Navigating Malpractice in Medicine with Peter Anderson

Just kind of got to do all those clinical rotations. And then you see, maybe you're going to. First time you deliver a baby, you're just going to be like, oh, this is fantastic. This is what I want to do.

Hi, everybody, and welcome to the podcast. This is Generation. My name is Stephanie, and I'm joined here by my colleague, Dr. Sarah Davis, who's also my mother. And today we have a very special guest, Peter Anderson. Mr. Anderson, if you want to give yourself an introduction, that would be awesome.

Okay. Yes. And thank you so much for having me on your podcast. I very much appreciate it. My name is Peter Anderson. I'm a lawyer here in Dallas, and I've been a lawyer in Dallas for many years at this point, since 1996, so quite a while. I have my own small law firm, Kershaw, Anderson and King. The king component of it. Jennifer King, my law partner, she mostly defends hospitals and entities in lawsuits. That's. That's kind of her specialty. I defend mostly doctors either in lawsuits or in medical board disputes, also at times, disputes with hospitals. So doctors have rights under the hospital bylaws and policies and procedures. So sometimes we have hearings with hospitals on behalf of doctors around that. That circle of work includes defensive nurse practitioners, nurses, podiatrists, dentists. But, you know, 95% of it, when I talk about healthcare providers in my practice would actually be doctors, and that's remained true for many years at this point.

That's great. Well, welcome so much. We really appreciate you coming on. And I. I really wanted to have you on the podcast because I feel like it's funny even just talking about medical malpractice makes my palms sweat and, like, gives me anxiety. I'm fortunate enough, knock on wood, to have. Have never been involved in a lawsuit personally, but many, many of my colleagues have, and. And I think that there's a lot. For doctors, there's just a lot of misinformation about it. There's a lot of things that doctors think that they can do to prevent a lawsuit that I think is maybe not always correct. So I guess I would just like to know from your perspective, what are some of the myths that you think that doctors have about getting sued or how to protect themselves from a lawsuit as well?

Yeah, fair enough. And I will say I've had many doctors over the years who have been my clients, who over time became my friends who have told me, you know, hey, Pete, I really enjoyed getting to know you, but honestly, I hope to never talk to you again for. For the reasons you, you expressed. And by its very nature, whether it's a lawsuit or a medical board complaint, it is something to take seriously. And I always, I'm always more concerned, frankly, about my clients who don't take it as seriously. I think it, I think you should be appropriately concerned if you're put under oath and sworn to tell the truth, and everything you utter can and will be used against you in the court of law. Well, then once you understand that, then you should take it seriously. As somebody trained in representing healthcare providers in those cases, then the other thing I like to express is much like you try to take care of your patients and do a good job and you might wake up at 1:30 in the morning worried about them. That's the same thing as a lawyer I do about you, my client. You know, once you're my client, then that's what I worry about. I wake up and my wife could attest to this, you know, many times during the night to think about my cases and wonder about this expert or wonder about the upcoming deposition. And so I always tell my clients, you have a right to be involved if you're a named party. There's a sliding scale in terms of how involved people want to be. I learned long ago with having some very bright clients that if a client wants to talk to me frequently about the case, I'd be a fool not to listen to them. So I have clients who literally, you know, will reach out to me almost weekly about the case and want to talk about it. I have other clients who frankly, you know, they still get uncomfortable when I send them an update because they'd rather not it not be going on. They don't even want to click the email open. And I tell them that's fine too. You know, I'll let them know when I need them. And part of it is just taking the mystery out of the process like there is in medicine, in the law. There's kind of a systematic way that these cases progress through the court system. And so often in our initial meeting, I can kind of sit down and talk to them about, here's what to expect, here's when I'll need you, when I don't need you, I truly won't need you to be doing anything. I don't need you to be studying the chart every night at home. You know, there'll be a time and a place for that. But, you know, there's really typically only about three times in these cases that I truly need my client. And I'll let them know when I need them. And sometimes it's taking the mystery out of it, explaining how long the civil process can take in Texas, that literally, you know, okay, we've been sued, but truly, this case almost certainly won't get to trial for, you know, a year or two. That's just on a civil case. So in a civil case, we don't have a right to a speedy trial like you do in a criminal case. So all these cases can take a while. I mean, that's really no one doing anything wrong. It's just the system. But sometimes taking some of the mystery out of it helps my clients, you know, calm down about the process and feel better about it. The longer I do it, the more I understand. And I don't know that I understood immediately when I got started with this. But at this point, truly, a board complaint, a lawsuit, I've never seen it define any professional I've dealt with, whether doctor, nurse, it just doesn't. It truly doesn't. And I tell my clients that if you're doing right by your patients, if you have a good career and the trajectory of your career is going in the right direction, a lawsuit, a settlement, a board complaint that we deal with isn't going to derail that. Stop that. The finest doctors in this country and in this state have been sued or have had board complaints. They've probably even settled cases. And it just doesn't stop or define a doctor. The reality is we're all human. We all can be sued for various things, and it just doesn't tend to define people. You know, on the other hand, if you aren't doing things right, you know, prevailing in a lawsuit or prevailing in a board complaint isn't going to change your trajectory. You're still probably going to continue on that path. And so it just doesn't tend to define somebody's career in any way. And I think that's probably the biggest misconception I. I find with healthcare providers is they believe it's defining. It's just human nature that we all. And this is the same for me. We could help a thousand people, but if one person complains about us, guess what? We dwell on that one person. We don't dwell on the thousand we've helped. And that's the same as me. If I have a client who's concerned or upset about something, you know, I'm really uptight about that as opposed to, you know, reflecting on everyone we've helped. And so getting sued, getting a board complaint isn't a reason to throw everything you've done well for 20 years to get to that point. You know, I think being a smart person, it's never bad to reflect on, okay, could I have done something better? Could I have done something different? Could I have nipped this in the bud, you know, just by a little more time with the patient or whatever it is. All of that's good, all that's appropriate. But, you know, a lawsuit isn't a reason to change everything about your practice. But I do know often that's, you know, a knee jerk reaction. Sometimes healthcare providers have, I have plenty of healthcare providers tell me it's just not worth it. Then if, if this can happen to me, I just want out. I always say, slow down, slow down.

Just dial it, dial it down a little. I went to a risk management thing by my malpractice company and they, you know, they did this presentation for like an hour. And at the end, what I got out of it was they, they said, you know, basically the best way to avoid getting sued is be nice. Like, being nice to your patients. Having them like you, that seemed to be more of a factor than, I mean, obviously you can't be incompetent. But we sometimes get in this mode of we think, well, I need to order more tests. I need to, like, really prove that I have the right diagnosis. Even though I'm pretty sure I have the right diagnosis, but I've gotta, gotta prove it and be, you know, in case I ever get sued or something else or I've gotta think about all these different, like, really remote possibilities of a diagnosis, all those different things. But they, I kind of came out from this thing of like, okay, hey, be nice.

I mean, I don't think it's ever wrong to be nice. You know, I think that's not a, that's not a bad piece of risk management advice. I think the reality of it is you can be nice. You can do everything you can do in a certain circumstance and just if there's a certain complication, if we're talking about a surgical case, if there's at least allegedly a delay in diagnosing or appreciating a condition a patient might have, then anyone, whether they were nice or not nice, could certainly be sued in a case. But I think, I mean, I do think it's true that being courteous, being attentive, you know, I worry about all this in today's world. This is so different than when I started doing what I'm doing. There's so many more barriers, I think, in the way between A doctor and a patient than there were 30 years ago, 25 years ago, 20 years ago. And so I think the opportunity for the doctor to be attentive, to be kind, to really hear a patient out, it's harder now than it was before for a whole host of reasons. Building that bond where the doctor truly is revered by the patient and the whole community knows the doctor. I mean, that's just not quite the way it is anymore. Doctors are so busy. There's so many demands, so many boxes to check if you're talking about the doctor getting reimbursed for the work they're doing. You know, I've been to plenty of doctor visits in my personal life, like with my kids, where like, literally the doctor will walk in the, in the exam room and just like, stare at their iPad and fill out information on the iPad, and they're not doing anything wrong. Like, I know they need to capture that information, but I think it's harder nowadays than it was 20, 20, 25 years ago to establish that rapport. You know, family practice doctors used to follow patients and see them actually in the hospital. Now, clearly there's a whole host of folks that take care of people in the hospital. It's not going to be your pcp. Almost certainly you have doctors who appropriately, you know, do their knee surgery. But guess what? After the knee surgery, it's the care extender. It's the PA or the nurse practitioner seeing the patient thereafter. And often, if something's going wrong with surgery, guess what? Those are the visits where something might arise. And so again, not to say that those people can't be absolutely appropriate caregivers. It's just that doctor spending that time with the patient, oftentimes that's not happening anymore. So I just think that's harder.

What's the most typical case that you see? And how can I, as a aspiring medical professional, avoid having to call you?

I would say, if you don't, if you really want to heighten your chances of not talking to defense attorney on healthcare liability claims, I would say, you know, there are certain specialties that certainly get sued more than others. And it's unfair, but it's true. So don't be a. Don't be an obstetrician, because no matter what, I mean, there's still some mystery behind the miracle of birth, and it's still a bit of a miracle. And even when people do everything they can, it doesn't always turn out, you know, perfectly. And so we defend a great deal of obstetrical cases. Either with allegations of shoulder dystocia or hypoxic ischemic encephalopathy. It's a very, very common lawsuit to be filed. And again, not to say doctors always get it all right. So certainly there can be times where somebody does something wrong, but just there's so many things out of the obstetrician's control when you're talking about is this baby going to be born with problems or not? And so we disproportionately defend obstetricians. We disproportionately probably represent surgeons. So if you're talking neurosurgery, orthopedic surgery, you know, and then you get into the specialties that kind of, I guess you call them procedures. So you're talking about dermatologists who are doing procedures, you're talking about plastic surgeons. I think we defend less the internal medicine doctor. You can still have a case there of failure to diagnose something. So, big picture, Stephanie, it really depends on your specialty. I mean, certain specialties. Almost 30 years of doing this, I almost never represent. Like, I probably represented an endocrinologist, but I would have to really go back and think about it. Rheumatologists, very, very rarely ER doctors. So.

Yeah, what about er? I thought that they were supposed to be a little more likely to get sued because they don't have a longitudinal relationship with the patient.

Yes. And they're dealing with trauma. So, like, you know, it's hard to triage things. They were sued a lot. The tort reform in Texas made it harder to sue ER doctors. They apparently had a better lobby than. Than other groups of doctors. And so to sue an ER doctor in Texas, you have to prove willful and wanton negligence. And that's a difficult standard. It almost akin to they really, you know, understood there was a problem, just didn't care. And that's. That's really hard to establish. And so ER doctors after that tort reform, they're not sued nearly as much. And a lot of people would say for the better, because this is such a difficult job. And as long as Texas maintains that standard for suing an ER doctor, then ER doctors aren't being sued nearly as much as they once were. But otherwise they would be because they're, you know, there's just so many things happening in an er. The main thing that's out of your control, and for better or worse as a doctor is simply whether or not there's harm. Because like any potential personal injury case or breach of contract case, what Lawyers look at who are evaluating whether to take the case is not necessarily whether there was an egregious wrong done. But, you know, by golly, if I prove that wrong, are there damages? You know, can I recover a good deal of money damages? And if I can, it might be worth it to go back and retrospectively and in hindsight try to figure out, did somebody do something wrong or could somebody have done something? One more thing. You know, I think it's always very unfair. And keep in mind, I'm always on the defense side, so I'm a little biased, but I think it's a little unfair because we literally go back, you know, in hindsight, retrospectively, and sometimes even in slow motion and nitpick. Every order made, every test ordered, you know, okay, you did this in an hour, but, you know, couldn't this have been done in a half hour? And if it had been done in a half hour, you got that CT back in a half hour, then you could have gotten the patient to surgery a half hour earlier. Could all that have made a difference? Well, no one knows. Probably not, but. No one knows. But the key is, and this is really why it's never truly. I mean, there are some exceptions to this, but a medical malpractice lawsuit is really almost never about the doctor. The doctors always feel like it is, and I don't blame them for feeling that way. But it's really about, is there a claim that has the potential for damages? And if there's not, no matter the mistake, a good attorney is never going to file that lawsuit because there's no recovery to be had. It says medical malpractice cases are expensive for plaintiffs to file and pursue. They have to hire at least one expert or two. And so they need to make sure, if I do that, can I recover enough money damages, potentially, that it makes it worthwhile. And that's the part that, you know, is really out of your hands. The tort reform in. In Texas alters how people look at that. I don't know how much you know about that, Stephanie.

Yeah, I. What's a TOR form? I don't know exactly what it is.

Yeah, I remember when the whole thing was, like, going through, but. Yeah. Can you just kind of back up and explain that a little bit more?

Yeah, so I want to say it was in 2003. It's been around for a while now. And tort reform, tort, I guess, means a personal injury. I mean, I may not even be defining this. Right. But. But it's probably like a personal injury lawsuit that could be a tort. And the idea in Texas was, is that there was a crisis. And Sarah, you may remember if you know what was going on at that time, but the concept was there were so many medical malpractice lawsuits at the time that it had a chilling effect on doctors coming to Texas. And so again, I was a pretty young lawyer at the time, so I didn't know all the details. But the idea was there were parts of this state where it was hard to even get doctors to go because of so many lawsuits being filed against them. It was hard for those doctors to even get insurance. A lot of the insurance companies who insured doctors had left the state. And so there was this idea that there was kind of a crisis in Texas. So they wanted tort reform and they enacted some things and they created what we call chapter 74, which is in the Texas Civil Practice and Remedies Code. It's the law that governs suing a doctor in Texas. So chapter 74 of the Texas Civil Practice and Remedies Code was made at that time and really the, the headlines related to these caps that were put in place. So if you sue a doctor in Texas, if you sue 1 or 10, it doesn't matter. 1 or 10, it could be 10, it could be 1. But for those healthcare providers, an individual healthcare provider, non economic damages are capped at $250,000 and non economic damages are pain and suffering in the past or in the future. And that's a huge, I mean it's a huge cap and a huge detriment for anyone just frivolously filing such a case because you're really capped down like, you know, before that. A jury could award $10 million in pain and suffering, you know, at a jury can still award that in Texas in the verdict, but the judgment the judge would take and apply the cap and bring it down to the 250amount. And so you can pick up another $250,000 cap if you sue the hospital. And if you sue two hospitals, if you had a case with a hospital and let's say a nursing home or a hospital in an acute care center, you could have a 250 cap non economic for the hospital, a 250 cap non economic for the acute care center, and a 250 cap for, you know, one or two or three or four doctors that you've sued. But, but if you think about what that means, what that means is that plaintiff attorneys can't sue a doctor or a hospital looking for A big pain and suffering award they have to look for. Does this case provide me economic damages? And economic damages are largely in two categories. One is medical expense, past and in the future. That's what we're always looking at in these cases. What are the medical expenses in the past? What could they be in the future? And so a big damage case could be one where somebody has a stroke or something or an anoxic brain injury, but they're still alive and they need attendant care for the next four years, 40 years, whatever it is. And so that could really build your damage model. And that's not capped those that economic loss is not capped versus if you went to the hospital. And this, to me this is all kind of unfair because it doesn't really align with anything rational. But like if you went to the hospital and within a day of arriving at the hospital, had a blood clot and died in the hospital, your medical expenses would basically be zero and you would be dead. So you wouldn't have future medical expense. So for that person there, you're really at that 250 cap, the non economic 250 cap. There's, I mean you're gonna have funeral and burial, but there's probably very little medical. There's certainly not going to be future medical. And so and on top of medical, the other economic loss, as you would guess, and it makes sense, is lost wages or loss of earning capacity there. You can recover as well. And it just depends. And again, that can be a little unfair. So if somebody is injured or dies who's a high wage earner, that would be more attractive obviously to a plaintiff attorney evaluating the case than somebody who had retired or was, was staying at home with the kids. It doesn't make much sense. But because of the cap we put in place on non economic, then you really have to study what is the economic loss there is overriding all of this. Not to make this overly complicated, maybe it already is.

No, it makes sense. This actually makes a lot of sense.

Yeah.

Okay. The, the overriding all of this is on a death case in Texas there is a healthcare liability death cap which fluctuates with the consumer price index, but it's currently at around 2.5 million. And so, and that's inclusive of everything other than medical expense. And so in a death case in Texas where somebody died, obviously it's a death case, so somebody's died then in that scenario the total amount can't be more than 2.5 million and that's inclusive of even exemplary damages. So like punitive damages. The only thing that's not included in that is medical expenses. So there might be, let's say there's $800,000 in past medical expense. That could be on top of the $2.5 million. And I say 2.5. That's a guess. It's right around 2.5 million. It continues to, it grows with the consumer price index. But those are the caps that came into place, I want to say, in 2003. I was a much younger attorney then. They're still in place. There's been talk, I don't know about serious talk of raising slightly the non economic cap of the 250. I would say the, the tort reform and the caps, I think had their intended effect. It made people think twice probably about filing a suit. It made it harder to sue doctors and recover money damages. In Texas with that tort reform, maybe it made it so more doctors wanted to come to Texas. A lot of your neighboring states, Stephanie, don't have this kind of tort reform like in Oklahoma or New Mexico, at least because of that tort reform. And there'd be plenty of other reasons. People might not love it, but because of the tort reform, it's a good place, I guess, to be a doctor and have that protection, which in some states you would not have.

I do recall it affected my malpractice rates because I had started my own practice by that time and my rates were like going up, up, up every year, like, and it was like doubling. It was, it was getting really high. And they did actually go down and then really stayed much lower, at least for me. And I remember that being like that was, that was pretty, you know, kind of life altering that, you know, I have to. These exorbitant fees.

I saw enough of it on the front end before the tort reform to know there were more frivolous cases filed. Then there were more cases, for better or worse. And again, people have different, depending on your thoughts on all this. I mean, people have different ideas on it. But back then there were more nursing home cases, you know, in some really big awards in Texas, you know, grandpa's in the nursing home, he's 90 years old, he develops some bed sores because he's not doing well, his health is not doing well anyway. The family or the facility take pictures of his bedsores. And now without the cap of non economic damages, you know, with the, with the tort reform, that case is going to cap out at about 250,000 because there's not going to be economic loss, there's not going to be future medical. Assuming then if grandpa dies at the nursing home, there's not going to be future medical, there's not lost wages. That case is worth, you know, it caps out at 250,000. But as you would guess, before that cap, you know, plaintiff attorneys were asking juries for millions of dollars on those cases for the pain and suffering. And we're going to show the juries these pictures and you better pay us a lot of money or else. And so tor form, you know, attacked that type of case. I think a misconception sometimes is, well, they're all capped at like 250,000 or something. But as long as there's an injury, not a death, which again, doesn't always make much sense, but if there's an injury, not a death, and somebody needs future care, like an infant on a baby case, well, then, you know, there's really no cap on that.

Yeah, I wanted to just kind of shift gears and talk about texting with patients or even texting doctors texting each other about patients. And I know that, you know, we, for the longest time, we were told, don't do it, don't ever do it. You know, if you want to send a message to a patient, you got to send a message to the patient portal, and then they got to sign into the portal and then you send them their message. And then I read something that like 50% of the patients never, ever log into the portal and get the messages that the doctor's offices are sending to them. And so to me, that just. I'm like, well, that's stupid. I'm not going to send a patient a message if there's only 50% chance that they're even going to get the message. So I do sometimes text with my patients. I tell them ahead of time, you know, we're not going to put anything personal in here at that type of thing. Sometimes they text me a lot of information, but it does. It is a very efficient way of communicating with. With patients and with other doctors. But what are your thoughts about texting?

I mean, I think, like, we all do. I think it's a fact of life if texting, if there becomes a different way to communicate, at some point, maybe people won't. But the reality is, in our cases now, there's not always, but. But not uncommon. There are text messages that are relevant either between the healthcare provider and the patient or, as you mentioned, two healthcare providers. And you know, my main advice on that would be if it's for healthcare, then I would just do it with an eye towards is part of the medical record, be professional. What I find is people sometimes say things in text that they, you know, they treat texts and I mean, I'm guilty of the same thing. They treat text like you're talking to somebody as opposed to the formality of what you might put in the medical record. So I think it's going to continue. I see it in a great deal of my cases. There was a time I did HIPAA compliant stuff. I don't anymore whether the HIPAA police would be offended by you texting with a patient or a colleague. I don't know that I know the answer right now to that. To me in what the work I do, that's not really the concern. The concern is just, you know, is somebody creating a permanent record at times, not, you know, not always in a completely professional way just because people tend to let their guard down a little bit or just, I mean, often we're texting people rapidly as we're walking to our car and it's not really, you know, fully thought out. I mean, that's the way of life right now. But I think it's going to continue in patients too. More and more doctors give out, particularly surgeons, I see give out their cell phone number because they want to be connected, they want to know if there's an issue. But just, you know, if you do that just then handle it appropriately. Keep in mind one day that text message may be a blow up, you know, in front of the jury. And so just handle it appropriately. You know, there was a time you needed a video camera. If I wanted to video the birth of my kids, I literally lugged in a video camera into at Baylor, the anesthesiologist helped me record that. But, you know, nowadays obviously we all carry recording devices, video recording devices, a way to take pictures. And so, you know, it's very common in these cases that doctors are getting recorded and not know it, conversations are being recorded and not know it. I mean, you know, I would just say, you know, be aware of that. Very, very common that patients are beginning to record. You know, somebody is concerned about their outcome of their surgery. And so from that point on, you know, when the doctor rounds on them, they're recording those conversations.

Do you think that's not legal?

Yeah, it is legal in Texas. So again, different states have different rules on this, but in Texas the law is as long as one party to the communication knows it's being recorded, then it's fair to record it. It's not fair to record. Like, if somebody recorded a conversation between two people and neither of them were the ones record. You can't do that. But as long as one of the persons in the communication, and as long as both of you are in Texas, because different states have different laws on this. But in Texas, yes, you could record. You could record anyone, too, Stephanie, as long as you knew as a.

But as a doctor, I can't record my patient, though, right?

I mean, I don't know that you couldn't. I don't. I also don't know that you'd want to go to the trouble of recording your patient. You know, just. I mean, it'd be a lot of work. But, I mean, I guess there are more and more scribes walking around. I don't know how much y' all might know better than I do. How much they're recording and then typing later, or are they literally just creating the note as they go?

Well, also, like, now there's AI so you go into the room and you just record. And then you. And I didn't even know if that was legal because you go in, you record, and then an AI just writes your whole. Whole.

No.

And I was like. I didn't know if. What the legality behind that is.

I mean, are they having you do that?

There are some companies that do it, yeah. And people are talking about using it more and more.

So I'm not aware. I mean, if there's some doctor ethical thing that says you can't record a patient, I don't know, y' all would maybe know that better than me. I'm not aware of anything that would say, a doctor cannot record a patient. I can tell you. I don't think I've ever. It's never been part of my advice. You know, if a doctor called me and said, hey, I'm kind of skeptical of this guy, what do you think I should do? I've never said, well, go. Tell you what, get him on the phone and record the whole thing. But, you know, I don't. I think you probably could. I'm not. Unless there's some ethical thing that I don't know about. Even as a lawyer, I can do that, though. And again, I don't tend to do that, but. But I can. And that's the law in Texas. I will tell you most of that. I. I mean, I can't really think of a circumstance where that helps the patient's case. It seems like I'm usually kind of proud of my client for, like, they usually tell people the same stuff when they're being secretly recorded, as they would say in their deposition. Like, they normally give them, you know, the best medical advice they can or the best explanation they can for what's going on. And so I don't really find that it's very meaningful to the cases, but it is happening a lot. So, yeah.

Yeah, that's. No, that's kind. I. I remember seeing one of these things. It was a doctor group discussing this, and somebody said, oh, yeah. You know, patients are saying, hey, can I record this interview? And a bunch of the doctors were saying, oh, yeah. When they say that, I say, no, you can't do it. And these were people in various states, and I thought that was so strange. Why would you say, no, you can't record it? That just seems like you're hiding something. I don't know.

And they don't need your permission. I think it's more courteous to ask somebody, you know, hey, look, we're. We are confused as to what's going on with Mom. I think it would help if we recorded this. I can also then play it to, you know, Aunt so and so in Syracuse who's a doctor who might help us figure this out, you know? So, like, I mean, I think it. I think it's courteous to ask people, you know, they certainly don't need to ask you. So.

Yeah, I prefer to make a recording, and that way you don't have to talk to the five different family members at five different times. Right?

Yes. Yes.

Let's just record it. Go ahead. Send it out to. You know, let's make a video here, and we'll. I'll answer all the questions in the group chat, and then you can send it all. And then. Then everybody's not calling me, you know, asking for an individual consult about Mom. So, yeah, I mean, to me, it seems. It seems fine, but I don't know, to guess. Some people, again, get a little. Get a little paranoid on things.

I had one question about. In regards to, like, the $250,000 cap. Like, if I got injured and I, like, in one instance, and I sued a doctor, but then in another instance, I sued another doctor. Like, is the250,000 cap for each case?

Yeah. Yes, you'd have a new. You'd have a new cap for your new case, but in that one case, it. Let's say you wanted to sue the dermatologist and the pathologist. So you, for some reason, went to a dermatologist, and they. You didn't like the way they removed a skin tag or something. They sent it to the pathologist. You think the pathologist got the pathology wrong? So you wanted to sue them both in the same case? In that case, those two people would share the 250 cap.

Okay, gotcha.

Yeah, but if you sued them, if you had two different claims against different people, then yes. Yeah, yeah.

Oh, I was just kind of shifting gears again. What do you do when, like I'm seeing a brand new patient and they are really, really angry with their previous doctor and they have lots of questions for me about what that doctor did and that type of stuff? I mean, I will say usually I try not to comment too much on any of that, but I mean, I have seen, sometimes I saw one time this PA actually did this in the chart. She wrote, oh, this patient should have had this procedure done instead of what was done. And I was like, did you really need to put that in a chart? So I don't know, what, what's your advice? When somebody comes in, they're really angry at this previous doctor or somebody, you know, or a specialist or something else.

I mean, within the bounds of honesty. So I would never ask somebody to lie to cover up what went on before them. But usually the next doctor who's seeing a patient and the patient's upset with the first doctor or the three doctors before, they usually don't have the full story. They don't have all the medical records. And, you know, I would just caution them because as you would guess, the shoe could be on the other foot the next time, you know. So I do see a good number of lawsuits instigated by subtreat what I would describe, as I would call them subsequent treating physicians or doctors, healthcare providers making comments or acting negative towards what went on before them. Boy, I wish I'd seen this three days before. I might have been able to do something about it, you know. Okay, well, you really don't know because you didn't see the patient three days before. But if you chart that, then one day you might not like it, but your deposition's probably going to be taken. Who might have encouraged these other doctors to be sued, whether they should have been or not, you know. So I would always encourage people to take a deep breath, you know, understand that the next time the shoe may be on the other foot, that, you know, they may be seeing the patient, a patient after this guy. But there is kind of a mindset that the net. I have so many cases where like, the subsequent treating surgeon is like the hero, like everything they did is wonderful and somehow, you know, everything wrong is, is, you know, put on the original doctor and I find it kind of short sighted and just kind of needless in a lot of circumstances. And again, it doesn't mean like if somebody really did screw something up and you can tell it well, then I'm, I'm all for honesty with patients and whatnot, but more often than not, it's people with just a sliver of the information. And keep in mind too, I mean, as ridiculous as it is, when you just take that stupid history, you take it from the discharge before, now the patient's coming to you and you're just copying that discharge. I mean, it makes it seem as though even if that discharge is totally wrong, even if like the diagnosis listed there is totally in error, but when you just keep reiterating it, and I have many cases like this where information just gets reiterated over and over with no one sitting down and saying, well, wait a minute, that's not, that's not what's going on. But when you do that, it starts to look like that really is what's going on, you know, And I, I see that a lot. I see particularly with the advent of, obviously it's wonderful in many ways, but the electronic medical record, just auto filling hospital charts that used to be 350 pages now might get sent to me and they're 2,000 pages and there's just page after page of garbage without anyone intelligently analyzing what information is getting carried over from the day before. I will say nurses are probably, in my opinion, more guilty of this than the doctors, but the doctors are guilty of it too, in many cases. You know, even though doctor charts and hospital charts were more difficult to read 20 years ago, 25 years ago when it was written, at least when somebody took the time, when a nurse took the time to write a note, she was actually writing down what was important to her. You know, it wasn't just carried over from, you know, neurovascular check two plus. And like now there's this page after page of this garbage. And it's hard to know sometimes is she really checking, you know, and I know in some cases based on what's going, what goes on later, she couldn't have been checking. But it's just boxes and boxes of information of sometimes nonsense. And again, it's just having a lot to do and a lot of paperwork to fill out and, and I think those electronic charts are created that way. So it's almost like you almost have to Fight your way through it to add anything original at times. And so it makes it harder. It makes our cases harder to defend. It really does. As opposed to when people were taking the time to write down, even if you had trouble deciphering it, if. When they were writing down what they really thought, it was very helpful, you know.

Yeah, a lot more. Yeah, a lot more concise. Yeah. And I think that that that happens, like with the physical exam when I'm doing a note, and then it's very easy to just click and autofill the same exact physical exam that I did the last time. But, you know, a lot of times you're like, okay, that time the person was here for a full physical, and I did everything. But this time they were just here for, you know, some quick thing. And, no, I didn't examine their abdomen and all of these other things. And so. But it's. You do have to, like, stop yourself and you're like, oh, no, just don't click that whole thing. Just click this. These parts, and it's. It's more cumbersome.

Yeah, no, I do see that all the time. I'm so used to looking at stuff like that that now I usually ask my client, like, okay, you were seeing him or her for the abdomen, so, like, it makes sense to me. You would have done a focus exam on their abdomen. I get that. But, like, here you have this whole physical exam. You have all these other things filled in.

Like, did you really not look in their ears?

Nor should you have? But. But it actually filled out that you did. You know, I mean, I understand the benefit of the electronic record. I guess at some point maybe it, like, connects everything up. And so now you taking care of a patient in Dallas, you can log in at some point in the future, and you'll even see their records from Ohio, and that might help you understand. Okay, wait, they said they were allergic to this medication two years ago in Ohio. I didn't. They didn't tell me that. I'm glad I see that here. I won't prescribe this medication, whatever it is. Like, there's certainly some value, but, yeah, it makes it harder in a lot of these.

It makes it so much more to sift through that. It's very. Yeah, it's just like. And like you said, it's just a bunch of garbage most of the time. And a lot of stuff that just makes it harder to find the pearls of actual information.

Yes. Like, what is an original thought? What is really going on with this patient? And, you know, doctors Inherently look at some of that, and they can understand what the other doctor is doing because they understand all this. It's harder. It's harder for me looking at it, to see through it and understand all that, you know.

Yeah. And like you said, like, copying an error. What? I knew somebody who. Somebody in her chart years ago wrote that she was a smoker, and she has never been a smoker. And it has carried over over and over and over again. When she goes to see different special specialists, they say, oh, well, you were smokers. I was never a smoker, and she hates smokers. And so it just makes her crazy. But, yeah, I mean, it's very easy when there's one error in there and then everybody keeps, like, copying and pasting that.

I think all this is so important to talk about. Especially, like, this is not something that they teach in medical education, like, at all. Like, we, you know, this is something that it's like, as you're saying at the beginning of the episode, just like, kind of pulling back the curtain a little bit and actually being able to, like, talk about this transparently rather than it being something that is, like, behind closed doors and we don't want to talk about. Like, it's good to, like, just be proactive about it and be able to discuss this openly. So I've definitely learned a lot. Do you have any, like, closing thoughts and. Or anything else that you feel like is important to say or any pieces.

Of advice you would give to a young physician?

Yeah, yeah. I mean, to a young physician, I would say, you know, I would not spend your time focused on this. I think statistically, depending on what specialty field you go into, I mean, certainly you could face a lawsuit at some point. My point would be it doesn't make or break or define you in any way. More and more medical board complaints are filed in Texas. And one thing for doctors to know is that typically your professional malpractice insurance coverage has an endorsement that covers the defense of those matters. Or sometimes we'll have fights with, like, Blue Cross, Blue Shield or like, an insurance company. They'll do a quality assurance review. A patient will complain to Blue Cross saying, hey, I shouldn't have to pay for this. The doctor was a half hour late for the appointment and, you know, didn't even really see me or whatever, and then will respond. And so your malpractice coverage typically has an endorsement that covers that. And some doctors don't know that and honestly, anymore, because of tort reform in Texas, your odds of facing some sort of Administrative headache, like a board complaint, like a fight with an insurance company, like a fight with a hospital is probably greater than, you know, facing a lawsuit. And I still talk to doctors at this time who don't understand they have that coverage. And so that's something to know. The medical board process is a whole nother. I mean, that could be an entire discussion in of itself. But it's good to know you do have that coverage. That's something I'd say.

Awesome. Good. I don't think I realized that. Yeah. Yeah. Well, there you go.

There you go. Yeah. So what kind of doctor are you thinking about being? Stephanie? Do you know yet?

I kind of want to do family. I think she's just saying that because.

I'm on the call.

Okay. Right, right.

I even realized, not only because of malpractice, I don't want to do ob gyn, but we're currently doing, like, embryonic development in school right now, and it's very confusing. And I'm like. And even today, I was like, I'm not going to be an ob GYN because this is not my strong suit. So this is another reason why I'm not going to do that.

Right, right.

Yeah.

Well, you'll make, you know, and you just kind of got to do all those clinical rotations, and then you see, maybe you're going to. First time you deliver a baby, you're just going to be like, oh, this is fantastic. This is what I want to do. I'll just keep Peter on. Steve Dial.

Back in the day, family practice used to deliver babies. I mean, when I first started out doing this, I'd have to get out of the city to do this, because it wasn't going on in Dallas or Fort Worth. But when I'd head out to other communities, more rural communities, family practice doctors were still delivering fairly routinely.

They do, like, in Kansas. They do a lot. That's where I went to medical school. And so even family practice doctors doing C sections and even things like appendectomies and lots of stuff, because they're just out in the middle of nowhere. There's nowhere else to do it. So they just get trained and, well, they got to do it. Yeah, not here in Dallas.

No, not here. I guess certified midwives, I think, are delivering. Okay, well, do y' all have any last questions or comments or concerns?

I don't think so. I like what you say about. I think that that's very good for doctors to hear about. You know, this is not a defining thing of your career. I think that there is a lot of like, blame and shame and just it's, you know, it's such an emotional thing to get sued that, or have a board complaint, any of that stuff that I think it's important to kind of stress that, that this. And probably doctors should be told that more in, in medical school and in training, you know, if this thing happens, it's going to be okay.

Yeah, right. You'll come out the other side, you know, depending on the personality. No matter how many times I say, don't worry about it, let me fret about it, that's my job. You know, just like you worry about your patients, I worry about you. And that's true. And so, you know, you try to tell people that. And I will say most of my clients listen to that advice. I think, you know, just depending on personalities, it's harder for some people to just step away and not worry about it. But you can. And it's not a defining issue in your life. It really isn't. It's not a defining issue in your, in terms of how great a professional you are. The best doctors in America will have been sued or will have faced a complaint. And it's just, it's not a defining moment. Again, it doesn't, it doesn't mean you should ignore it. You should take it seriously. If you get a notice of claim letter, you should get it in the hands of professionals like your insurance people, like. So you should never stick your head in the sand and ignore it. And sometimes there are lessons to be learned. You know, even if, even if the case we think is defensible, there might be a thing or two. You're like, okay, yeah, I wish, you know, I wish in retrospect I had called up the radiologist after I got that report and just asked him what the heck he meant here or whatever it is. So there can be learning moments in it. But yeah, it's not a career altering or defining moment by any stretch. And it typically has little to do with the doctor themselves. Themselves. Even though all my clients think it's all about, you know, like, is there something I could have done different? Well, no, there's not. Because in this case, you know, they're claiming a lot of damages and that's really what caused them to decide to file this suit. Had you been nicer, it wouldn't have mattered. Again, it's still better to be nice. I mean, you, you really truly probably can, you know, avoid some situations by just being attentive, by listening, by answering questions. I mean, I think that's always good advice. And then even if you are sued, at least you've done the right thing, you know? So, yeah.

Yeah, I think that's all, like, very important. Thank you so much for being here. So you know where to find us @Generations MD on Instagram, @Generations MD on tick tock. And if you have any questions or if you're interested in being a guest on the podcast, you can email us@ask generationsmdmail.com thanks for listening and we'll see you next week.

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