Lawrence Schlachter was an accomplished neurosurgeon in Atlanta until a ball came flying off a hitter’s bat, shattering bones in his right hand and rendering him unable to operate. At that point, the 52 year-old took a novel approach: he went to law school and became a medical malpractice attorney.
Having seen medical malpractice issues from both sides of the aisle, Schlachter provides a unique perspective in the discussion over medical malpractice. He recently wrote a provocative op-ed for the Wall Street Journal regarding what should be done to expose bad doctors, and is preparing to release his book “Malpractice” shortly.
His most compelling statistic (from a recent article in the New England Journal of Medicine) is that 1 percent of physicians are responsible for almost 1/3 of all medical malpractice cases. Despite that, very little is done to curb their ability to practice medicine or harm patients. He also sheds light on a broken system in which doctors, afraid for their careers and those of cherished colleagues, will lie or cover up instead of admitting mistakes and getting justice for injured patients. Everyone makes mistakes, but with the policies put in place by insurance carriers and licensing boards, even a single mistake can cost a doctor tremendously. As a result, patients often suffer.
The following is an excerpt from a Q&A with Propublica earlier this year.
Q. What did you see as a medical malpractice attorney that you did not see when you were practicing medicine?
A. I saw doctors and hospital officials cover up records, lie, not tell the patient and family what happened. I’ve seen fractures in the health care system, a lack of patient safety, and human nature and arrogance causing people to circle the wagons. I saw doctors come to court and say things that weren’t true. I saw patients come to court and not get justice. After 12 years of this I’ve reached the point where I’ve almost become the investigative reporter instead of the lawyer. There has to be something done about this. It’s not sustainable, and it’s not right.
Q. Did you see these problems when you were practicing medicine?
A. To a limited extent. When you’re practicing medicine you don’t see any of the legal cases unless you’re in them or testifying in them. In terms of actual cover-ups or denials, you do see it to some extent between yourself and your partners. You tend to not do much about it. For example, when one of my partners got sued, I thought he did something wrong but I didn’t step up and say it. I just stayed out of the way and stayed quiet.
Q. So when you were a doctor were you part of the problem?
A. Not to the extent that I’m seeing as a lawyer. I never went to a courtroom and lied about anything. I never gave expert testimony that was dishonest to protect someone else at the expense of an injured patient. I certainly was part of the doctors that tried to stay out of it. I didn’t throw myself into the fray.
Q. Do you think lots of doctors are in a similar position to the one you were in?
A. Yes. The real issue is that medicine is incapable of regulating itself. Doctors, like any other profession or business, will act in their own self-interest and protect their own self-interest. How far they go is an individual choice, depending on the stresses that are on the institution or the doctor. But everyone tries to not discuss what went wrong, to not expose themselves to a medical-legal situation or litigation. I think the self-interest of all the different groups has such control over who is supposed to do the regulation that there is just enough regulation for the public not to create a riot.
Q. What are the biggest patient safety problems you see?
A. I see a lot of non-physicians being deeply involved in the patient’s care. I see doctors now who have physician assistants, nurse practitioners, scribes, all different types of things. As a matter of efficiency, for economic benefit, the physician does less. That can be an advantage if the helpers really care about the patient. They may see things the physician doesn’t see. But the extension of that to the extreme can be very dangerous.
I was just on the phone an hour ago where a spine surgeon here in Atlanta did an operation on a patient in the hospital and then never saw the patient again. Within hours of the surgery the patient was complaining to everybody. All that was necessary was for someone to listen to him and for the doctor to help him. They could have done a CT scan immediately, taken him to the operating room and he would have been OK. But now this guy has a chronic pain problem for the rest of his life. He’s on chronic medication. He can’t work. His life is ruined. This is unacceptable. Why does this physician practice in such a way he doesn’t see his patients after the operation?
Q. What do your friends from the medical field say about your work as a medical malpractice attorney?
A. My friends know me as a person who has integrity, and they know me as a good doctor. So they think I’m doing the right thing. Mine is an unusual combination of talents and circumstances. I have a doctor’s heart and compassion and a lawyer’s awareness that great harm is sometimes done to patients through narcissism, carelessness or ineptitude.
Q. Lots of doctors care about improving patient safety. So why is it so hard to keep patients safe?
A. They’re afraid to come out. They’re in the closet. They’re afraid of retribution, isolation. Why aren’t all the doctors knocking my door down to be expert witnesses? They’re not. I struggle to find people who will help me. The flip side is why are so many willing to testify the other way and stretch the truth and not tell it like it is? I think most of my colleagues don’t hate me, but they don’t want to help me.
Q. What’s the way forward?
A. That’s the question everybody asks to which I don’t have a simple answer. Things in this world don’t change quickly. We have a complicated political and legislative process. Medicine as practiced today is an evolution of 100 years of different economic stresses, different political stresses. Nothing is going to change quickly from anything I do or you do. It all is an evolution. I don’t think I have the power to fix anything in and of myself. Other than raise the awareness of people. Just like your investigative reporting does: You almost shame people into making things better.
There has to be a way for people to be told the truth and for there to be accountability. Accountability doesn’t necessarily mean punishment. It could be rehabilitation, supervision, a lot of different things. But there has to be a just and fair way for people to get good care and for doctors to know what they’re doing and be held accountable when they make mistakes.
Q. How do you mandate doing the right thing?
A. There have to be punishments or sanctions involved in accountability. The only way to make people accountable if they don’t want to be is to take away their license or take away their income. What other ways can there be? It’s pretty draconian, but if people are fearful they are more likely to do the right thing. Everyone’s going to act in their own self interests. That’s the way the world works.