Home | Biography | Forty-Eight X | Future Books | Stories | Credits | Contact

The Unkindest Cut

The patient had cut his hand on broken glass. I glanced at the wound. It didn't look serious, half an inch long, just four or five stitches would close it. But I left further examination and repair until later. I ordered an x-ray of the hand and waited.

Nearly a decade earlier, another man had suffered a small glass cut not unlike the one I've just described. He had punched a window in a fit of anger. The wound was less than half an inch long, on his wrist, near his palm. It appeared superficial. He felt nothing uncomfortable in the wound when I examined it. He moved his wrist and fingers without difficulty. He had no numbness. And I sutured his cut. It healed well, his stitches came out a week later, and he went back to work.

A month later, while lifting a box at work, he felt a sharp pain in his wrist. He went to another doctor, x-rays were taken, and a small piece of glass was seen, lodged deep to the old wound. The wound was re-opened, the glass removed, the cut repaired, and the patient sued.

Though this patient resumed work and had no significant problem with his hand except for an additional scar, my attorney advised me to settle, to pay the patient $10,000 for his "pain and suffering." It was unfortunate the patient had to undergo a surgery. But I did not feel guilty. Sometimes things are missed despite the best of efforts. I felt I had used good judgement. But regardless, my attorney advised me that there was a risk that a jury might find a doctor liable for failing to remove a foreign body, like a piece of glass. I took his advise and settled. My insurance carrier paid. And I learned a lesson. Almost everyone that comes into my emergency room now with a cut from broken glass gets an x-ray. Even if the patient doesn't feel anything in his wound, even if I can't feel anything, or find anything after exploring the wound. Even if he has no deficits, no problems with movement or feeling. I still order an x-ray. Afterall, there is always that faint possibility that some small piece of glass could still be lodged in the wound.

Since that incident many years ago, I have ordered hundreds of x-rays, at a cost of tens of thousands of dollars. I don't want to miss any more glass in any more wounds. I don't want to be sued again.

And that's a lot of what's wrong with medicine nowadays. Clinical judgement is of minimal importance. The public expects a perfect outcome every time. Even though the medical odds on a particular ailment might be one-in-a-million, we'll order the x-rays, the blood tests, the CAT scans, so as not to miss that one-in-a-million. And somebody has to pay.

My new patient with the cut hand had no glass visible on x-ray. I sewed him up. He went home pleased. His insurance paid one hundred percent. The malpractice insurance for every patient seen is about $6.00. And everybody pays.