Agraphia Medical Tragicomedy


Defensive Medicine

Getting ready to enter a patient's room last week, I overheard her speaking loudly into her cell phone. A snippet of what she said appalled me.

"... uh huh, I am going to MILK this accident for money. Naw, I ain't hurt at all, I'll be home for dinner. We gonna get ourselves a fat check from this one..."

Walking through the door, it was as if a lightswitch had been thrown. Suddenly she was speaking in whispers, tears flowing from her eyes, with excruciating neck, back, side, arm, and head pain. She swore she was fainting in and out of consciousness.

I found out later that a city bus had been nicked by a car and all the bus occupants had taken the waaaaambulance to the ER, like sharks to blood, in search of lawsuit money.

A very good friend of mine was on the other end of something similar, so I have become hyperacute to the role my medical charting plays in the legal arena. As such, I've started practicing "defensive" medicine... or put another way, ensuring that I protect everyone involved in an accident - and not just my patient.

In this particular case, there was clearly nothing wrong with this woman. Written all over my chart is "no suspicion of serious injury" and "completely normal physical examination". I even went so far as to give her a work excuse note specifically stating that she could return to work the next day.

Of course, this isn't to say that some people involved in these incidents don't have real disease. But when neither the bus nor the car have any damage - and you're yammering into your phone about how the lawsuit is going to put food on the table - well, I simply don't like to see people taken advantage of.

Good luck suing the city with that chart, lady. It's bulletproof. I went ahead and quoted your cellphone conversation, too, as I suspect a direct quote of "I am going to MILK this accident for money. Naw, I ain't hurt at all" doesn't go over so well in a courtroom when you're filing for damages.

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  1. Oh, snap! I’m so glad you happened to overhear the phone conversation, because this is crazy and ridiculous!

  2. Ugh, patients with this sort of attitude always make me eager to move on to the next patient for a chance to restore my faith in humanity. Such a shame that some folks feel so unreasonably entitled to rewards they don’t deserve. Great job documenting the facts to keep any court or lawyer from believing her lies!

  3. Awesome response! Wish everyone would do this.

  4. As someone who’s been on the sued-end, thank you for this. I was told at the scene by the woman who sued me that she was on her way to her chiro– then her friends showed up at the scene and encouaged her to “take [me] for all [she] can get”. Awesome.

  5. Ha! We also have a mob of patients hit the waiting room by waaambulance whenever a city bus taps a curb — which is all the time. I usually end up having to x-ray something for my attendings and the lawyers, which: sigh. SIGH.

  6. OMG please write more. I understand not having time being in the medical field myself, but I love reading your stuff.

  7. Excellent post keeping us informed about the possibilities for abuse inherent in the system. I’ve been doing IME’s for the past six months and have been exposed to a fair amount of abuse (though nothing as egregious as you describe).

    One minor point: the amount of physical damage to a vehicle isn’t a good indicator of the amount of “real” damage to the occupant. For two reasons:

    1) there’s no lower boundary of velocity below which physical injury isn’t possible. That’s because physical injury depends on the amount of the vehicle(s) momentum transferred to the occupant (or in the case of whiplash, the occupant’s head) Imagine a 5mph-moving vehicle coming to a dead stop with a ping pong ball on the roof. The ping pong ball (representing someone’s head) is going to rocket off the roof.

    2) If a vehicle is more crumpled, that means that more of the original momentum has been converted into deforming the vehicle body and thus less into accelerating the occupants – so, ironically, the less vehicle damage, the more potential for occupant damage.

    Keep up the good work…

    Ron Lavine, D.C.

  8. Ron –

    Appreciate your thoughts. In this case there was a small car that hit the bus; neither the car nor the bus had any damage.

    For a bus occupant to sustain any significant amount of damage in this case would involve some pretty impressive force vectors.

    The most important thing is to examine the patient carefully and fully so as not to miss any injuries – especially if they plan on filing suit!

  9. Ahh awesome.

    I was sued for ‘all she could get’ for a ‘permanent injury’ due to a fender bender. I won the case… maybe the woman that sued me is related to the pt.

    The best part of the trial, besides the reading of the jury’s decision was the bailiff telling me that all this (my trial) and similar trials were all total bs, that these people were basically worthless and don’t know anything about a hard days work, ect. Poor guy was totally burned out, counting days till retirement and declared the civil lawsuit system utterly broken.

    I relish the fact the woman could have taken the settlement my insurance company offered, but instead ended up paying attorney fees out of her pocket. My attorneys were provided by my insurance company, so she lost out big in the end.

  10. This is funny – just the other day I was on a city bus that hit a taxi cab really hard and many of us went flying or at least shifted down about three seats or so (the bus driver applied the brakes, as she should have!!).

    It was quite a big hit and was inconvenient because of the delay. Anyway, the transit supervisors all came screaming down the aisles yelling out Anyone Hurt . . Anyone Injured . .. Everyone OK . . .to which everyone yelled back YES, we are fine . . . we just want to get to where we were going! Upon leaving the bus, the man behind me whispered in my ear . . . I am from the States and am absolutely bewildered by the reaction to life or death situations you Canadians portray . . we would at least sue someone for the trauma!

  11. . . To which I replied . . . What trauma – the next bus is waiting to pick us all up . . .

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