HH: If you don’t want people calling critical labs, you need to write an order saying ‘Call hospitalist immediately only if K < 2.8′ or something. Otherwise, you’re leaving it up to the nurses’ judgment.

Look, I don’t necessarily disagree with you. I think you very well would know better than I would on this nuanced issue. My point is that when your blog is linked to by Overlawyered, the very title of the blog suggests the implicatation that this is the fault of “overlawyering” and that medical malpractice claims are the root of this evil. My original post was directly on point to this: that you can’t bundle every problem of blame shifting and defensive medicine at the doorstep of malpractice claims. You can dump some problems, I’ll grant you. But we have to be careful which choose to place on that doorstep. One reader, Deoxy, blames the sub prime housing market crisis and the kidnapping of Patty Hearst on tort lawyers. Walter Olsen and, I suspect, you, take a little more discerning view which is why I made the original comment.

This is the longest comment of my life!

Speaking of Dalbert, is there a single case in the country where a court has found that there is not science to support a relionship between CP and malpractice? Has there been a single decision that says that?

Again, we all agree that it happens. The question is one of degree.

You don’t have to take me seriously, but my experiences on the front lines of medicine provide a lot of useful information from real world examples and experiences. I’m not going to write a stuffy and boring blog, but I will write my slant and experiences in an educational and humorous way. If you want stuffy and serious, you’ll be disappointed. You’ll likely be offended by a lot of what I write.

In case you missed the point of this post which appears to be causing you a lot of unnecessary stress, it was not simply about me not wanting to be called critical lab values. It was intended to show that the system of shifting liability is set up so all critical lab values are treated the same in terms of the documentation and the legal paper trail. Nurses have been removed from their role in critical thinking by not allowing them to make determinations as to whether a lab value, while defined as critical by hospital standards, is in fact not critical and represents a normal value for the patients. By not allowing the nurse to do the job they were trained for, it adds a whole lot of unnecessary work for the nurse and doctor and interrupts patient flow and care to the detriment of other patients. If she has to make a call, then wait for the response from me, document she waited for me, then document that she talked to me, then I must be pulled away from other patient care to answer the page that was not necessary in the first place and interrupt other patient encounters, it is the result of shifting responsibility, not patient safety. If it was patient safety, the nurse could make determinations that she is not allowed to make.

Next week I may have a poll about lawyers. You’ll need to stop by and see for yourself.

Deoxy, the suggestion CP can’t be caused by medical malpractice is simply not supported by the scientific literature. The notion that C-sections are non indicated to avoid birth injuries in many cases is a premise with which you could not find a single medical doctor to agree with you on.

1) you avoided the very specific case I was making about C-sections. Of course they are indicated in some cases (I was born by C-section).

2) your point about CP is a bald assertion on your part, and it is wrong.

If medical malpractice during birth were the cause of CP in any statistically significant way ,the massive increase in C-section births would have reduced the prevalence of CP. That has not happened.

Your suggestion that people just need to “look into it” and then they would agree with you is just anti-intellectual.

No, “just agree with me” is anti-intellectual. “I’m a doctor, so you should just believe me” is largely anti-intellectual. “Go check real data to verify my claims” is essentially the opposite - I’m NOT asking you to take my word for it.

But, just to get the point home (and with less than 2 minutes spent), I give you this:

Recent research has demonstrated that intrapartum asphyxia is not the most important cause, probably accounting for no more than 10 percent of all cases; rather, infections in the mother, even infections that are not easily detected, may triple the risk of the child developing the disorder, mainly as the result of the toxicity to the fetal brain of cytokines that are produced as part of the inflammatory response.[22]

That’s from the Wikipedia entry on cerebral palsy. Blaming doctors for CP at birth was essentially routine for quite some time (ask John Edwards), and no other evidence was necessary save the CP itself, despite the fact that the birth itself likely had nothing to do with it.

So, as I said, we have a well-documented case where doctors are doing more and more C-sections to remedy their liability, not a problem with the patient.

You want more opinions than just mine? Google “therpeutic radiation” (one deragotory catch-phrase I happen to remember seeing) for doctors talking about giving unnecessary scans of different types to cover their liability, even though the chances of it being medically useful are easily outweighed by the extra radiation exposure to the patient.