Surgeon Goes From 'Brilliant' to Banned

yahoo news/AP ^ | May 20, 2005 | WILLIAM McCALL

[gas_dr]

I don't hold doctors up on any higher platform than I would a common brake mechanic.

Next time you need healthcare, might I suggest you go to Jiffy Lube, then.

[B4Ranch]

>>And one other thing, my 20 partners, of whom you assume all are crappy doctors, I would let anyone of them put my wife or daughter to sleep.<<

That says more about them than your ranting about how good you are. Would they do the same?

The Doctors that I hold the most faith in do not place themselves so high that questions or misinterpretations don't immediately become a personal attack on them.

[B4Ranch]

And should I come to you for a brake replacement?

[Dinsdale]

Whats the differance between a doctor and God?

God does'nt think he's a doctor.

That said in my experiance most doctors are arrogant competent professionals.

How many lives do engineers hold in their hands every day? Doctors are not the only highly trained and licenced professionals who can kill you by screwing up.

There was a book published called 'Best Doctors' that collected the names of the doctors other doctors take their familys to from around the nation. The AMA pulled strings, it is no longer available. Then again there is no best engineers book available so my profession is'nt better.

[B4Ranch]

"It used to be one anesthesiologist for one surgery patient, not anymore. I'm not sure of the numbers but it has changed so you do have to be able to handle I think, at least two patients at the same time.""

>>I do my own cases, one anesthesiologist for one patient. I spent 2 nights on call last week one of which required an emergency heart procedure which involved anesthetizing a critically ill person.<<

Please explain to me if the following doesn't mean an anesthesiologist cannot provide services for multiple patients concurrently.

>>Medicare pays for the physician's medical direction of anesthesia services for one service or two through four concurrent anesthesia services furnished after December 31, 1998, only if each of the services meets the condition in section 415.102 (a) and the following additional conditions:<<
http://www.medicine.uiowa.edu/fppcompliance/teachingbilling.html

[B4Ranch]

Airline pilots carry as much or more weight on their shoulders as most doctors do. One slip and bam, 120+ people are wrapped in body bags.

[B4Ranch]

>>gas_dr
It really bothers me that you think you are an expert in all health issues.<<

Please show me where I stated I was an expert in all health issues.

Doc, here's some numbers for you to scan.

annual deaths from doctors (the self proclaimed experts)
"If these rates are typical of the United States, then 180,000 people die each year partly as a result of iatrogenic injury, the equivalent of three jumbo-jet crashes every two days."
- Leape LL. Error in medicine. JAMA. 1994; 272(23): 1851-57.
JAMA: The Journal of the American Medical Association.

(annual deaths frommotor vehicle crashes)
From 1980 to 1992, motor vehicle crashes were the leading cause of work-related deaths in U.S. workers. During this period, traffic-related motor vehicle crashes accounted for the deaths of 15,830 workers—or 20% of all fatal workplace injuries. Also during that period, 1,997 worker deaths were associated with motor vehicle crashes that were not related to traffic on a public highway. The number of traffic-related deaths was eight times the number not related to traffic.
http://www.cdc.gov/niosh/motralrt.html

[Polybius]

"a State investigator will be complicating that doctor's life "

Is this your opinion of what State investigators accomplish? Is there anything in your mind about the necessity to protect the public from negligence and unprofessional conduct.

That is not the point of what I wrote.

I was addressing the issue of having a Nurse claim that Nurses cannot report malpractice committed by doctors because doctors can somehow make their life difficult.

I pointed out that the power of the Nurse is considerable and all it takes is one letter to the State Board to complicate that doctor's life for 6 months.

The bottom line message was, "You are by no means helpless. Don't use 'The doctor will make my life difficult' as an excuse for not performing the legal duty to report malpractice when it is observed by a Nurse."

[B4Ranch]

Thank you for the clarification.

[gas_dr]

That says more about them than your ranting about how good you are. Would they do the same?

I have put 3 of my partners to sleep, as well as two surgeons that I work with.

In all honesty, it does not bother me what you think of my practice. You claims, however, are outrageous and downright dangerous. The comments swirling about this thread about how out of 100 doctors, 1 is good, and the other 99 are mediocre or crappy is misinformation at best, lies at worst. If you think that all doctors are dangerous, fine, just don't come and see us when in need.

As for the comments about pilots, as they hold hundreds of lives in their hands at a time -- true. I am a licensed private pilot working on my commercial rating. I also understand that the majority of deaths on airplanes are pilot error. Further, the airplane does not have tens or hundreds of pathological variables at a time that make the flying a different experience for each patient. In general, especially commercial aircrafts, there is little to do except fly the plane. Not to degrade the airline pilot, but his education, his moment to moment decision making is not as difficult as being a physician.

And you point out that we make a good living doing what we do. That is true, I make a comfortable living. I also have a quarter million educational debt to my name, and when I treat a patient, I do not get paid my commercial rate. Either I have a contract forced on my from the insurance industry, or the goverment far underpays me as in the case of medicare or medicaid. Furthermore, the non-insured, I take care of for free, using the same high standard of care that I use on all my patients. What is the benefit of all this? If anything goes wrong -- a complication that may be expected or a bad outcome (which by Black Law definition is NOT malpractice), I can lose absolutely everything. The airline pilot does not take the same risk, nor the brake mechanic.

The bottom line is that I think your comments are selfrightous, arrogant and ignorant. I think you falsely say things in the tone as if they are gospel truth. The majority of physicians are quick to point out if a colleague is dangerous, and we get sued for that as well (see above post by my friend polybius). But rest assured that at 3 in the morning, when you are having a heart attack, appendix or gall bladder attack, I will be there for you. I will take care of you with no expectation of anything beside earnestly praying and doing what is commisurate with my training to heal your problems. I will do this without regard to your ability to pay, or anything else. This is the blessing of my work. And you can expect that I will do this having been trained by the dinest instutions of medicine in the world, and that from moment to moment, as your situation changes, I will be vigilant and anticipate what is going to happen next.

As for your excellent quotation of the medicare laws, yes, a MDA MAY supervise up to four rooms at a time. However, your original post said that "anesthesia is no longer provided by individual physicians, one anesthesiologist per patient." That is patently flase, as everyday, I provide anesthesia one patient, one anesthesiologist. I think that a nurse anesthetist is not as qualified as I am to give anesthesia. Therefore, I sought a position where I did not have to superivise 4 rooms, where I made the decisions instead of cleaning up someone else's mess. But the point appears lost on you as you make generalizations assuming you are correct.

As for your other comments, I think you ought to do your homework before making statements that just are not true.

[gas_dr]

And should I come to you for a brake replacement?

Not if you want your car to stop...:)

[B4Ranch]

>>In all honesty, it does not bother me what you think of my practice.<<

In theory, theory and practice are the same;
In practice, they're not even close!

I am still chuckling that you have chosen to make this a personal debate because you feel as if I came ahunting for just for you.

For all I know you might just be that one superior Doctor who outshines every other anesthesiologist is the entire State. Your technological abilities might just be as close to perfect as can be. Your doctor patient talents may be able to calm the flightiest ones and your anticipation capabilities of what the next possible problem will be so refined that you eliminate every possible hazard long before the symptoms occur. Your postanesthesia care may have standards unknown to most. It would be the other Doctors who then are the mediocre (60) ones and and 39 lousy ones.

Go ahead and tell me that there isn't any anesthesiologist physicians in the entire State whom you wouldn't be apprehensive about even if they were just working on your 18 year old cat.

Suppose you wife needed an operation that was going to be 8 hours long. Given a list of 100 anesthesiological physicians I am positive that you could easily scratch 40 from the list who fit the qualifications in your mind of "Never!" (lousy) Then with the 60 remaining (mediocre) ones, you would select the one whom you deem to be superior above all the rest.

One of my daughters went through a critical surgery a few years ago. I hired three physicians just to make the confidential decisions of how to compose the surgical teams. My family MD and I sat at the table silently until the last moments when there was a strong debate about three neurological surgeons. I settled the debate by asking who performed the best with others. I didn't want someone who would get flustered when an RN was slower than he desired. Staying calm and not upsetting the rest of the team were the qualifications I demanded. Surgeon #1 hired numbers 2 & 3 for a full presurgery consultation as instructed by my family MD. Number 2 volunteered to be on standby in the operating room should something unfortunate occur. You'll be proud to know the youngest man there was the anesthesiologist(41). Everything went successfully I am happy to report. I believe that I had hired the best of the best, the top 1 percent.

Now do you comprehend why I am able to speak in numbers of 1, 60 and 39? I witnessed those doctors using approximately the same percentages themselves. The check offs of the "lousy" ones went surprisingly fast even though every one of them was licensed in their field. The debate of whom were the mediocre ones was slower but also rapid. It was of the final 8 that heavy brainwork and research came into play.

The entire debate took less than four hours and cost me $4000. $4000 for 15 hours of high grade professionals time making decions about an operation they wouldn't even perform. Was I overcharged? I don't think so. The results were what I wanted so there wasn't any further discussion.

[B4Ranch]

Thanks for the eyeopener! LOL Then I'll have to stay with the maintenence team I have now for the family vehicles.

[gas_dr]

The spirit of this debate is well taken. So you know, I think that physicians do take this personally, and I am guilty as charged. everday before I go to work I pray for wisdom and guidance from God for my patients. that being said, of course I concede there are anesthesiologists who are mediocre. I have been fortunate not to meet a dangerous one as of yet. Surely if I do, I will make the necessary report.

Having said all of this, we take this very personally because we invest our lives into our art. The hippocratic oath is the cornerstone of our ethical practice...and yes, I believe in the hippocratic oath, not the oath of the united nations. When you work hundreds of hours a week as a resident, and 60+hours a week in private practice doing the best you can, some of the comments you made did rub me the wrong way. For taking it personally, I am sorry.

If i keep this oath, may I be revered among all men for all time. If I swear by it falsely, and fall away from it, may the opposite be my lot.

[ccmay]

"If these rates are typical of the United States, then 180,000 people die each year partly as a result of iatrogenic injury, the equivalent of three jumbo-jet crashes every two days."

Those figures include a great many deaths for which you cannot hold the physician directly responsible. Hospital-acquired infections are one such case, assuming the doctor uses proper hygiene. Allergies and other known risks and side effects of treatment are another.

If you are dying of a snake bite, and they give you antivenin, and you then have an allergic reaction and really truly die, is that the doctor's fault? Of course not, that is a known risk of antivenin treatment, and the doctor made the judgment that the potential benefits outweighed the potential risks.

Until we have Star Trek tricorders, doctors will have to do that every single day, and sometimes they will be wrong. Nobody knows how to choose the patients receiving treatment so there will never be any side effects. It's always a tradeoff, and doing nothing is just one more treatment option among many, with its own set of risks and tradeoffs.

These are "preventable" deaths, but only in the most trivial sense: They could have been prevented by withholding useful treatments from all patients, lest a tiny minority have a complication. So don't read too much into these articles about "hundreds of thousands" of patient deaths. Most of them have nothing to do with real malpractice.

-ccm

[ccmay]

Suppose you wife needed an operation that was going to be 8 hours long. Given a list of 100 anesthesiological physicians I am positive that you could easily scratch 40 from the list who fit the qualifications in your mind of "Never!" (lousy) Then with the 60 remaining (mediocre) ones, you would select the one whom you deem to be superior above all the rest.

What a pointless and statistically stupid thing that would be. You are implying that if a doctor is not perfect, then he is no good at all. This is madness.

By definition, in any group of people, 50% of them are always going to be below the median in whatever test of skills you care to administer. You could have a hundred anesthesiologists who were each valedictorians of their college classes, scored 99th percentile on the medical board exams, and did residency at Harvard, but you would still (theoretically) be able to rank them such that half of them were below median. Would you not then be comfortable being treated by someone in the bottom half? Don't be a fool.

-ccm