Physician’s Weak Points at Court
Sukhit Phaosavasdi MD*, Surasak Taneepanichskul MD*, Yuen Tannirandorn MD*, Boonchai Uerpairojkit MD*, Chumsak Pruksapong MD*, Aurchart Kanjanapitak MD*, Vorapong Phupong MD*
Affiliation : * Members of Medical Association of Thailand
The Medical Association of Thailand invites its member to attend a meeting on the nation’s medical liability system(1).
Since 1973, the number of malpractice suit went up from 250 to over 500 per year. Furthermore, the
cost of the medical litigation and each malpractice suit is increasing(2). Besides, each Baht paid in damages is
a Baht that otherwise could be spent on patient care, reducing the amount available to be spent on each
patient. This crisis is therefore preventing physicians from providing optimal and efficient care.
A medical liability discussion is necessary to restore sanity to a system that right now severely
inhibits physicians’ efforts to learn from mistakes and make health care safer for everyone. We believe that the
health care, legal systems and patients must come together to resolve this issue. The ultimate goal is to make
health care as safe as it can be, assuring appropriate redress for patients when this is warranted and allowing
the doctor to learn.
As Hippocrates’ oath stated: “I will use treatment to help the sick according to my ability and
judgment, but I will never use it to injure or wrong them.” Thus we must actively pursue patient safety
initiatives that prevent medical injury, promote open communication between patients and doctors and create
a just compensation system.
Counting the cost of medical litigation
From the court, we know that doctors are bound to exercise a degree of care and skill that could
reasonably be expected of a normal, prudent practitioner of the same experience and standing. This test
applies to each specialty. Therefore, a brain surgeon will be expected to act, as would a normally prudent
brain surgeon. As this is objective and does not have hard and fast rules, it is difficult to evaluate in certain
case. Litigation is a ‘win at all costs’ game that we found dishonorable.
The time and energy that the doctor must spend to prepare and appear in court is time and energy lost
on patients. During this time, society would question the doctor’s reputation, self-confidence and belief(3).This
can last many years until it is resolved. Additionally, the stress will take its toll on the doctor and affect their
relationship with their spouse, children, colleagues and staff as they try to support the doctor. At the end, even
when the doctor prevails, many can lose confidence in the system furthermore, the attorney’s fees can force this
doctor to stop practicing medicine. He may even have to live with the defamation to his name forever and the
reputation of his character will remain injured.
On the other hand, if the doctor loses in court, it could mean a complete lost of assets. While we think
of the material assets such as house and car, the most important assets in their life may also be gone such as
their family, job, reputation, dignity, love, respect, freedom, and even lives. While the doctor may believe that
they have a good case, they may still lose(4,5) as happened in the past. Therefore, many attorneys strongly
recommend to settle the cases out of court. While it is hard to accept, it may be the most economical way to
retain sanity and some financial assets.
We have one point to ponder. While we all recognize that good doctors are good pupil, this may be
their weaker point as well. During their medical training(6), they were taught to be patient, always offer
assistance, work alone as help is not available, have very high self-confidence, know and be able to explain
everything, give recommendation and be a strong leader. Therefore, they come to believe that they are infal-
lible, never get tired, never have to retire, never get sick. Furthermore, they must always remain calm even when the other party’s temper flair, they do not listen to reason, they always complain about the doctor’s
privilege, they question everything but do not listen to the answers and they keep talking non-sense, even
when they are wrong. Nevertheless, doctors are fallible and should know their limitations.
All the doctor’s behaviors, as listed above, can be observed daily in every portion of the hospital, from
the outpatient clinic, to the operating room, passing by the private clinic, the physical examination room and
the inpatient ward. If the doctor’s behavior is not as expected, should this be revealed during a trial? Is the
past behavior relevant? Is this assumption correct as the doctor is spending most of his life in the hospital and
his behavior may sometime be misinterpreted?
Maybe it is time to write a white paper on how to actively pursue patient safety initiatives that
prevent medical injury, promote open communication between patients and doctors and create a just compensation system without hindering the doctor’s ability.
Keywords : Physician, Weak points, Court
