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Information for people contemplating
a career in emergency medicine and
other medical specialties

By Kevin Pezzi, MD


by , MD

Introduction: By discussing frivolous malpractice allegations, I am not minimizing the reality of genuine malpractice. I've been a victim of it, too. In my teens, I had a peptic (“stomach”) ulcer that bored a dime-sized hole in the back wall of my duodenum. It hurt and bled so much I repeatedly went into stage 2 hypovolemic shock. My Mom eventually took me to see an osteopathic doctor (D.O.) who x-rayed most of my body and concluded my symptoms resulted from one leg supposedly being 4 mm (a bit more than 1/8th of an inch) longer than the other. This rocket scientist prescribed a 4 mm leather shoe lift and told me to walk a lot to put my spine back in alignment.

It didn't work, not surprisingly. Once I got into medical school, I realized I had CLASSIC symptoms of a peptic ulcer—something any medical student should be able to diagnose. I didn't sue him, or even think about it at the time, but I should have. That was malpractice.

Another Frivolous Lawsuit Attempt

On my site, I described a case I was involved in that must be one of the most outrageously frivolous medical malpractice lawsuits of all time. Here is another example of how giving perfect care cannot shield doctors from this legalized form of attempted extortion:

I received an e-mail several years ago from Bob, a Physician's Assistant (PA) I used to work with. Bob said that he received the now-required (in our state) notification of intent to sue from an attorney representing one of Bob's former patients. Bob contacted me because I was his supervising physician on this case.

I immediately recalled this case because it involved one of my favorite activities: snowmobiling. A woman (I'll call her Brat) of college age was riding on a snowmobile driven by her boyfriend (I'll call him SpeedRacer). Brat's back began hurting after SpeedRacer hit a bump. The back pain persisted, so she came to the ER several hours later. Bob saw her and ordered back x-rays. Bob thought that the x-ray showed a compression fracture of one of the lumbar vertebra, so he asked me to check it. No doubt about it, I said, it's broken. I asked if she were neurologically intact (nerve injuries sometimes result when the spine is broken), but she had no impairment of bowel or bladder control, normal reflexes, no weakness or numbness, and no other problems. In fact, she had walked into the ER without difficulty.

Bob called the on-call orthopedic surgeon, who admitted Brat. Coincidentally, Brat's father was an attorney and old friend of that doc, but he'd moved to another area of the state and was now a judge there.

When Bob informed me of the impending lawsuit, I drove to the hospital and read Brat's entire medical record. Initially, I worried that we may have missed something … but what? After I read the last word in the chart, my blood began to boil. We'd missed nothing. The patient was admitted to the hospital and had no problems except for complaining that she did not like the back brace the ortho doc prescribed for her.

The notification of intent to sue also named the orthopedic surgeon. I thought this was odd, because he had also done nothing wrong, and he was, after all, a friend of Brat's father. What was even more inexplicable about this case is that Brat's Dad was clearly a sophisticated and intelligent man who knew the law. He wasn't one of those room-temperature IQ plaintiffs who think that every misfortune calls for a lawsuit, even if the misfortune preceded any contact with the doctor in question. Yet his scruples evidently did not preclude suing without cause—or perhaps it was just Brat who wanted money more than justice.

This was not a complex case. Brat's back was broken before we saw her. We discovered the fracture, documented the absence of associated injuries, and had her admitted to an appropriate physician who provided flawless care. If doctors (and PAs) can be sued for giving such perfect care, we may as well be sued for breathing in the vicinity of a person who has had a bad day for any of a million and one reasons. If carpenters could be similarly sued, the ones who repaired a home after a lightning strike would be sued BECAUSE lightning struck it. Nuts.

This case was eventually dropped, undoubtedly because there were no grounds to proceed—not even for folks with vivid imaginations and a lust for making easy money. That did not surprise me, but I was still amazed that Brat tried suing in the first place.

Speed limit …
What speed limit?

If Brat wanted to sue someone who may have contributed to her injury, the most logical person to sue was her boyfriend, for driving too fast. Or she could have sued Michigan's Department of Natural Resources (DNR), the state agency responsible for maintaining snowmobile trails. The state takes millions of dollars from snowmobilers every year in the form of registration fees, trail sticker fees, sales taxes, gasoline taxes, and whatnot. In return, they are supposed to groom (smooth) the snowmobile trails. All too often, they don't.

If you've ever snowmobiled in Michigan and nearby states, you know that Michigan trails are horrendously maintained. Legislators take money earmarked for grooming and divert it to other needs, such as their own retirement plans. My brother once volunteered for a State Legislator, and he was amazed to find how generous the legislators were in funding their own retirement plans … it's called priorities.

Or perhaps Brat should have sued the manufacturer of the snowmobile she was riding. As a former editor of a snowmobiling magazine, it is my opinion that snowmobile manufacturers are doing far less than they could to maximize safety (see my article, Snowmobile trails painted with blood). If you look at their year-to-year innovations, their priority is obviously making engines ever more powerful. In fact, many snowmobile engines now have more horsepower than some automobiles. I think this trend is nuts because it simply feeds the psychotic love of speed in the "No Fear" (and No Brain) crowd who equate more speed with more fun. If you can't have fun on a snowmobile trail at 20 to 40 mph, you need a psychiatrist, not more horsepower. Yet what do the snowmobile manufacturers do? They stuff more horsepower under the hood every year, while paying little or no attention to ride safety. Wouldn't it make more sense to maximize safety before giving snowmobiles enough power to go 120 mph?

However, there is one notable characteristic of snowmobile manufacturers: they are incredibly arrogant. They think they have all the good ideas, even though snowmobiles have not appreciably changed in the past few decades, other than cosmetic changes—and more horsepower, of course. The incremental changes they do make are typically oversold and disappointing. What's new? Just more power to feed the Speed Psychos, enabling them to more effectively terrorize others on the snowmobile trails. It will be the same old story next year, and the year after, and the year after that. A great way to wake up the snowmobile manufacturers and have them reassess their priorities would be a multi-million dollar lawsuit with punitive damages. I'd be happy to give my testimony as an expert witness, too.

Had Brat contacted me and said, "Dr. Pezzi, I would like some money to compensate me for my fractured vertebra. Can you think of someone that I can plausibly sue?" then she might have made a million dollars from this case. I could easily show that snowmobile manufacturers have been negligent in ignoring safety while enhancing top speed. There are ways to further reduce back injuries on snowmobiles, but manufacturers don't bother to implement those ideas. Or take one of the most common fatality mechanisms for snowmobilers: hitting a tree. I have a simple way to make almost any tree impact survivable. I would love to show the jury what the snowmobile manufacturers should have done long ago. But I am not in the mood to help Brat with any get-rich-quick scheme. Heck, I should sue her for intentional infliction of unjustified emotional distress. The stress of being threatened with a lawsuit** by her ended a relationship I had with an attractive, intelligent, wealthy, and slim (now that's a rarity in this state!) female physician I'd been dating. Thus, when avaricious people like Brat sue physicians, the collateral damage doesn't end when the lawsuit is resolved one way or the other. People like Brat are too self-centered to consider how their actions may affect others. I didn't damage Brat's back whatsoever, but she did damage my life. Permanently.

** I was never actually sued in this case. The Intent to Sue was filed but the case eventually fizzled out. Nevertheless, it was stressful, because I obviously did not have a crystal ball to see how it would end.

So are frivolous lawsuits a rarity? No, they happen all the time. In fact, a Harvard study concluded that 80% of malpractice lawsuits are frivolous. Thus, frivolous malpractice lawsuits are not an occasional imperfection in the legal system; they are its bread and butter. I won't claim that doctors do not make mistakes. I've made some, and I've seen enough ones made by others to make me realize that medical mistakes are very common. Fortunately, most of these mistakes do not cause appreciable harm. Human biology is more resilient and robust than you may imagine.

Since there are so many medical mistakes, why are there so many frivolous lawsuits? Why can't malpractice attorneys find more meritorious cases? The answer is primarily greed. Most medical mistakes result in little or no harm. Attorneys want cases in which people die or suffer significant permanent impairments, since this translates into a greater potential payday. Unfortunately, most of those cases are caused by an act of God, using drugs, smoking, drinking too much, overeating, recklessness, an egregious lack of common sense, or other forms of personal stupidity. The lack of a nexus between the bad outcome and what the doctor did or did not do is of little concern to most attorneys. They pore over every word in the chart and try to think of any reason to sue, no matter how flimsy or outrageous. They know that sympathetic juries sometimes give huge awards to unfortunate folks, even if the doctor did nothing to cause that misfortune. The doctor's insurance company is cognizant of these sympathy verdicts, so they are eager to make out-of-court settlements. Since these settlements are often large enough to buy a luxury car or even a house (or two), there is a strong incentive to sue again for an equally frivolous reason. Result? More frivolous lawsuits, based not on medical errors, but on bad outcomes that befell Joe Sixpack as he staggered through life.

Frankly, I am amazed by people like Brat and her attorney who evidently think they can go on the offensive without any repercussions. Doctors are typically anal, perfectionistic people who want to give perfect care to our patients. For us, any error—or even the allegation of an error—is devastating. Some doctors have committed suicide when they were mired in a state of self-flagellation after making a mistake or being accused of that. In my site years ago, I predicted that sooner or later a doctor is going to snap and kill someone: not himself, but the plaintiff's attorney, the plaintiff, or both . . . and perhaps a few of their family members, too.

Once this happens, I predict that it will become increasingly common once the seed is planted. When I was a kid, students with an axe to grind didn't go around shooting other students and teachers. One of my brothers and I made cannons and bombs when we tired of the relatively wimpy power of a double-barreled 12-gauge magnum shotgun and high-powered rifles, but we blew up inanimate things like stumps and an old dog house that our mother instructed us to get rid of (we reasoned, correctly, that it would burn faster if it was splintered into a million pieces). However, the thought of injuring a human never crossed our minds. In contrast, today's students have been given lessons in retaliation courtesy of the evening news.

It took a few centuries for that first school shooting to occur, but once word of it spread, the violent seed of "how to get revenge" was planted in our collective minds, and we've since seen school and workplace violence mushroom. Most of us would never shoot anyone, of course, but that should be little comfort for the bullies of the world who pick on others. Why? Unless they have a crystal ball, they cannot predict who will snap, and who will not—or if they think they can, I wish them luck; they're going to need it. Furthermore, most bullies are betting that the ones bullied will not retaliate because they are afraid of the legal repercussions of murder. However, many people eventually reach a point in their lives when they face death from cancer or some other terminal disease. If you're going to die six months from now, you're probably not going to worry too much about being found guilty of murder two years hence as the slow wheels of justice grind forward. People like Brat are betting that doctors would never retaliate. Wrong. Today's doctors are under unprecedented pressure, and more than a few of them might snap from the next major stressor. Remember that old saying about the straw that broke the camel's back? (That's an especially apropos proverb in light of Brat's back injury.)

Consequently, I forecast that a doctor with nothing to lose is going to make some attorney and plaintiff awfully sorry they filed a lawsuit. The doc might "even the score" immediately if he snaps, or the attorney and plaintiff might be given a reprieve until the physician figures that he has nothing to lose. That might be in 25 years, or it might be in 5—or less. Sometimes docs reach the "I have nothing to lose" point before their health runs out. For example, I know a doctor who lost his license after using narcotics in the OR to get high. Unfortunately for that doc, he doesn't have any other marketable skills. What he doesn't know is that his luck is about to get even worse: his wife is planning to leave him and take their children with her. Once that happens, he is a prime candidate for a reprisal directed at any attorney or plaintiff foolish enough to sue him for something he did while he still practiced medicine (it can take a couple of years for a suit to surface). Granted, he probably wouldn't do it, but statistically he is much more likely to seek vengeance than someone whose life is going along hunky-dory.

An estimated 300 to 400 U.S. doctors commit suicide every year—in a decade, that's more deaths than terrorists caused on 9/11. Once someone decides to end his or her life, they have nothing more to lose. If they decide to first settle the score, they won't pay a price for it.

If you are one of the many students who visits this site, you may not comprehend the intense emotions that doctors endure when they are sued. This fury can reach the boiling point if the doc perceives that the suit is unjust, because I think most of us possess an internal barometer of right and wrong that makes it particularly unpalatable to be charged with something that we think lacks sufficient grounds for a lawsuit. If you are one of the students, and you become a doctor, I have two words for you: Just wait.

Odds are, you will be sued, and when you do, it will ignite emotions that you never could imagine before that day. Even if you "win" the lawsuit, you'll still lose. You will lose time and money—guess who pays the deductible? You may lose your significant other (it happened to me, twice*), not as a direct result of the suit, of course, but as an indirect effect secondary to the associated stress. You will lose sleep, and your reputation may be damaged. Bear in mind that this is the crap you face when you "win." It's even worse when you lose.

* Had it not happened to me, perhaps I wouldn't spend every Saturday night alone. Perhaps I would have married and had children. I'll never know, but it's something I think about. Only so many “great catches” come along in any one lifetime. If an attorney hits you with a frivolous malpractice suit at the wrong time, it can be impossible to undo the damage.

Is this the only way to make a lawyer regret suing a doctor?
Lawyers seeking gold
may instead get lead

Most attorneys are smart enough to limit their plunder to whatever they can obtain from the doctor's malpractice insurance policy, not because they are kind-hearted people, but because they know that once you begin raiding a doc's personal bank account and other assets, he might give you something else: hot lead, as in a bullet traveling at 3000 feet per second, headed straight for some vital body part.

I sometimes go years without watching the news, but from what little I've seen, I know that people do shoot attorneys and judges. To my knowledge, no physician has yet imposed a "Smith & Wesson" death sentence on an attorney, judge, or plaintiff involved in a malpractice suit, but it is inevitable. Just wait.

Now that I am on this subject, I wonder if any sociologist or psychologist has investigated whether bullies in all walks of life are less likely to torment their victims now they know that by acting that way, they may be sentencing themselves to death when an "I'm mad as hell and I won't take it anymore" person seeks justice not in a courtroom, but with a gun. If the incidence of bullying is not decreasing, it is perhaps because the bullies don't perceive themselves as being that way. In their minds, they are just doing their jobs, or seeking justice for themselves by trying to seize money from someone to right some perceived wrong. This obtuse lack of self-perception will cost some bullies their lives. It's happened before, and it will happen again. Physicians usually possess a high degree of self-control (contrary to what you might think after seeing the Hollywood depiction of doctors), but I predict that they will soon reach the "I'm mad as hell and I won't take it anymore" threshold.

Just wait.

By discussing this, I am not trying to condone the murder of malpractice attorneys and their clients, but I would like to analyze the pertinent ethics. On the face of it, killing someone is always a moral transgression, correct? No. Here are some exceptions:

For example, a man living about five miles away from me recently called the police to say that he was feeling suicidal. Sixty officers were sent to surround his home, and one of them—a sniper reportedly positioned across the road—shot the depressed man in the head and killed him—even though the man was in his home!—because he said that the suicidal man pointed his gun at him. First, it is insane to send 60 officers to the home of someone who obviously has mental problems. That is likely to escalate the situation, not calm things down. Second, it doesn't take a rocket scientist to realize that a mentally ill person might feel threatened by having guns pointed at him, so he might shoot in self-defense. The man killed never fired a shot, and frankly I doubt whether he intentionally aimed his gun at anyone. With 60 officers surrounding his home, he was bound to point his gun at someone. The sheriff's office put that troubled taxpayer in a precarious situation. Some local physicians and therapists are outraged at the trigger-happy killing and the whitewashed "investigation" of it, in which the police decided, "Yup, the shooting was justified." If the depressed man was the sniper's father or brother, do you think he would have shot him? No way! The police could have obviated the "need" to kill him by taking cover behind some bullet-proof shield, and there are dozens of alternative ways in which they could have handled this situation so it was much more likely to have a better outcome.

Physicians will eventually begin killing malpractice attorneys. It's not a question of IF they will do it, but WHEN. Once that happens, I think that most of the bullets will be motivated by revenge, one of the most powerful human emotions, and one that incites people to murder innumerable times every day, generating excuses that range from flimsy ("You looked at my woman!") to understandable ones ("You raped and murdered my daughter, but got off on a technicality"). However, other reprisals could be motivated by a mental calculus in which a physician, using the ethical logic in the paragraph above, might reason that by killing one attorney, he might indirectly save several lives.

Such logic may seem tenuous because most malpractice attorneys don't kill people, right? Not directly, of course, but it is easy to show how their actions indirectly result in death. In the United States, physicians are so cowered by the fear of being sued that they order countless millions of defensive CYA tests and procedures. The umpteen billions of dollars spent on that makes healthcare so expensive that many people cannot afford it.

Want to save money on hospitalizations whether or not you’re insured?

It's even happened to me. At a time when I had no medical insurance, I developed a cardiac arrhythmia (as a side-effect of a medication) that almost killed me. Knowing that I could be dead in five minutes was frightening, but I was also terrified by the huge bill that would undoubtedly be generated by the ER visit and subsequent admission. Hospitals are relentless in collecting money, so they'd raid my bank account and probably end up with my house, too. (Incidentally, hospital bills are often fraudulently inflated, as documented by 60 Minutes and other investigative journalists.) Hospitals prey upon people without insurance, routinely charging them much more than insured folks—one of the great moral injustices of our time.

I could risk losing everything I'd worked for, or risk dying. Some choice, eh? So, in desperation on this day before Christmas, I went to the ER and explained to the charge nurse that I didn't want treatment unless I coded, so I spent the day sitting in the waiting room with my heart thumping like a V-8 running on bad gas with only three cylinders firing now and then. My arrhythmia was so bad that I became short of breath as a result, because my cardiac output (the amount of blood pumped by the heart per minute) was very low. Needless to say, this "Just code me if my heart stops" game plan wasn't an optimal one, because I could have passed out and died while sitting in the waiting room chair, with people thinking that I was just sleeping—IF anyone even noticed me. (Here's a tip for you self-conscious people: Unless you're a hot woman, virtually no one will give you anything more than a fleeting glance. People are wrapped up in themselves, period. If you're worried about what others are thinking about you, stop worrying: they are thinking about themselves!) Read more about my trip to the ER.

If malpractice attorneys were eliminated, healthcare would be so affordable that everyone could be insured for substantially less than what we now pay for only some people to have insurance. Apart from the astronomical cost of CYA medicine, the millions of CYA tests and procedures injure and kill many patients every year because medical tests and procedures can be risky. This risk may be immediately obvious (e.g., an allergic reaction to a radiological contrast agent), or it may be delayed for decades (e.g., cancer developing as a result of exposure to x-rays). You could fault doctors for succumbing to the pressure to perform CYA tests, but doctors who don't practice defensive medicine risk lawsuits that could bankrupt them. With such onerous pressure, I think it makes more sense to blame malpractice attorneys for being so viciously aggressive. The bottom line is that they don't kill patients directly, but they do kill many patients indirectly by forcing doctors to order so many tests and procedures, and by forcing people to forgo healthcare because of its expense.

Malpractice attorneys like to think that they improve healthcare, but they harm far more people than they help, and I have no doubt that they indirectly kill more patients than they save. Therefore, from an ethical perspective, eliminating them could be viewed as being justifiable (if you haven't already read it, see the discussion above describing how some ethicists justify such “kill one to save five” actions). It would be preferable to eliminate malpractice attorneys by persuading them to just go away, but like hungry sharks smelling blood, malpractice attorneys will continue their plunder until someone stops them.

Want this free book? Contact me.

But who? Surely not their lawyer brethren in the legislatures, who've enacted laws making frivolous lawsuits ridiculously easy to initiate and profit from. Consequently, I think that some doctors will eventually conclude that they are performing an ethical service to future patients by neutralizing some malpractice attorneys. (Again, I am not encouraging that; I am predicting that.) The impact of those murders could vastly exceed their absolute number as fearful attorneys transitioned to other careers or became more judicious in selecting cases in which there was true malpractice—and hence cases in which it would be ethically impossible to justify killing anyone seeking compensation for the victim.

The problem for attorneys is that they evidently have very poor judgment in determining what cases are meritorious from a malpractice standpoint, and which are not (incidentally, this is not just my opinion; as I mentioned above, a Harvard study concluded that 80% of malpractice lawsuits are frivolous). A doctor can do everything he is supposed to do and then some and still be sued. In theory, doctors don't have to give perfect care to avoid malpractice suits; average care is all that is legally required. In reality, ANY care—from below average to average to perfect—can and does result in malpractice lawsuits, because attorneys know that shortsighted malpractice insurance companies—eager to resolve the cases and reluctant to pay for good defense—often make generous settlement offers to make the cases "go away." Naturally, this encourages malpractice attorneys to sue more often, and hence make more loot.

Politicians do not want to solve this problem because many of them want our healthcare system to be such a mess that we, in desperation, finally accept socialized medicine and let the government that's bankrupted the Social Security system dictate to doctors and patients what they can and cannot do. With such a bleak outlook for winning the battle against frivolous malpractice lawsuits, I forecast that some doctors will attempt to make things better for future patients by killing malpractice attorneys. Or perhaps it will be plain ol' revenge. Whatever the motive, it is bound to happen.

Just wait.

Although guns are the primary tool for killing, attorneys of the future might face a far worse threat. I thought of various ways to kill people without being caught. If you're looking for the perfect crime, this would be it.

From the Wikipedia: "A perfect crime is a crime committed with sufficient planning and skill that no evidence is apparent, and the culprit cannot be traced. The term can also refer to a crime that remains undetected after commission, or sufficiently unsubstantiated to prevent active investigation, so that nobody knows conclusively if the crime has in fact been committed."

In one case, I could stand by someone and appear to be helping that person when I was in fact killing him, even though dozens of onlookers would never spot how I did it. It's not that I go looking for ways to kill people. I have a mix of intelligence and exceptional creativity that makes myriad ideas pop into my mind. The ideas I generate range from inventions pertaining to robotics, electronics, computers, healthcare, math, sex, weight loss, snowmobiling, ATVs, automobiles, aircraft, boats, tractors, energy, tools, kitchen gadgets, toys, and everything from A to Z, including murder.

The world can breathe a sigh of relief knowing that I am a doctor dedicated to preserving life, not taking it. If someone more nefarious had my gift for inventing, he could rule the world as people eager to stay alive agreed to do whatever he commanded. Atomic bombs are too nonselective to have the same effect, and other selective weapons (e.g., firearms) leave traces that eventually limit how much damage someone can inflict before he is caught.

However, when it is possible to silently kill at a distance without a trace of evidence, killing and not being caught would be child's play. The world would be indelibly changed, and for the worse, obviously. If you have any doubt about that, look at how people's behavior degenerates when they have some sense of anonymity, such as flaming others on the Internet, or behaving like selfish jerks while driving a car. When that cloak of anonymity is removed and people must face others and be held accountable for their actions, they generally exhibit a reasonable level of civility. While most people are inherently good folks who would not routinely go around killing others for trivial reasons, we're all human and hence susceptible to human failings, such as passionate tempers that can temporarily cloud our sense of propriety and erode our self-control long enough to murder someone. When you look at the utter hatred that develops between people going through a divorce, or people in courtrooms for other reasons, it is easy to understand how many of those individuals would become killers if they had a way to do it and not get caught. And I do. It's tempting to use it at times, but I prefer the ethical way to go through life and hopefully achieve great things without revealing something that would permanently ruin the world by making murder too easy to commit without repercussions. The men who murdered my father reinforced a lesson: that it is wrong to kill. Obviously.

But if you're an attorney, I have some free advice for you: Don't press your luck. It might run out sooner than you think. Even good people sometimes snap. In my blog, I described how one of the richest men in my area was shot to death in the parking lot of an upscale restaurant by a Catholic-school coach who'd previously led a rock-solid life. The coach was mad because Mr. MegaBucks had an affair with his wife, who was now divorcing him—presumably to be with her sugar daddy and his piles of gold. However, Mr. MegaBucks had enough lead pumped into him that his gold will now go to someone else, since he will be spending the rest of this winter and eternity under six feet of dirt … far away from his money and the wives of other men.

Everyone gets mad, but some people get even. Predicting who is a very risky business—so risky that the prudent course of action is to never screw other people, or their wives.

It's now Christmas Eve, and I am, once again, spending the day alone, as I've done many times after the death of my mother, the murder of my father, and—thanks to people like Brat—the loss of my girlfriend. Visions of sugar-plums may be dancing in the head of Brat tonight, but I'll be thinking of something else. Can you guess what it is, Brat?

This article predicts what some doctors will inevitably do: seek revenge, possibly before suicide; it does not condone it. No one has the right to take a life unless in self-defense. People are much more than what they seem. It isn't feasible to get a good idea of what someone is like from the Internet, although many people try to do that after reading 0.000001% of what someone has said in their lives. A snapshot of that 0.000001% just isn't a good picture. Similarly, we often intensely and harshly judge others after seeing a tiny slice of them, their actions, and opinions. After seeing that, it takes a hell of a lot of arrogance to conclude one is qualified and justified in killing someone because the snapshot looked like an ugly picture.

“I bet you if I had met him [Leon Trotsky] and had a chat with him, I would have found him a very interesting and human fellow, for I never yet met a man that I didn't like. When you meet people, no matter what opinion you might have formed about them beforehand, why, after you meet them and see their angle and their personality, why, you can see a lot of good in all of them.”
Will Rogers
Comment: Trotsky was a Russian Marxist revolutionary. Like him? Well, virtually everyone is good in some ways. Adolph Hitler was a reasonably talented artist and a stunningly effective economist. If President Obama did one-quarter as much for the U.S. economy as Hitler did for the German economy, even folks committed to smaller government would say “screw the Tea Party!” and jump on the Obama bandwagon.


  1. Why Doctor Ratings Are Misleading
  2. Crazy, Scary Reasons Why Patients Sue
  3. Never underestimate what can happen with a smart lawyer and a stupid judge or jury. People like Casey Anthony can walk free, while innocent people go to the electric chair. Our criminal justice system is an abomination, as is our civil litigation process. It's all a big joke because it is supposed to be about justice and only justice, when in reality chance probability—a throw of the dice—frequently determines who walks and who fries.
  4. 'Vast Majority' of Neurosurgeons Practice Defensive Medicine
  5. A study reported in The New England Journal of Medicine (Claims, Errors, and Compensation Payments in Medical Malpractice Litigation) analyzed 1452 closed malpractice claims and found that 37% did not involve errors and 3% had no verifiable medical injuries.
  6. Looming Malpractice: Waiting for Claims Resolution Takes Up More Than 10 Per Cent of the Average Medical Career
    Excerpt: “The average physician can expect to spend nearly 11% of his or her career with a malpractice claim waiting to be resolved … Some specialists will spend nearly a third of their careers with open claims.”
  7. Patient Safety Improves When Leaders Walk the Safety Talk
    Excerpt: “When nurses feel safe admitting to their supervisors that they've made a mistake regarding a patient, they are more likely to report the error, which ultimately leads to a stronger commitment to safe practices and a reduction in the error rate.”
    Comment: Until the day (that will never come) when humans can always perform perfectly, healthcare mistakes should be addressed more intelligently. It's convenient to blame the one who committed the error, yet many mistakes arise from systems problems, not individual problems. When people are rushed, given second-rate equipment, or work in an environment in which they must frequently battle the mistakes of others, more mistakes are inevitable. I documented real-world examples of those causative factors in this site, my other ER site, my ER book, and my blog. Imagine that you're a doctor working in an overly busy emergency department like this one; realistically, how long do you think you could go before making a mistake?
  8. Assessing doctors' responsibility in medical malpractice cases Excerpt: “Medical malpractice court judgments should not be confused with actual medical malpractice. There are many cases in which a patient wins a case where no wrongdoing can be found by even the most conscientious state medical board. Ideally, court decisions on medical malpractice should be made based on objective testimony by experts in the field. Unfortunately, such testimony is rarely objective, and is frequently given by "medical whores", doctors who will say whatever is requested for the right price.”
    COMMENT: Since medical whores can be paid an hourly wage that now easily exceeds $1 million per year, they have a strong incentive to say whatever the attorney who hired them wants them to say.
  9. 5 Unexpected Ways You Could Get Sued
    Excerpt: “… cardiologists in the United States have a roughly 1 in 5 chance of being sued in any given year.”
  10. Wharton professor Adam Grant: What Makes Malcolm Gladwell Fascinating
    Excerpt: “… an audiotape with the words garbled so that we can only hear the tone still allows us to identify the surgeon who was sued for malpractice …”
    Comment: People like friendly people who seem to like them. People like friendly doctors who seem to like them. People HATE arrogant, angry docs; if given a chance to punish them via a lawsuit, even a flimsy one, they'll jump at the chance.
  11. My proposal to control healthcare costs: American healthcare will remain horrendously expensive as long as patients are allowed to sue doctors, yet harmed patients deserve compensation. I propose a prohibition of malpractice litigation, replacing settlement awards with money saved by avoiding defensive medicine, which would no longer be necessary. This system would be administered by an independent panel comprised in part of doctors participating in a Quality Assurance system, as I've previously discussed. Advantages:
    (a) Harmed patients would receive compensation quicker and wouldn't lose a big chunk of it to lawyers and legal expenses.
    (b) There would be less risk of “throw the dice, maybe I'll win and maybe I won't” chance determining if a harmed patient is compensated or not.
    (c) Patients would be compensated for lesser injuries that don't interest malpractice lawyers because they don't warrant awards large enough to justify malpractice litigation.
    (d) Awards would be much more likely to be based on evidence, not emotion.
    (e) Patients would not be inconvenienced AND HARMED by defensive medicine procedures and tests (such as x-rays, CT scans, fluoroscopy, etc.).

    Doctors who make too many errors (ALL doctors make mistakes!) should not be sued; they should have their licenses revoked or restricted (e.g., an ophthalmologist not very skilled at surgery would be limited to doing eye exams).

    Fearing loss or restriction of their medical licenses, doctors would finally get serious about providing topnotch care, not the half-assed care often now given. Doctors would demand major improvements in the CME system, which is abysmal, as I discussed in my blog in articles such as Sham CME (Continuing Medical Education), Medscape CME problems, and The secret pact of silence in medicine.

    American healthcare is simply too expensive. It is strangling our economy and us (for example, see Health Care Spending in Last Five Years of Life Exceeds Total Assets for One Quarter of U.S. Medicare Population and Health-Care Costs Hit the Elderly Hard, Diminish Financial Wellbeing, both based on Out-of-Pocket Spending in the Last Five Years of Life).
  12. Are Your Personal Assets at Risk if You're Sued?
    Excerpt: “'Bad-faith suits allege that the [malpractice insurance] carrier put its own financial interests ahead of the physician's …'”
    Comment: Don't they always? They typically settle frivolous lawsuits for small to moderate sums to avoid the expense of contesting the allegations and the possibility of a verdict issued by a sympathetic jury. That makes obvious business sense for the malpractice insurance company but not the doctor, whose record is tainted by the settlement that simpletons often interpret as evidence of a medical mistake. Wrong. Serious legitimate claims are not settled for less than what they're worth—and if a genuine mistake occurred, they're worth a fortune.
  13. “According to a 2009 report about the California board, 1 of every 8 physicians in the state was being reported to the board each year. About one quarter of complaints to the board were investigated, and about one quarter of investigated complaints led to disciplinary proceedings against the physician …” (source)
  14. Rudeness at Work Causes Mistakes
  15. Lawsuits: 'It's Not All About the Doctor'
    Excerpt: “Although patients may ultimately sue over an egregious error that has harmed them, more typically, there are other reasons involved. "Patients sue due to anger … they want revenge or retaliation; or they have an entitlement attitude …"”
  16. Job Stress and Mental Health Problems Contribute to Higher Rates of Physician Suicide based on Details on suicide among US physicians: data from the National Violent Death Reporting System
  17. Medical Errors in Hospitals: Doing the Right Thing When Things Go Wrong
  18. Spending more on patients lowers doctors' malpractice risk, study finds: 'Defensive medicine' may work for physicians, but possibly at the cost of undermining health care reforms
  19. Patient complaint procedures leave doctors emotionally distressed, finds new study
  20. Majority of physicians have favorite patients, study finds

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