If All the Docs are Doing it is it not Malpractice

Part of the legal definition of malpractice includes the idea that the treatment provided falls below the accepted standard of practice in the medical community.  In other words, it must be shown that the practitioner was acting in a manner which was contrary to the generally accepted standard operating procedures that are currently being widely used by other physicians in the city in which the doctor practices.

For a malpractice case to be successfully pursued in court, the treatment must also be shown to be negligent and of course result in some quantifiable harm to the patient. But what happens if certain harmful procedures were being widely performed by almost all of the other doctors in the community? Even if the harms are predictable and significant, is a doctor protected from liability just because "everybody's doing it?"

Many mothers back in my day used to answer their kids' protestations that "other kids get to do it!" with, "If everyone jumped off a bridge, would you do it too?" I can't speak for others, but mindlessly following the herd was not something that was encouraged in my family system.

I do not know off hand what the answer is to the question above. Perhaps some malpractice attorney who happens to read this might write in with the answer. The reason I thought of this question was something I recently read in the psychopharmacology (psych drug) newsletter Biological Therapies in Psychiatry (July 2014) about how often kids are monitored for side effects when they are prescribed psychiatric medications.

Regular readers of this blog know that I think that the diagnosis of pediatric bipolar disorder is in the vast majority of cases a scam, and that prescribing antipsychotic drugs to children to control their behavior is a reprehensible activity. Kids should not be sedated into being less affected by family dysfunction.   

That would be bad enough, but what is worse is that antipsychotic drugs have potentially dangerous side effects. Particularly with the newer, "atypical" antipsychotics, there is a significant risk of causing weight gain, type II diabetes, and high cholesterol. These risks may be higher in children and adolescents than they are in adults.

If a patient is psychotic, the benefits of these medications generally outweigh the risks, especially if the patient is monitored for the emergence of these side effects. And there are few other options. (Sometimes one drug in a class will do it in a given patient, but not another drug in the same class). If patients are not psychotic, and very few kids are, the benefits decidedly do not outweigh the risks.

At the very least, the doctor should take blood tests periodically to see if these side effects are developing. You would think that doing that would be the standard community practice.

Well, if you thought that you would be wrong. 

In a retrospective study by Delate and others (JAMA Pediatrics, 2014 May 5) of pediatric patients started on an atypical antipsychotic within the Kaiser Permanente system HMO in Colorado, the authors found that only 1 patient out of 1023 received the full recommended panel of baseline and follow-up blood monitoring!

That's right; you read correctly. 1 out of over 1000, or one tenth of one percent. Of course we don't know if kids in other health plans are being treated this negligently, but I would not be surprised.

So if almost all of the doctors in a community are making little kids jump off bridges, does this mean that they are not going to be held liable if they are sued for malpractice?

At Least vs If Only

I spent January lost in a sea of WIP misery.

Yes. It happens to everyone, I know. My agent said something to me like, "you've only been at this writing thing for what, a year? Writer's block is 110% normal. Go read some books and don't worry about it."

[Here's an aside: Kathleen Ortiz is awesome]

But the whole thing terrified me, because ever since I started writing, I've been half-convinced the whole thing was a fluke. I'd gone through the first 35 years of my life without writing so much as a short story or a poem, and in the last year ... well. So perhaps you can understand why I'd believe my 2010 was some weird karmic joke. I've wondered if I'm like Charlie in Flowers for Algernon, destined for a brief period of illumination before losing all that light.

I'm still hashing all that out in the space between my ears.

But a week or so ago, I ditched my January WIP, even though I had written, in chaotic bits and pieces, at least half of it. And last weekend, I outlined another novel. And in the five days after that, I wrote the first 20,000 words.

Huzzah! Back in business.

Until Saturday, when I realized I'd written that first 65 pages from the wrong perspective.

All right, so I go on Twitter, and I mention this hilarious bit of stupidity. And two lovely Twitter-friends, Jennifer Walkup and Amparo Ortiz, reply and basically say the same thing--"AT LEAST you didn't [insert even more frustrating writerly experience here]"

Their sentiments, my friends, are called "downward counterfactuals".

And they were like a salve on my bruised writer's heart.

Funnily enough, I did some research on counterfactual thinking when I was an eager young undergrad. A counterfactual thought is a mental construction of an alternative to facts or events. It's a "what might have been." Human beings engage in this sort of thinking all the time. I do, too. Heh.

There are two major types of counterfactual thought--the upward and the downward.

The upward: "If only I had realized this book must be written in third person, I would have saved myself days and days of work."

The downward: "At least I didn't write a complete novel before realizing first person, though I loves it so very very much, is just not the right POV for this book."

The upward: "If only I had let this sit for a few days before plunging in, I might have figured this out sooner."

The downward: "At least I've put serious words to page for the first time in a few months, because that's a sign I am not regressing into my pre-writer existence."

Get it?

Both kinds of counterfactual thinking are useful.

If you are in need of MOOD REPAIR, downward counterfactuals should be the mental trick of the day. Thinking about how you've avoided a much-worse outcome will make you feel better! And who doesn't want to feel better (we'll save that for another post, shall we)?

If you are in need of a LIFE LESSON, upward counterfactuals are more your poison. After all, if we're all filled with relief because it could have been worse, we're not focusing on how we could do better. And who doesn't want do do better (you guessed it, another post is called for)?

All right, so which type of thinking fits your style? And in what kind of situation?

Do you comfort yourself with the downward counterfactuals? And if so, are you sure you're not protecting yourself a little too much?

Do you delve into possibilities for improvement with the upward counterfactuals? And if so, are you sure you're not beating yourself up a little too much?

Be sure to check out Lydia's Medical Monday post and Laura's Mental Health Monday post today as well!