Dr. Guidry Responds

I appreciate Dr. Stoskopf taking the time to raise the question of the true definition of malpractice and welcome the opportunity to continue this discussion.

Interestingly, upon review of the article, I discovered that I only used the word “malpractice” once and not in reference to the case in question. That said, from a practical point of view, malpractice is what a plaintiff’s lawyer can convince a jury that it is. Dr. Stoskopf’s observation that large judgments (whether malpractice or dereliction of duty) tend to encourage more suits is probably accurate.

Patient injury does occur with no error or negligence. However, we all recognize that some patient injuries are the result of fault. I personally categorize fault in four areas:

1. Lack of knowledge of the practice (e.g., use of adenosine for paroxysmal supraventricular tachycardia);

2. Lack of knowledge about the patient’s condition (e.g., failure to ask about nothing-by-mouth status);

3. Technical error (e.g., an esophageal intubation or a wet tap); and

4. Failure to fulfill our duty to the patient (Dr. Stoskopf referred to this as “dereliction of duty”).

There are numerous ways that we can fail to fulfill our duty to the patient by putting our own interests above those of the patient. Examples include starting a general anesthetic without a functioning capnograph, inadequately evaluating a patient preoperatively, missing an ST segment elevation while chatting on the telephone or ignoring a postanesthesia care unit nurse’s request to evaluate a patient with an airway problem. The reasons can be fatigue, greed, laziness or production pressure.

I don’t know whether or not patient injury from these “moral lapses” meets a legal or practical definition of malpractice, but in my opinion, they are the most difficult to explain to the public and the most heartbreaking to hear about.

To continue the movie theme, you might want to watch “The Verdict,” a 1982 Paul Newman film in which he plays an attorney pursuing an anesthetic malpractice or dereliction of duty case.

Orin F. Guidry, M.D.
New Orleans, Louisiana

The Invisible Physicians

There is a phrase “you deserve what you get.” Regarding the comments about Francis H. McMechan, M.D., in “From the Crow’s Nest” (April 2004), I feel Dr. McMechan had the right idea. Anesthesia should be administered by physicians only. Unfortunately physicians have had a poor track record of standing up for each other, especially across specialties. When Dr. McMechan insisted on physician-only anesthesia administration in hospitals during the 1920s, the American Medical Association (AMA) opposed it. I realize there was a shortage of anesthesiologists, but a temporary solution could have been implemented while more physician anesthesiologists were trained. It may have meant an abbreviated anesthesiology training program for a short period. Either way a method to ensure that anesthesia was administered by physicians should have been perceived by AMA as a worthy goal. Would AMA have permitted surgery to be done by nonphysicians?

The “near invisibility” of anesthesiologists is our creation. We are constantly proclaiming the safety of modern anesthesia. So some of our surgeon colleagues and even some of the general public come to believe that it can be done by nonphysicians. The fact is, anesthesia is still dangerous. The situation we now find ourselves in is of our own making.

George A. Mampilly, M.D.
Lafayette, Louisiana