Dr. Lung: Oh, much worse! I just sat in on my friend’s malpractice trial, and it was all theatrics. There was no substance at all. The expert witness—a cardiologist from a very famous hospital—brought in an EKG complex, which is usually three to four millimeters long, and magnified it to four feet long, and kept on saying “The doctor missed this!” No doctor would have seen that—we don’t see it that magnified! The patient died three years after having that cardiogram—and the doctor said he died because this was missed three years earlier. My friend lost the case.
Dr. Heart1: I don’t think about malpractice. The most important thing that a doctor can do to prevent malpractice is to have a good doctor-patient relationship. The doctor who has the good doctor-patient relationship but makes a few mistakes is less likely to get sued than the doctor who does not have a good relationship with the patient and makes a mistake once in a blue moon. The doctor-patient relationship has been shown time and again to be the most important thing.
Dr. Heart2: Overall, malpractice has made good doctors worse rather than bad doctors better because of the fear that you’re missing something and you may be sued for missing a diagnosis. So someone has back pain. You could diagnose a stiff neck with 95 percent certainty, but there’s a 5 percent chance that he could have cancer or a serious infection, and instead of going with your gut, you order a bunch of extensive tests to rule out the improbable.
“I dropped a baby once. The nurses were calling me into different rooms, and the baby just fell out of my arms and onto the floor.”
But does extra testing do any real harm to the patient?
Dr. Heart2: Sure. Procedures have their own risks: unnecessary cardiac catheterization, unnecessary downstream testing when you pick up something that’s not important on a test that you shouldn’t have ordered in the first place. Then you go chasing incidental findings, again, further fear of being sued. So, testing breeds more testing. And it can be a vicious cycle.
What could be changed about the health-care system to better help patients?
Dr. Baby: Universal health care.
Dr. Heart1: But you’re talking from a public-health perspective. If you are an individual … if your dad is sick and he has access to insurance and money, do you want him to live in the country with universal health care or our kind of health care? Our kind of health care.
Dr. Virus: The only place I’d defend American care is for the catastrophically ill, where there are miraculous outcomes still.
Dr. Heart2: If you’re talking about separating Siamese twins, yes, I’d want to do it in the United States rather than anywhere else in the world. When money is not an issue, I would still contend that we have the worst, because we get overtested. We chase incidental diagnoses that might not affect the patient’s health.
Dr. Virus: With universal, you’d get the same kind of mediocre shittiness that you’d get in all other kinds of standardized approaches. But for millions of people, that would be a big upgrade.