Have the Societal expectations of modern medicine become too unrealistic

An article published in the New York Daily News on May 31st 2015 written by Ben Kochman describes the unfortunate case of a fourteen year old boy from Long Island, who on November 2002 underwent corrective scoliosis surgery at Columbia Hospital in Manhattan. Sadly the procedure did not go according to plan and the young man was left paralysed but was able to live for a few more years before his body succumbed to complications. The case was litigated in a courtroom in the Bronx and the jury awarded the family $45 million for the tragic outcome.

The above tale is heart wrenching and to anyone that has a child the emotional pain is admittedly unimaginable. This is without question and one can feel nothing but sympathy for the bereaved family, with the father commenting that the money held little value and he would pay anything to have his beloved son back.

Modern medicine has come a long way in the last three decades and the irony about the exponential progress it made is that it has created a monster of unrealistic expectations in the public, who now think that adverse events and deaths should never occur and that if they do something terrible was intended. Physicians devote their entire lives to acquiring the education and training to allow them to help people with the diseases and painful afflictions that affect humanity, but in life nothing is perfect. Medicine is not perfect, doctors are not perfect, patients are not perfect and quite often clinical outcomes are not perfect. It is an indisputable fact that patients undergoing clinical care do sometimes die or suffer adverse outcomes, for this is the nature of modern medicine.

The specifics of the case described in the above referenced article suggest that it was a complex spinal reconstruction in which titanium hardware was initially placed intra-operatively into the correct anatomical locations, and then most likely became displaced later as the patient began to move. This phenomenon of spinal surgery is usually the explanation for cases in which all the intra-operative x rays are normal, but which are subsequently contradicted by films taken once the patient has been moved and is mobile. This would be described as one of the accepted risks of the procedure and would have been described in detail by the surgeon to the patient and his family before they agreed to sign the surgical consent form allowing the procedure to commence. Specifically in a case such as this that involved a severe spinal scoliosis the option of doing nothing would have inevitably led to a significant deterioration in the quality of the boy’s life and a premature painful death. The surgeon therefore was motivated to help the patient in the manner in which he judged most optimal with nothing but the interests of the boy at heart.

The medical malpractice crisis in the US is one of the most significant contributors to the markedly elevated healthcare costs that this country has the unfortunate reputation of holding, and nowhere has it been shown that these legal actions lead to an improvement in clinical care. In fact some commentators argue that the toxicity of the medical malpractice environment actually stymies physicians from innovating for fear of being sued. This is one of the principal reasons that the majority of research and development of new medical devices now occurs in foreign countries that are unshackled by the legal yoke that hangs around the neck of the US.

The article is brief which would explain why there was an absence of any reference to the amount of the money that the attorney received. The fee splitting that occurs in these cases should be cause for public consternation as it is usually about 40% that the lawyer collects. Now off course our legal friends would argue till their blue in their duplicitous faces that they deserve every penny they get. However I would suggest a more socially responsible course of action would be to take some of that money, and reinvest it into medical research that would work towards finding a solution to prevent such future catastrophes. This I believe would a far more constructive use of the capital than simply using it to purchase another set of shiny suits and cuff linked shirts.

Spine surgery is one of the most complex and challenging disciplines of medicine and the men that enter this arena should be applauded for their courage and commitment to treating a human condition that makes life unbearable and some would say unlivable. The media, off course, feel compelled to report only the bad outcomes but it would serve societal interests more responsibly if they equally reported all the good outcomes. This would definitely paint a more balanced picture of the world of spine.

Finally one of the legal historical details that I have always found rather bewildering is the use of lay juries in medical cases, which by their very nature are complex and require individuals with at least a basic understanding of medical terminology. The jury system was conceived to be a panel of citizens who were intended to be a ‘jury of your peers’. Well if this critical detail were to be upheld today then the jury on the case referenced would have consisted of healthcare professionals, who in my humble opinion would have been more qualified to make the correct decision in such a complicated and tragic case deserving of nothing but human sympathy.