| | |  Health & Beauty | December 2008 
Whether to Save a Stranger's Life
 Nancy R. Terry - Medscape Family Medicine
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If a stranger collapses on the street, would you come to his or her aid? That question was posed by a doctor of internal medicine on Medscape's Physician Connect. "Admittedly," says the doctor, "the ethical first response would be to help the person. However, in this litigious era, where a saved person can come back and file a suit, is it worth your liability?"
The resulting discussion, which has been active since July, is replete with accounts of physicians' heroic efforts to save lives. Equally numerous are the admissions that such actions can be met with litigation. The threat of malpractice lawsuits causes physicians to hesitate before coming to a stranger's aid.
Says one MPC contributor, "Certain things would rouse almost all of us to action (think choking baby), but a strong sense of self-preservation might make most of us hang back in other situations (think breech presenting baby outside the hospital). Would you rush in to help with that at the mall? Good luck."
An anesthesiologist, who once came to the rescue of a man and his choking infant, said, "There was a panicked father with a child in potential trouble, so I instinctively responded. After many years and many gray hairs, I think that I would hesitate at least for a moment were the same thing to happen again."
"How often can you kick even the most loyal dog before he will run and hide?" asks a general surgeon. "No one here says it's good that we have to consider not helping (or helping and remaining anonymous as I gather most of us would try to do), and the feeling I get from the discussion is that there is a fair amount of guilt associated with that, but we don't do our profession, our patients, or our families (to whom we have a profound responsibility) any good if we have to leave practice due to litigation."
In most states, Good Samaritan laws protect the laymen and physicians who render good-faith rescue efforts to a person who is stricken in a public place; however, the circumstances covered by each law can vary from state to state. "Just because there is a Good Samaritan law does not protect you from a lawsuit," says an MPC contributor. "It [the case] may eventually be thrown out, but you will still have to hire a lawyer, go to court, put up with continuances, etc. It will cost you."
Some contributors are willing to come to the aid of strangers but are careful not to identify themselves as doctors. Says one physician, "It's wrong just to leave someone to die. So do what you can, and summon EMS. Let them take the credit (or blame)."
"On the street, I agree with not telling anyone you are a physician," says another MPC contributor. "Assess and see what you can do—short of mouth-to-mouth contact. I go so far as to never make reservations as 'doctor.' When I practiced in New York City, I didn't apply for 'MD' plates, which could have helped me park. I only intervene anonymously outside my practice environment, and I would not disclose my profession."
Malpractice suits do not constitute the only risk incurred when a doctor comes to a stranger's aid. In helping persons at high risk of contagious diseases, the physician may endanger his or her own health. One family medicine physician stopped at the scene of a head-on collision and found one of the drivers in respiratory distress. The physician climbed through the windshield and, in the process, cut his hands. He stabilized the driver and tended to his multiple facial lacerations until the EMS arrived. Later, the emergency department doctor called to inform the physician that the driver had AIDS. Did the physician have any regrets? "Only while taking the antivirals -- they made me sick -- and living in fear of contracting HIV. For a while I thought I'd never do something like that again. After I got a negative HIV test at the 1-year interval, I was back to my old self."
"We have an obligation to live ethically and provide assistance, even if it endangers us physically or financially," says a psychiatrist. "Even though I am a successful survivor of two lawsuits (and, yes, they are a real pain), I would still put myself in legal harm's way to attempt to assist others...I have assisted at many road traffic accidents, in movie theaters, in private homes and never regretted any intervention. In fact, they were some of the most exciting and memorable interventions in my career."
Says another MPC contributor, "There is certainly a significant portion of us who see rendering aid in an emergency as a core and primary value. I, for one, find that somewhat reassuring and encouraging."
Most Annoying Patient Behaviors, Charging for No Shows, Patient Use of the Internet
Physicians are also talking about the most annoying patient behaviors. An emergency medicine doctor cited a Medscape General Medicine survey that asked neurologic conference attendees to identify the 5 most annoying patient behaviors. Their responses were: (1) skipping appointments; (2) being verbally abusive with staff; (3) having poor compliance with medications or treatment; (4) being late for an appointment; and (5) not knowing their current medications. The top 5 complaints of MPC contributors stack up differently. Most annoying to MPC physicians are: (1) family members who insist on the highest level of care for terminally ill patients and who later complain of the cost of that care; (2) drug seekers; (3) noncompliant patients; (4) patients who tell the doctor how to treat them; and (5) patients who answer their cell phones during office visits.
One patient behavior -- that of missed appointments -- not only is annoying but also cuts into a physician's revenue. An MPC contributor asked whether it was a common practice for physicians to charge for no-shows. The response was a resounding yes. "No-shows and same-day cancellations will kill you," comments one physician. "We have a fixed overhead (eg, rent, salaries, malpractice insurance) that eats up 70% of the day's gross collections. The only part left for the physician and his family is the other 30%. But, if 15% of the patients do not show that day ... your income is halved." Says one general practitioner, "It is reasonable and prudent to charge for no-shows. I have been doing this for over 5 years and there have been no problems with my patients with this policy. My patients sign documents reflecting and consenting to this policy." The charges for missed appointments vary from a token amount (eg, $5 or $25) to the full charge for the visit. Most doctors said that it is customary to give their patients a reminder call the day before an appointment. "I would think the token charge for a missed appointment is more of encouraging responsibility than trying to recoup costs," says a family medicine physician. "We enable bad behavior without such policies."
Patients frequently research their medical conditions on the Internet. One MPC contributor is interested to know whether physicians find this practice useful. Several doctors comment that most patients download information from unsupervised sites, and this information helps no one. One surgeon replies that it is beneficial to be preemptive. He tells his patients, "I know you'll want to check this out on the Internet. There's a lot of confusing, sometimes unreliable information out there, but here are some useful sites for you to use." A vascular surgeon agrees, "I commonly refer people to the Internet to supplement their understanding of their disease process. This works especially well for a focused problem (like symptomatic carotid artery stenosis) and not so well in the case of a generalized disease process (like dyslipidemia)."
And where do physicians go to get away from it all, especially if they have small children? A pediatrician and spouse went to Puerto Vallarta with 3 boys under 4 years of age and a nanny. The family rented 2 rooms, one of which was equipped with a kitchen. An adventurous family medicine doctor took a week-long wagon train trip through the Grand Tetons. "You could ride a horse, walk alongside, or stay in one of the wagons... At night, the wranglers dressed as Indians in war paint and rode in the trees at the perimeter [of the camp]. The kids had eyes the size of saucers." |
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