The 1L and Dr. Douche

I caught a lot of hell for going to law school, but I never thought it would make me fear for my life.

It’s been less than two months since I started law school, and in that time I’ve endured a steady stream of email forwards with lawyer jokes from my annoying uncles, suffered snide comments from friends who insist that I’ve chosen a “dick profession” (their words, not mine), and ignored two verbally abusive encounters with fellow subway riders who saw my law books and launched into angry (and mostly incoherent) diatribes about how lawyers are “scum.”

Of course, it doesn’t help matters when I read news stories about guys like that Covington and Burling partner who wrote a book called Life Without Lawyers: Liberating Americans from Too Much Law and his big objection to “over-lawyering.” It’s fair to say that we might be a better society with fewer laws.  I happen to think there’s a lot of merit to that point, but the trouble is arguments against litigiousness (and by extension, lawyers) end up in the hands of reactionary half-wits—like the ER doc who had the audacity to lecture me on the harm that frivolous lawsuits have on healthcare in this country while he was supposed to be diagnosing the cause of my seemingly life-threatening chest pains.

The chest pains began in the midnight hours while I was trying to brief Palsgraf for Torts the next day. I’ll spare you the gross details of my other symptoms. I ended up in an emergency room at 3:00 a.m., which is no place for any human—even your worst enemy. If Dante were alive, he’d create a tenth ring of hell and call it an ER.

The place was loud, crowded, and about as clean the gyro cart halfway down my block. Thankfully, there was no waiting for me. That’s what happens when you collapse in the triage line. A kind, flu-stricken woman stepped over my writhing body and harangued the indifferent nurse until she agreed to take a look at me. After a few quick questions and vital signs, the triage nurse sent me back to see a doctor.

That’s when the real trouble began.

“What do you do for a living?” the doctor asked as he began his physical examination.

I think he was just making small talk, but my answer set off a hornet’s nest.

“I’m a first-year law student.”

He practically hit the roof. And the examination ground to a halt.

“I’ll tell you what’s ruining medicine in this country—medical malpractice,” he said.

That was his opening salvo in a lecture that made me miss the Socratic method.

I don’t remember how long his diatribe lasted, but it included such choice offerings as: “Lawyers cost the system more money than insurance company profits; and tort reform is all we need.”

In actually, medical malpractice lawsuits account for about .5% of the total healthcare costs in the U.S., according to a recent report from the Congressional Budget Office summarized at FactCheck.org. Yes, that half of one percent is real money ($11 billion this year, $41 billion projected over the next decade), but it is not the whole enchilada. Not even close, Doc.

Now, of course none of these facts and figures were available to me in the emergency room, and arguing with the good doctor would have been about as helpful as performing the examination myself. Which is why I found myself doing something I thought would be at least three years away.

I threatened to sue the bastard.

I told Dr. Douche that if he wanted a firsthand look at a medical malpractice lawsuit, I’d give him one. In my extreme pain, I may have even threatened to take his license and mount it in a frame on my wall next like a Moose head.

That might have been what got the attention of the attending physician, who asked me what the problem was.

After I explained that I wanted treatment, not a lecture from Doctor, the attending sprung into action.

That was the good news and the bad news. I survived, but my bank account is going to be in critical condition for sometime. The attending was a genuinely compassionate doctor, or some lawyer before me had trained him. Either way, I got the very best defensive medicine money could buy.

Now, don’t get me wrong. I’d much rather get defensive medicine than no medicine at all. Ultimately, I got very good care and was able to walk out of the hospital alive less than a day later. But to call the battery of tests and the thousands of dollars of medical care that the attending ordered “overkill” would be a huge understatement.

I’ve since taken my bill (part one of three!) to four doctors for some explanation. None of the doctors can agree on exactly what they would have done when presented with my symptoms, but they can all agree that the attending went too far. Way too far.

All four doctors agreed that anywhere between 50% and 70% of the tests ordered on me were unnecessary. Apparently, that’s not uncommon. An irrational fear of medical malpractice lawsuits among doctors drives up medical costs by as much as 3%, or about $60 billion a year, according to a recent article in The New York Times that cites the work of Amitabh Chandra, a Harvard economist whose research is used by both the American Medical Association and the trial lawyers’ association.

But here’s the truth as it pertained to my case: Three of the four doctors said they were confident that any decent physician could have diagnosed my condition with medical history, a physical exam, an X-ray. I got all that, plus an MRI, blood work, and enough tests to make the Princeton Review people salivate. The fourth doctor said he would have ordered a few more tests, but not nearly as many as the attending physician, who he said was clearly “covering his ass.”

In other words, I got the do-everything-special that seems to be in vogue with American doctors these days.

But that was not what I asked for. I asked for treatment, not the best treatment ever. Not record-breaking, medical heroics stuff. Not George Clooney and his pulling-out-all-the-stops ER fantasyland crap. I just wanted real medical attention that meets, or exceeds, the standard of care in my area. No more, no less.

Sometimes that means really expensive care. But in most cases, a little bit of common sense and cost benefit analysis can produce the best possible outcome for the patient.

Now, I’ve explained that when I went to the ER, I thought I was dying. Chest pains will do that to you. But none of the doctors thought I was dying, especially since you don’t often see a lot of 24-year-old healthy males going into cardiac arrest.

As it turned out, I had one of those medical problems that certainly feels dire, but really isn’t all that serious once you figure out what it is.  It was more painful than anything else, and once the attending came back with a diagnosis of kidney stones, I was instantly relieved.

And that means that this was one of those routine situations where common sense and some cost benefit analysis would have helped me a lot. It would have delivered the same healthcare outcome at a fraction of the cost.

Unfortunately, I began the experience with a rude and reactionary doctor who forced me to do a little legal saber rattling just to get what anyone who walks into a hospital expects—competent medical care. But by insisting on my right to treatment, I ended up becoming the victim of my own advocacy.

That’s the rub, as I see it. There’s no such thing as reasonable, cost-effective care in this country. Doctors are too afraid of lawyers to think straight. Hell, they’re even afraid of law students.

Do lawyers add unnecessary costs to the healthcare system in this country? Of course they do. But those costs—while real—aren’t anywhere near the whole problem, and yet we have absolutely no clue about how to put that issue in perspective.

If we’re going to talk about tort reform in this debate (one of those ideas that might not make it into a final bill, but just won’t die, either), we had better be prepared to answer this question: What if I had died while Dr. Douche was busy lecturing me? Would my family have been able to file a lawsuit against him and the hospital for failing to properly supervise this zealot? Would that lawsuit have put a damper on his career and—maybe—taken a bad doctor out of circulation? Would it have prompted the hospital to rethink the way it supervises doctors and perhaps even offer additional training on dealing with all the people who walk their doors?

Hopefully.

I’m not sure how much that lawsuit would’ve been worth (I hear the lifetime earning power of lawyers today isn’t what it used to be), but I don’t see why doctors are so special when we’re really just talking about cracking down on negligence. After all, the best defense to a malpractice case is not to commit malpractice. 

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I caught a lot of hell for going to law school, but I never thought it would make me fear for my life.

It’s been less than two months since I started law school, and in that time I’ve endured a steady stream of email forwards with lawyer jokes from my annoying uncles, suffered snide comments from friends who insist that I’ve chosen a “dick profession” (their words, not mine), and ignored two verbally abusive encounters with fellow subway riders who saw my law books and launched into angry (and mostly incoherent) diatribes about how lawyers are “scum.”

Of course, it doesn’t help matters when I read news stories about guys like that Covington and Burling partner who wrote a book called Life Without Lawyers: Liberating Americans from Too Much Law and his big objection to “over-lawyering.” It’s fair to say that we might be a better society with fewer laws.  I happen to think there’s a lot of merit to that point, but the trouble is arguments against litigiousness (and by extension, lawyers) end up in the hands of reactionary half-wits—like the ER doc who had the audacity to lecture me on the harm that frivolous lawsuits have on healthcare in this country while he was supposed to be diagnosing the cause of my seemingly life-threatening chest pains. 

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22 Comments

  1. PI Guy

    October 22, 2009 at 6:17 am

    Love suing arrogant doctors.

  2. BL1Y

    October 22, 2009 at 6:35 am

    One of the biggest problems with health insurance is that people use it to pay for everything.  When you buy insurance you’re paying to avoid risk.  Your premiums are higher than your expected costs, but you pay the extra amount to avoid a catastrophic expense.  But yet we want our insurance to cover so much more.  We want it to handle routine doctor visits, antibiotics, etc.  Imagine using your auto insurance in the same way, having it pay for windshield wiper fluid, tire rotations, and oil changes.  Of course your insurance would be ridiculously expensive.  Most people need insurance against the risk of a $50,000 bill, but practically no one needs to insure against the risk of a $200 checkup.

  3. Smurf

    October 22, 2009 at 6:38 am

    So you go to the ER, you threaten to sue the doctor, you get a few extra tests and you complain that THEY lack common sense.
    Interesting…

  4. BL1Y

    October 22, 2009 at 6:42 am

    As for this guy’s particular issue, he should call the hospital and explain that he had his bill reviewed by several other doctors who all agreed than many of the tests should not have been ordered.  Tell them you won’t be paying for them.  If a doctor orders a test to protect himself from a malpractice suit, then that’s his expense, not yours.  Also, odds are your bill includes a ~$300 charge for aspirin; either pay only $1 of that or go to a store that sells single serving packets, and mail one in with your payment.  You don’t have to pay a bill just because it came from a doctor; you’re allowed to challenge it.  People challenge the bills of their lawyers, mechanics, construction contractors…pretty much anyone who writes bills; no reason you can’t treat your doctor the same way.

  5. TNG

    October 22, 2009 at 6:48 am

    Well, I never tell anybody I don’t know I am a lawyer…especially Doctors.  If they ask me what I do, I say “consultant”, which itself is a pretty nebulous answer and then if they ask what does a consultant do, I say help business and people with their organization problems, make things run efficiently.  That just about ends the questioning about what I do.

  6. Craig

    October 22, 2009 at 6:54 am

    Lawyers are not the problem, it is lawyers like you that are the problem.  I don’t trust doctors either, but I don’t threaten to sue them if they try to make small talk before diagnosing my stress induced disorder.  Acting like you somehow deserve special treatment, or acting like you know something more than the general public, just because you took half a semester of law school, is about as lame as it gets.

  7. Guvment Cheese

    October 22, 2009 at 7:19 am

    I’ve had doctors ask me what I do and I always respond, “I’m a lawyer, but don’t worry; not that kind.  I work for the government.” and then they treat me like anyone else usually.  And no, not the FDA… I work for ineffectual, local government.

  8. BL1Y

    October 22, 2009 at 7:31 am

    I think that’s a little harsh, Craig.  Yes, the kid was out of line for threatening to sue his doctor.  But, this kid was in the ER in the middle of the night, in pain, and fearing for his health, and then instead of treatment he gets a lecture from his doctor.  That would make almost anyone react emotionally.  Part of being a doctor, especially one working in the ER, is managing your patients.  If you can’t handle people who are angry, afraid or hysterical, perhaps emergency medical care isn’t the best profession for you.  The student and both of the doctors acted inappropriately, but I’m more inclined to forgive a student suffering from a potentially serious medical issue than an experienced professional performing in his regular capacity.

  9. Craig

    October 22, 2009 at 7:36 am

    I agree that both the law student and the doctor acted like, well, a typical douche law student and douche doctor.  If you want to give the student a pass because of his situation, then I can see that.  Maybe I was being too harsh.  But when you are really looking for help, it is better to get the doctor on your side, then threaten suit, which is really a joke to begin with.  I admit I was probably a bit to harsh.  I was just cranky after having to read that long, boring and bland post.  Hoping that M. Richardson or LF10 would write today, and then got this.

  10. Not a 1L

    October 22, 2009 at 7:47 am

    Kidney stones at 24?  I think I smell another source of our healthcare costs. I’ll bet his medical bill that our 1L friend is obese, smokes, drinks like a fish, or hasn’t seen the top side of a treadmill this decade.

  11. BL1Y

    October 22, 2009 at 8:26 am

    Kidney stones are largely caused by dehydration, so smoking wouldn’t contribute in any way, nor would obesity.  Drinking would obviously raise your chances, but exercise could as well.  In other words, Not a 1L has somehow managed to confuse kidney stones with hypertension.

  12. mOLLY

    October 22, 2009 at 9:14 am

    Love rants!!

  13. Not a 1L

    October 22, 2009 at 10:29 am

    BL1Y – According to the Mayo Clinic, risk factors for kidney stones:
    Fluids (often alcohol related as you discussed)

    Family History

    Age

    Diet

    Limited Activity

    Obesity

    High blood pressure (often caused by smoking)

    IBS
    http://www.mayoclinic.com/health/kidney-stones/DS00282/DSECTION=risk-factors
    Spend some time in an ER (1 year – not enough for a scientific sample, but enough to shoot my mouth off on a blog).  While I’m sure it can happen, I never saw a healthy kid under 25 get kidney stones.  I would still take the bet.

  14. KateLaw

    October 22, 2009 at 10:30 am

    Yeah, pretty boring post.  Challenge the bill.  Alot of hospitals even have a hardship form on the back of the actual bill that you can fill out.  Send that in with a well-written letter and you should be golden.  I think he is an idiot kid with an inflated sense of importance for threatening to sue.  And no, I am not being too harsh.

  15. www.pinkshoelawyer.blogspot.com

    October 22, 2009 at 2:42 pm

    I dunno what kind of freaking kool aid they pass around in med school, but every MD and wannabe I ever met gets realll jumpy about “Frivolous lawsuits” and tort “reform.” Like we were stealing food from their mouths, the poor starving babies.

  16. BL1Y

    October 22, 2009 at 6:21 pm

    Just want to point out, since it hasn’t been said yet, that tort reform means limiting juries’ abilities to impose punitive damages.  If juries only impose high damages because they’re sympathetic to patients and don’t care about malpractice insurance companies picking up the cost, we need reform.  But, if they’re imposing the damages for any of the other legit reasons punitive damages exist, “tort reform” is just a shield for bad medical practice.  I think a big step in improving things for both sides would be to cut the cost of med school (loan repayment assistance programs?), which means new doctors can function more as doctors as less as businessmen, and patients can have a doctor-patient instead of doctor-customer relationship.  I think this is what many doctors would prefer, but the economics of practice make it unrealistic.  …The same is likely true of law.

  17. Pujades

    October 23, 2009 at 9:01 am

    I agree with Craig’s first post. One he is overly indulgent–ER? C’mon. Two, even if the doc was rude, learn how to deal with people other than by suing them: “so you won’t be taking off the wrong leg tonight right?” Or a bit more appeasing, “yeah those ambulance chasers are a problem.” And he ought to pay the bill:he asked for gold plated care and got it. There is a time for threatening lawsuits. That’s not one of them. The poster sounds like a whiny hypochonrdriac on his way to suing over poorly pressed pants.

  18. JW

    October 23, 2009 at 10:19 pm

    Have you thought about suing under your state’s Unfair and Deceptive Trade Practice law over the unnecessary medical exams?

  19. Guano Dubango

    October 24, 2009 at 3:04 am

    I think perhaps this law student was too brash in dealing with Dr. A-Wipe.  Also maybe this law student had too much stress studying, which he could have gotten rid of with consensual sex with pretty law student (if he could find one).  I think law students should worry less and be more happy.  Sex is the way I got rid of stress when in school.  I am no longer a student, so I need a wife for sex.

  20. anon

    October 25, 2009 at 12:22 am

    Normally i love reading bitter lawyer, but this is the worst post ever. 
    The problem with healthcare is that people expect too much, and alot of people pay too little.
    Whether it is a doctor’s choice of tests or the drugs themselves, people expect medicine to be perfect…people sue drug companies for adverse effects and keep these drugs off the market even when they do help 999,999 people out of every million…no wonder drug costs are high
    You complain when he orders too many tests all at once, others complain when a doctor orders tests in series, claiming he wasted too much time before ordering the right test, and at the end of the day, complain about paying just because you didn’t like a guy’s attitude, and a doctor for covering his ass after you threatened to sue?
    Each one of these tests are expensive; maybe the doctor should have disclosed to you how much each test is and let you choose your own treatment next time…but then are you going to sue his ass when he lets you go ahead with a decision against his judgment?
    Of course, you did pay your bills which is better than many.  I even know a doctor who is being sued by his patient’s relative because he didn’t perform a certain test on his patient, because she couldn’t afford it, and it was only speculative, and this is after already giving her free treatment for months and eating the costs of her expensive cancer drugs.  Where was this relative when this patient needed the money to get this test?
    What a load of crap.

  21. say what?

    November 4, 2009 at 8:17 am

    I can see why your uncles said you’re going into a “dick profession”—it is because you are a dick, and an ignorant one to boot.
    You tell the ER doctor that you’re going to sue him (having no cause of action) before you are treated, and you wonder why you get defensive medicine.  You are obviously the type of lawyer that the doctor has already had to deal with—one who files suit first and finds a cause of action later.
    Hint,:  Practicing law is about serving clients.  Not about threatening others before you even know what proximate cause means.
    Change your attitude or you’ll be baking cookies.  Or being sued for malpractice yourself once you get out.

  22. Frat Guy Lawyer Type

    November 6, 2009 at 8:46 am

    Doctors are susceptible to believing that med mal is the sole source of the rising cost of health care because, by and large, they’re awful at business and never look at the numbers.  Many of them believe that their judgment is infallible and no one has the right to question them.  Almost as many will never openly question the work of another doctor, no matter how obviously negligent it is.  Bottom line – if doctors did some reading and realized how badly they were being screwed over by their carriers, they would have been self-insuring in their own pools decades ago and they would have an effective lobby to make it advantageous for them.

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