.
It struck me that this patient wasn’t threatening to sue because his glipizide was prescribed incorrectly. “To sue” would have implied that we, the medical practice, committed a fault against him.
He threatened to sue he met because his life was in utter shambles. He needed someone, anyone, to blame, for the loss of what he thought was rightfully his. But you can’t sue for a better life. And honestly, I wasn’t sure if we could write any prescriptions that would give him the satisfaction he wanted.