“Doctor, Doctor, Give Me the News...”

Six anonymous doctors—all of whom have practiced or are still practicing in Colorado hospitals—disclose their secrets, explain the mysteries of medicine, and divulge exactly what they think about their patients and their colleagues.

What’s the most common mistake doctors make every day?
Dr. Internal Medicine: Overprescribing medication. Giving a high-powered antibiotic for a bladder infection is like killing a mosquito with a cannon. It works, but it’s very lazy and dangerous.
Dr. Anesthesia 1: Not listening to what their patients are telling them and instead relying on what tests and labs are telling them. The way health care is these days, you don’t get reimbursed for taking a long history. But you should.
Dr. Psychiatry: I 100 percent agree with Dr. Anesthesia 1. The patient’s history is the most powerful tool that you have.
Dr. Ob-gyn: We all try hard, but we probably don’t wash our hands before and after every patient encounter. No exaggeration: If I were batting a thousand, I would wash or sterilize my hands 60 times during one workday.

What’s the worst mistake you’ve ever made?
Dr. Internal Medicine: I don’t have a moment in time where I held my hands up and said, “God as my witness, this will never happen again!” I have given wrong meds, missed labs, and discharged patients who should have stayed. I will tell you that a large majority of my mistakes were when I was being pushed by a patient: things like, “The morphine isn’t working” or “I really have to be home today.”
Dr. Anesthesia 1: Physicians are human. Some patients are more difficult than others. On obstetrics, I don’t feel like I should ever wet-tap (which means that the needle has penetrated the dural sac, releasing cerebral spinal fluid, often causing a painful headache) somebody when I’m administering an epidural. But I’ve done that. I guess I think of a “mistake” as synonymous with negligence. The difference is that there are often bad outcomes without mistakes.
Dr. Anesthesia 2: Wait? Just one mistake? (Laughs.)
Dr. Psychiatry: When a bad outcome happens, the natural instinct is to say, “What did I do wrong?” I do a mental review of my care when something doesn’t go right. That’s helpful because it often shows you that you practiced within the standard of care.
Dr. Ob-gyn: I make mistakes every day, but there are layers of protection. Thank heaven for good nursing, ancillary staff, and pharmacists—they help us catch mistakes. Thankfully, I have never made a life-or-death mistake.

What’s the biggest mistake you’ve ever seen another doctor make?
Dr. Internal Medicine: A good friend of mine is a cardiologist and was performing a heart catheterization. He took an IV line from the nurse and hooked it up to the patient’s central line, then pushed the medicine in the IV. The problem was the tech hadn’t flushed the line to get the air out and my buddy didn’t check it, which realistically wasn’t his job. But the patient got a massive air embolism and died the next day. Was that my buddy’s mistake? I’m not sure, but I know he still doesn’t sleep well some nights.

What is the best—and worst—time to go into the hospital?
Dr. Internal Medicine: Going to the ER in the morning, after 7 a.m., is the best because you will see ER docs who are fresh. Going in early in the morning, 2 to 4 a.m., is a bad idea. Everyone is tired and the internist wants to be asleep, so he might convince himself to ignore findings that might be something but would require him to do more work. Avoid teaching hospitals in October. The interns who started in July know just enough to be dangerous and are confident enough to be reckless.
Dr. Anesthesia 1: The best time to go to the ER is during a Broncos game. If you’re going in for surgery, and you have the choice, take the earliest time slot. It’s like air travel—the longer the day goes on, the more likely delays are.
Dr. Anesthesia 2: For a nonteaching hospital, I’d avoid the holidays and weekends. If you’re going to be admitted for a workup, go in on Monday.
Dr. Psychiatry: Well, not July 1. That’s when the new residents first come out of medical school.

Do you work when you’re sick?
Dr. Anesthesia 1: Physicians don’t call in sick. Not to belittle any other job where work will pile up, but if you have 25 patients scheduled that day, how or when do you fit them in if you can’t go to work that day? I did go to work one day not feeling well. I had a stomach bug. I tried to fight through it, but I had to leave the room in the middle of giving a pregnant woman an epidural to puke in the hall.
Dr. Anesthesia 2: If I call in sick there are patients that don’t get their surgeries. It’s like, “Hey, sorry that you’ve been waiting three months for your hip replacement surgery, but I’m sick.” How do you do that to someone?

Do you worry about lawsuits?
Dr. Internal Medicine: Every day. It is such a part of your consciousness you don’t even realize you do things to avoid getting sued. You write things in your notes solely for the purpose of it being there if the note gets pulled up in court, like: “Discussed Coumadin with patient, and patient verbalized understanding of increased risk of bleeding.” In what world would you discuss Coumadin (a blood thinner) with a patient and not talk about bleeding risk? Yet we write it down because if it isn’t written down, it didn’t happen.
Dr. Anesthesia 1: I don’t worry about it all that much. I feel lucky that I have the job that I have. I get to make a difference in people’s lives every day. I would never ever trade those kinds of rewards that I get out of my job for not doing it out of fear that I’m going to get sued. The thing I think about is, when is it going to happen? It’s not if. It’s when. And that’s part of the business. If you can’t deal with that, maybe you shouldn’t be in this business. Unfortunately, our society is litigious. Everyone thinks everything is curable and that there should never be a bad outcome. I’m not saying there isn’t negligent care. There is. But I would say the majority of lawsuits are unfounded.
Dr. Anesthesia 2: I’ve known physicians who’ve been through lawsuits. It destroys them. They think they’re somebody who’s helping people and then they’re accused of malpractice. I’m petrified of that.
Dr. Psychiatry: These days you can be sued even when you’ve practiced within the standard of care. You can be dragged through the turmoil, headaches, and drama of a lawsuit even when you’ve done everything you were supposed to do.
Dr. Ob-gyn: All the time. I think ob-gyns get sued an average of three to four times in their careers. Even a lawsuit without merit can wreak havoc in a physician’s career. Most doctors care a lot about their patients and their outcomes, so to have someone angry enough to bring a lawsuit is very upsetting at a personal level. We didn’t go into medicine to ruin someone’s life, and it makes us doubt our abilities to be good doctors.

Do you practice defensive medicine?
Dr. Internal Medicine: You have to. The best piece of advice I got was from a physician I worked for at a Boy Scout camp. He told me to “practice with courage.” That doesn’t mean you are reckless; it means you do what you need to do to be thorough, but don’t order every possible test so you don’t miss a thing.
Dr. Ob-gyn: Absolutely. Most of my documentation and probably 25 percent of my lab orders are simply to cover my backside. I’m not proud of how much defensive medicine I practice, but I have spent more than 10 years and hundreds of thousands of dollars to become a physician, so if a $50 test will protect my career, you better believe I’m going to order it.

What do patients not understand about being a doctor?
Dr. Internal Medicine: Every minute you take from me, you are taking from someone else.
Dr. Anesthesia 1: How many hours we really put in.
Dr. Anesthesia 2: Hours, historically and currently. They don’t understand what we gave up in our younger years to get here.
Dr. Psychiatry: That I have other things going on. That I have a life. That I’m a working parent.
Dr. Ob-gyn: I only have 10 to 15 minutes to see you for your annual visit and 10 minutes or less to see you for your obstetrics appointment. I won’t be able to address all of your issues in one visit.

What do doctors forget about what it’s like to be a patient?
Dr. Internal Medicine: Patients have no idea what is going on 90 percent of the time. They talk to us once a day, and then for the other 23 hours and 30 minutes of the day, if they are lucky, they sit in their rooms scared or bored.
Dr. Anesthesia 1: That it’s scary.
Dr. Psychiatry: We take for granted the knowledge we have, and forget the patient doesn’t have that same knowledge.
Dr. Ob-gyn: Definitely how scary it is to be a patient. It’s a great reality check to be a patient every once in a while.

What advice do you give friends and family going into the hospital?
Dr. Internal Medicine: You and your doctor are on the same team. Extend trust until you have a reason not to trust.
Dr. Ob-gyn: Everyone responds to bribery. Bring candy or food to your nurses—they will love you for it.