Anesthesia Given Without Consent And Against Patient's Will

[cyjeff]

Gigirle Thanks for the insult. Perhaps I didn't express my view how I wanted. I never ignore my patients concerns. What I was refering to is I hate when people come in with preconceived unwavering notions on what they should have me do inspite of the fact that their desires put them at increased risk for complications and I communicate this to them and they still insist and refuse to compromise.
I'll give you an example early in my practice -- when I could be bullied by these demands --- a patient was getting a diskectomy on their lower back ( a 1-2hr operation ). They insisted on local only -- I explained to them that this would be a very claustrophobic, uncomfortable position and to then sedate in this postition it could become dangerous for them. They still demanded local only. I accepted -- 30min into the operation they became uncomfortable and panicky. I gave some sedation the patient kept moving to the point the surgeon couldn't operate. So the question is what do I do now any more sedation and they could stop breathing effectively, yet to convert to general anesthesia we would have to roll them over on an open wound -- exposing them to infection. I vowed to never do this again; I would never allow myself to place a patient in danger by comprimising my standard of care because of their insistance. Now, I will discuss the issues but if the patient wants me to perform some anesthesia I feel could endanger themselves I have them refered to another anesthesiologist.

Then that is what you do.

Listen to the patient. If you can't agree on care, the answer is not to agree in words but digress in action but to simply refuse the patient care.

Lastly, I want the ability, like every other service, to refuse to pay my doctors if I don't get the quality of service that my dollars should command.

Oh no, you say.... we couldn't do that! Doctors must get paid even if the patient's condition worsens!!!

And then Vinnie wants to demand that we don't sue.

You get to pick. I either get to refuse payment for less than expected results or the ability to sue after the fact.

You choose.

[Vincent B]

Jeff, you mean well , but you are flat out wrong with this particular case. I understand your emotional take on having the input of the patient on your care. I want to have input on my care. But this really refers to a medical plan and decision making formed by you and a primary care physician, oncologist, surgeon etc. The field of anesthesiology is different. You can refuse certain procedures up front like spinals , epidurals, or the entire procedure. But don't ask me to take off the plane with only one out of 4 engines just because you want to but don't know how to fly. But once you are administered anesthetic agents of any kind, sedative etc. You pretty much give up your "personal " choices to the medical care of the anesthesiologist because you can not make decisions anymore. You are now at the mercy of your doctor to do what ever is medically necessary to get you through surgery safely. Patients think they are tough, want to be awake for the surgery, a very inexperienced anesthesiologist will let himself be talked into this. Then the patient moves, rips out the screws placed in the knee by the surgeon, the surgeon blames the anesthesiologist, the anesthesiologist blames the patient for honoring the patients request, the patient blames and sues the anesthesiologist for ruining his knee because even though he asked to be awake, the anesthesiologist " should have known better" and performed below the standard of care. Seen it. Also, most all malpractice suits come from non paying indigent patients to begin with, so give up on your doctor payment refusal crap.

[cyjeff]

Jeff, you mean well , but you are flat out wrong with this particular case. I understand your emotional take on having the input of the patient on your care. I want to have input on my care. But this really refers to a medical plan and decision making formed by you and a primary care physician, oncologist, surgeon etc. The field of anesthesiology is different. You can refuse certain procedures up front like spinals , epidurals, or the entire procedure. But don't ask me to take off the plane with only one out of 4 engines just because you want to but don't know how to fly. But once you are administered anesthetic agents of any kind, sedative etc. You pretty much give up your "personal " choices to the medical care of the anesthesiologist because you can not make decisions anymore. You are now at the mercy of your doctor to do what ever is medically necessary to get you through surgery safely. Patients think they are tough, want to be awake for the surgery, a very inexperienced anesthesiologist will let himself be talked into this. Then the patient moves, rips out the screws placed in the knee by the surgeon, the surgeon blames the anesthesiologist, the anesthesiologist blames the patient for honoring the patients request, the patient blames and sues the anesthesiologist for ruining his knee because even though he asked to be awake, the anesthesiologist " should have known better" and performed below the standard of care. Seen it. Also, most all malpractice suits come from non paying indigent patients to begin with, so give up on your doctor payment refusal crap.

Wrong.

The minute we start saying, "you, mr. or mrs. patient must just accept blindly the treatment you are about to receive" we all lose.

Malpractice suits come from indigent patients mostly? Really?

I tell you what. I will look up the stats. You do the same.

Lastly, why are doctor's protected from the contract of service for pay? You wouldn't pay the kid up the street the $20 bucks you owe him if he screws up the lawn he was supposed to mow, but I am supposed to pay a doctor a hundred grand no matter the outcome?

C'mon. You can't have it both ways.

[Vincent B]

I think you may have some anger issues, maybe you should go to canada and get your healthcare.

[Betty3]

I'm at stage III with Endometriosis. I am actively planning my funeral. I believe that when someone becomes ill in this fashion it's time to let god take control and accept fate.

I didn't read this thread until today. I, too, am sorry for your sickness. Take care and good luck.

[lealea1005]

I think you may have some anger issues, maybe you should go to canada and get your healthcare.

Agreed. BMWs...big screen TVs....$100,000 procedure fee for an individual Physician (no, sorry, not even the premier pediatric neurosurgeon at Hopkins pulls that in for one surgical procedure).

cyjeff, no one expects patients to blindly accept treatment. Docs would just like the benefit of the doubt that they actually know what they're talking about. Your magazine articles and wikipedia info is welcome, and sometimes entertaining, but it doesn't replace the skill, education, and experience of your Physician. Just ask yours...you know, the one you consider a friend.

[cyjeff]

cyjeff, no one expects patients to blindly accept treatment. Docs would just like the benefit of the doubt that they actually know what they're talking about. Your magazine articles and wikipedia info is welcome, and sometimes entertaining, but it doesn't replace the skill, education, and experience of your Physician. Just ask yours...you know, the one you consider a friend.

That is EXACTLY what you are asking.

Don't bother the nice doctor with your questions, sonny, you really shouldn't even be establishing eye contact.

I do trust my physician... to a point. Ultimately, it is MY decision, and no one else's, what happens to my body - because no one, OTHER THAN ME, pays for the mistakes made.

Vince, yes, there may be a monetary component, but you tell me... what is your sight worth? How about the ability to move without a cane? How about 9 months of PT hell?

What is that worth to you? What about a disfiguring facial injury? You know, the kind that is listed as "cosmetic" but will forever prevent you from walking down the street without children pointing and juries looking away?

How much is that worth? 25K? here's 25K... when can you show up?

Oh, and as for the 100K... I was using as a reference my grandfather's open heart surgery... cost of surgery was $125K. He didn't make it. The surgeon still got paid.

So... if I am your car mechanic and instead of fixing your car I blow it up. Make it unusable forever. Forever deprive your family of its use and any revenue it would help generate.

Would you still pay me for the repair?

As for the rest.... Are you honestly trying the "poor poor pitiful me" act?

The mean income for doctors in this country is as follows...

Physicians and Surgeons. Medical Group Management Association, Physician Compensation and Production Report, 2003.

Table 1. Total compensation of Physicians by Specialty; 2002

Anesthesiology $306,964
Surgery, general $255,438
Obstetrics/Gynecology $233,061
Internal medicine $155,530
Pediatrics/Adolescent medicine $152,690
Psychiatry $163,144
Family Practice $150,267

Are you really screaming poverty here?

[lealea1005]

That is EXACTLY what you are asking.

Don't bother the nice doctor with your questions, sonny, you really shouldn't even be establishing eye contact.

I do trust my physician... to a point. Ultimately, it is MY decision, and no one else's, what happens to my body - because no one, OTHER THAN ME, pays for the mistakes made.

Vince, yes, there may be a monetary component, but you tell me... what is your sight worth? How about the ability to move without a cane? How about 9 months of PT hell?

What is that worth to you? What about a disfiguring facial injury? You know, the kind that is listed as "cosmetic" but will forever prevent you from walking down the street without children pointing and juries looking away?

How much is that worth? 25K? here's 25K... when can you show up?

Oh, and as for the 100K... I was using as a reference my grandfather's open heart surgery... cost of surgery was $125K. He didn't make it. The surgeon still got paid.

So... if I am your car mechanic and instead of fixing your car I blow it up. Make it unusable forever. Forever deprive your family of its use and any revenue it would help generate.

Would you still pay me for the repair?

As for the rest.... Are you honestly trying the "poor poor pitiful me" act?

The mean income for doctors in this country is as follows...

Physicians and Surgeons. Medical Group Management Association, Physician Compensation and Production Report, 2003.

Table 1. Total compensation of Physicians by Specialty; 2002

Anesthesiology $306,964
Surgery, general $255,438
Obstetrics/Gynecology $233,061
Internal medicine $155,530
Pediatrics/Adolescent medicine $152,690
Psychiatry $163,144
Family Practice $150,267

Are you really screaming poverty here?

Sorry about your grandfather, truly, I am. The amount you gave is the total cost of surgery. I see you ARE angry. It's a normal part of your grief process. That answers a lot of my questions.

BTW..your statistics are old. A recent (2007) study by MedChi found that Physician salaries have been overestimated for years and have continually dropped every year for the past 6 years. The figures you cited do not include $20,000+ in malpractice premiums, staff salaries, rent, health insurance, etc.
Salaries are not the issue here.

[cyjeff]

Sorry about your grandfather, truly, I am. The amount you gave is the total cost of surgery. I see you ARE angry. It's a normal part of your grief process. That answers a lot of my questions.

BTW..your statistics are old. A recent (2007) study by MedChi found that Physician salaries have been overestimated for years and have continually dropped every year for the past 6 years. The figures you cited do not include $20,000+ in malpractice premiums, staff salaries, rent, health insurance, etc.
Salaries are not the issue here.

My salary does not include my costs of doing business either.

My grandfather died over 20 years ago. My grieving process ended years ago.

However, whenever ANYONE tells me that I should just pay and trust that the people I am paying are going to do a stellar job, I worry.

Again... you wouldn't give the same level of trust to a mechanic, a carpenter, a landscaper or any other skilled trade.... but I am demanded to stop asking my medical "partner" all those darned questions.

[Vincent B]

Jeff, I hope your insurance plan pays for a psychiatrist because you need one asap. You did not provide us with that average and medium income figure. What happens when you leave your psychiatrist's office and you are still just as messed up and delusional as you are now ? Do you sue him ?? Let me answer for you, yes. Its got to be somebodies fault i'm so messed up, but not my own.
Just to update are stats department put together by you, anesthesiologist malpractice premiums are $80-$85K per year with no incedents.