A debate is quietly raging in the medical community on the value of having an annual physical, most likely because next year millions of soon-to-be-insured Americans will be required under Obamacare, aka the Affordable Care Act, to receive annual checkups.
Today, I am sitting on an examination table covered in hard waxy paper in the medical office of Dr. Robert Thomas in Coral Gables. I have just had my blood drawn, and I am waiting to be seen for my annual physical. Being a lawyer in Miami who sues doctors and hospitals has given me years of experience in analyzing and investigating potential medical neglect cases. I have learned that a majority of the cases involving failures to diagnose a given illness or condition were defensible -- because while the diagnosis may have been made late, the disease was too far along for intervention to have made any difference in the outcome. This is called causation, and it is one of the three necessary elements and often the most difficult element required to prove any potential medical malpractice case against a hospital or doctor.
The three elements of a medical malpractice case:
1. Negligence or a mistake. Did the health care provider actually make a mistake in the manner of care provided to the patient? This includes what the physician, nurse, or midwife actually did or did not do in a given circumstance. While this would seem obvious, medicine is open to multiple interpretations as to what is appropriate for a given patient in a given circumstance.
Appropriate care is defined as the "standard of care," but rarely if ever is there an agreed upon "standard of care" amongst health care providers, especially one that can be relied upon in evaluating a potential malpractice case.
2. Causation. Did the alleged mistake or neglect actually cause a particular change in the patient's prognosis or outcome? This is the point of my blog today and the reason I frequent my doctor's office for periodic physical and diagnostic testing. I know from experience that the sooner a disease can be diagnosed, the sooner it can be treated. And the sooner treatment can be started, the more likely a positive outcome can be effected. From personal experience, and for the benefit of my readers, I recommend that you seek a qualified and board-certified internal medicine physician whom you like and trust.
The annual examination should include the following at a minimum, but my physician does even more:
A. Blood Work
B. Blood Pressure
D. Review of family history
E. Discussion of any changes in your medical condition
F. Review of detrimental lifestyles choices, such as smoking, alcohol, drug use or abuse, diet and exercise, etc.
In the context of a medical malpractice case, I have reviewed many circumstances that indicated a particular failure by a client's surgeon or radiologist in identifying a medical condition, but found that the delay in ultimately recognizing that failure may have done little or nothing to change the outcome. This can be best illustrated by stroke cases. I have represented a number of people who have presented to an emergency room or urgent care center with the obvious signs and symptoms of a stroke. However, if the patient presents outside the "window" of time when interventional medications or surgery can be given, the outcome is usually not going to be any different even though the initial diagnosis was wrong.
3. The third element is damages. This means that one must first prove the mistake caused some damage. Sometimes in a medical malpractice case, even the worse mistakes can be resolved. This is particularly true in botched plastic or cosmetic surgery cases. I have seen situations where patients have been left with horrific and seemingly permanent disfigurements after undergoing a breast augmentation or tummy tuck. Yet with time and the skill of a competent reconstructive surgeon, they can be made to look as good as new, and often better.
The point of this post is to illustrate how medical malpractice law works in an effort to motivate you to receive at least a yearly physical and blood work, and to encourage you to focus on disease prevention and health optimization. And for those without insurance, when next year's Affordable Care Act takes effect, some 30 million people will be added to the roster of the medically insured and become eligible for government-mandated preventive care through annual health exams.
I respectfully disagree with the critics of annual exams -- those who challenge the axiom that an ounce of prevention is worth a pound of cure -- when they argue that the added burden and cost to our health care system outweigh any benefit. They can cite a recent study published by the prestigious BMJ (formerly the British Medical Journal), which found that general health checks did not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes.
Instead, I recommend that it is far better to be safe than sorry. "The doctor will see me now."
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