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.