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 SURVIVING YOUR DOCTORS
Why the Medical System is Dangerous to Your
Health and How to Get through it Alive

Richard S. Klein, M.D.

ROWMAN & LITTLEFIELD PUBLISHERS, INC.

Lanham • Boulder • New York • Toronto • Plymouth, UK
Published by Rowman & Littlefield Publishers, Inc.
A wholly owned subsidiary of The Rowman & Littlefield Publishing Group, Inc.
4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706
http://www.rowmanlittlefield.com
Estover Road, Plymouth PL6 7PY, United Kingdom
Copyright © 2010 by Rowman & Littlefield Publishers, Inc.
First paperback edition 2011
All rights reserved. No part of this book may be reproduced in any form or by any electronic or
mechanical means, including information storage and retrieval systems, without written permission
from the publisher, except by a reviewer who may quote passages in a review.
British Library Cataloguing in Publication Information Available
Library of Congress Cataloging-in-Publication Data

The hardback edition of this book was previously cataloged by the Library of Congress as follows:

Klein, Richard S., 1938–

Surviving your doctors : why the medical system is dangerous to your health and how to get through
it alive / Richard S. Klein, M.D.
p. cm.
Includes bibliographical references and index.
1. Medical errors—United States. 2. Medical care—United States. 3. Self-care, Health. I. Title.
R729.8K64 2010
610.28’9—dc22 2009027238
ISBN 978-1-4422-0139-2 (cloth : alk. paper)
ISBN 978-1-4422-0140-8 (pbk. : alk. paper)
ISBN 978-1-4422-0141-5 (electronic)
™ The paper used in this publication meets the minimum requirements of American National
Standard for Information Sciences—Permanence of Paper for Printed Library Materials, ANSI/NISO
Z39.48-1992.
Printed in the United States of America
This book is dedicated to the memory of John and the thousands of
Americans who needlessly die every week
 FOREWORD

Richard Klein introduces the raison d’être for his latest work, Surviving
Your Doctors, as providing a “basic training manual” to guide patients
through the “medical minefield” that is the modern practice of medicine.
His basic premise is that “at least 100,000 patients die in American
hospitals because of malpractice,” and the purpose of this book is nothing
less than to immediately start saving “tens of thousands of lives a year” and
“ultimately save millions more in generations to come.”
The author’s perspective reflects his 38 years in the medical profession,
including the past 25 years that he spent “reviewing thousands of medical
malpractice cases for plaintiffs (the injured) and frequently testifying
against guilty physicians or ancillary health care providers.” In New York,
almost 70 percent of plaintiffs do not prevail in their lawsuits, and one
wonders how many of them were perhaps “injured” by the medical system
as opposed to their disease process. Despite the wonderful advances of our
medical system and the care and diligence of the health care team, 77-year-
old men presenting in abdominal crisis sometimes die from their disease
process rather than errors in the medical care they received. Having said
that, Dr. Klein is absolutely correct when he points out that as a society we
need to promote an environment where health care providers can discuss
errors and “near misses” in an open way, free from intimidation or
repercussion. It is well known that one of the foundations of the
extraordinary safety record of the airline industry alluded to in the book is
the freedom that all members of the profession have to freely and openly
discuss errors, without fear of reprisals. Medical conferences where
“morbidity and mortality” can be discussed openly and candidly are critical
for error prevention and have no place in discovery and the legal process.
Regardless of whether one agrees with Dr. Klein’s perspective on the
medical system as a whole, certainly his advice to individual patients is
right on target. Patients should be aware of every medication they take and
not blindly follow orders. We all need to be active participants in our own
health care, both at the preventative level in our choice of lifestyles (healthy
eating, avoiding cigarettes, regular exercise, etc.) and in our conversations
and questioning of our doctors and nurses. When patients, physicians,
nurses, hospital staff, and pharmacies all work together, optimal health care
is provided, and we as patients have our best chance at cure. At my own
hospital, there are multiple signs that prominently advise patients and their
families to remind all of their caregivers to wash their hands. This may
sound silly or obvious, but routine and regular hand washing is more
effective than antibiotics in preventing infection, and this hospital policy
may save lives. When it comes to health insurance companies, Dr. Klein’s
description is both Kafkaesque and correct, and his advice on selecting your
insurance plan is right on.
The advice Dr. Klein offers to patients reflects a tremendous body of
experience and is worth thinking about. His mantra, “being an active
participant in one’s health care is essential for survival,” is a morsel worth
savoring. And whether you ultimately agree with Dr. Klein or not, his views
are thought provoking and, despite his stated intention, may indeed “shock
and scare the reader.” When it comes to our health, that may be an
appropriate prescription.

Dr. Michael Rosenberg

Past-president, Medical Society of the State of New York
 ACKNOWLEDGMENTS

This, my second book, required many hours of research and a lot of advice
from my medical friends and colleagues. Robert Schwartz and Jacob Harris
gave up hours of their free time to make sure that I got pediatrics and
psychiatry (respectively) down correctly. I also thank my friends Janusz
Rudnicki and Gino Bottino for their input in ob/gyn and oncology. I thank
Michael Rosenberg, president of the New York State Medical Society, for
his thoughtful words in the foreword. My wife, Caryn, has been at my side
during all of the time that was committed to produce this work. And lastly,
many thanks to my “writing coach” Derek Rydal, who was there any time
that I got stuck or had a question.
 INTRODUCTION

The malpractice crisis is malpractice (itself).

—Vice President Albert Gore, May 19931

The problem is not a malpractice insurance crisis. Nor, contrary to popular mythology, is
the problem a lawsuit crisis. The real crisis is the degree of malpractice itself.
—Business Week, August 3, 19872

Every year at least 100,000 patients die in our American hospitals because
of malpractice.3 You might want to read that statistic again. It is more than
the number of soldiers who died in the Korean and Vietnam wars combined.
Every year.
That is like having 300 jumbo jets crash and kill everyone!
Every year!
Or one jumbo jet crashing almost every day!
And that figure doesn’t represent those who are hurt or maimed, which is
probably two to three times that number. And the price to these individuals,
their families, and society at large is approximately $30 billion annually!4
The financial and human costs are staggering.
Out of the 800 million passengers who fly every year in the United
States, on average 50 to 200 are killed in commercial air crashes.5 If that
figure were artificially raised to 100,000 people killed in crashes, the
percentage of mishap would be low, but frightening. In comparison, there
are 36 million admissions to the 5,700 hospitals in the United States
annually and at least 100,000 people are killed by medical malpractice.6
Certainly, this is a larger percentage than flying mishaps.
However, if jumbo jets started falling out of the sky like flies don’t you
think there would be an outcry or maybe an investigation? I think that we
can say with certainty that the entire air travel industry would grind to a
screeching halt and the whole world would become galvanized around the
issue. But how often do you hear stories focusing on this medical crisis?
How many politicians are speaking about it in Congress? How often does
the president address the fact that more people die every year in medical
mistakes than a total of thirty September 11 tragedies combined?
Instead, the news cycles are crammed with the latest celebrity news of
who is dating whom and who is having whose baby.
Again, the question arises, where is the outcry about medical injuries and
malpractice?
Surviving Your Doctors is that voice.
For too long, wrongful outcomes from substandard or negligent care have
been swept under the rug. We hear from physicians complaining about the
high cost of medical malpractice insurance. They besiege our political
leaders regularly, asking that caps be placed on awards given to injured
patients or their surviving family members. High insurance premiums have
forced good doctors out of the medical business. Others have stopped
performing high-risk procedures. And all of this has left patients with less
access to advanced medicine and doctors who are less willing to really
engage in an intimate way, the only way that can ultimately lead to better
health care in the long run.7
Patients need to know what is really going on, and just like walking into
a war zone, they need to know how to protect and defend themselves. In
this book I provide the in-depth explanations, guidance, and directions that
will be the basic training manual we all need to survive and, hopefully, even
to thrive. This book will serve as a map of the medical minefield, designed
to show you where to step, where to stop, how to walk around the danger,
and how to get out alive. Filled with case studies (in all cases names are
pseudonyms to protect patient identities), anecdotes, questionnaires, and
checklists, this book will walk you through every major area of the medical
world—from the doctor’s office, through the pharmacy, to the labs,
outpatient procedures, hospital stays, surgery, and the emergency room—
giving you a clearer picture of how things really work, what the workers
really think, what is really going on, and how to take back control of your
health care destiny once and for all. If you take to heart what is in these
pages, I believe it will be an invaluable tool in your wellness kit.
This book may not solve all the sociopolitical issues surrounding this
silent pandemic, but it will prepare you to protect yourself against these
needless medical mistakes. And maybe, if enough of us begin to speak up,
our media and our leaders will begin to wake up to the number three killer
in America—the medical industry itself.8
But the intention, and if I dare say, the mission, of this book is much
more. It is nothing less than to immediately start saving tens of thousands of
lives a year while laying the foundation for, and sparking a national
dialogue about, our healthcare system that will ultimately save millions
more lives in the generations to come.
 I
EVERYDAY MEDICAL AND
HEALTH CONCERNS
 1
TAKING CONTROL OF YOUR HEALTH
CARE: OR THE WISDOM OF SECOND AND
THIRD OPINIONS

Mankind has survived all catastrophes. It will also survive modern medicine.
—Gerhard Kocher1

My friend John was an elderly Italian American who always wore a warm
smile. He was one of my favorite patients. At 77, he was physically fit and
still worked part time, fixing kitchen appliances. Every summer he would
bring in large boxes of homegrown zucchini, basil, tomatoes, and anything
else he could grow. He was proud of his farming ability.
One year I told him I was thinking about planting my own vegetable
garden. The next day he showed up at my home with a shovel, asking my
wife where I wanted to plant it. I was amazed and honored by his unasked-
for generosity. Unfortunately, the ground that I had chosen was rock hard,
not ever having been worked before, and we had to get a roto-tiller to turn
the soil over. I am a city boy and living in the suburbs has been quite an
education. I didn’t even know how to grow a tomato when I first started
gardening. And my knowledge of a roto-tiller was far less. When I picked it
up at the rental office, they told me to “hold it back when I used it.” They
meant that I needed to put a little back pressure into it as it propelled
forward. Instead, I took their advice to mean that I should pull it backward.
John, it turned out, knew less than I did about this contraption, despite his
years of growing those wonderful vegetables. Together, we spent four hours
and every fiber of muscle we had to drag that tiller backward, trying to till
an area only twenty by twenty feet! We were dirty, sweaty, and exhausted
when we returned it, only to find out that we had done it completely wrong.
We felt like fools, of course. But we laughed about it every time John paid
me a visit because of his chronic medical issues.
As is the procedure when I am off during a particular weekend, the
answering service awakens me on Monday morning to inform me of any
admissions to my service. John had been admitted late Sunday night with an
acute abdomen. Often, when a close friend or patient gets sick, I get that
adrenalin rush, becoming both anxious and revved up, as well as touched by
sadness. I rushed to see my “tiller” buddy.
At 7 a.m., John was near death, his abdomen felt as hard as a diving
board and his pulse was weak and thready, racing at 110 beats per minute.
These were all sure signs that an abdominal organ had ruptured and acute
peritonitis had set in. I quickly called the surgeon, who had admitted him
five hours earlier. “Gosh,” he said, “John’s abdomen was soft and nontender
when I left him.” At the surgeon’s request, while he rushed in, I called the
operating room to prepare. I then went down to the emergency room and
reviewed John’s record.
Unfortunately, because of his initial intense pain he had been given an
injection of meperidine (Demerol) just before the surgeon had arrived.
Analgesics, especially narcotics, should never be given to anyone with an
abdominal crisis until the exact nature of the complaint is known. The
narcotic relaxes the abdominal muscles as it relieves the pain and
tenderness, thereby hiding findings that an examining doctor needs for
evaluation. In other words, the emergency room physician not only killed
the chance for my friend to be properly diagnosed and treated in a timely
manner, he killed my friend. This isn’t an exaggeration. His error was the
direct cause of why John died as they placed him on the operating table.
This book is dedicated to the memory of John and the other 90,000
patients in our American hospitals who die needlessly, every year, because
of medical malpractice. As I mentioned in the Introduction, that is
equivalent to 300 jumbo jets crashing and killing everyone on board every
year. That is one jumbo jet crashing almost every day.
Surely, the medical world is not the safest place to be. My intention here
is not to shock or scare you from ever entering a physician’s or dentist’s
office again. Neither is it meant to discourage you from treatment in a
hospital or emergency room. I have been a practicing physician in the fields
of internal medicine and infectious diseases, as well as teacher at a medical
school, for the past 38 years. For the past 25 years I have been reviewing
thousands of medical malpractice cases for plaintiffs (the injured) and I
frequently testify against guilty physicians or ancillary health care
providers.
Both physicians and the public at large have to deal with the core
problem. They have to acknowledge that medical malpractice occurs. I feel
that it causes death and disability to an unfortunately large portion of our
patients. This book is an attempt to educate both sides, with the goal of
promoting open communication and dialogue.
Patients need to know how to navigate the mine fields of the medical
world and how to involve themselves in their own care. No longer should
you just swallow a pill handed to you by a nurse, or increasingly more
common, by an aide. Knowing that one of the single most common causes
of hospital negligence that occurs is from mistakes resulting in adverse drug
reactions, you should ask what a pill is for and why it is actually needed.2 It
is probably more prudent to ask your physician to list all of the medications
that you will be prescribed during your hospital stay. In this way, you will
know which pills or injections were really designated for your body. All too
often, a nurse will enter a room, ask you to turn over, and inject you with
something that was intended for the patient in the next room.
Most of us older physicians know that effective open communication
with our patients will lower the number of malpractice suits. That is
because we talk to our patients and allow them to become a part of the
treating team. We must, however, set up better guidelines to protect the
safety of those in our care and to empower patients to become educated
about their health care options.
Years ago I was crawling through a newly dug tunnel under Mount
Moriah, sacred to both Jews and Muslims. One member of my group,
crawling next to me, complained that he had dirtied his raincoat and that it
was the only one that he had brought with him on this three-day,
ambassador-level trip to Israel. I looked at him and realized that it was Sy
Simms, well known because of his television ads for his clothing stores.
Only someone in the clothing business would be upset about having only
one raincoat with him! The Simms’s slogan was “An educated consumer is
our best customer.”
 I want you to be an educated medical consumer. I want you to be
informed about what is really going on. I want you to be in control of your
health care rather than placing it, through blind faith, into the hands of an
industry that is simply not designed to have your best interests at heart most
of the time. My hope is also that this book, together with you, the informed
patient, will stimulate the medical licensing boards, as well as the medical
societies and hospitals, to attack the medical malpractice problem as if we
were threatened with a pandemic—which is really what it is. I feel that we,
the medical practitioners, have to admit to the fact that we, albeit
nonintentionally, sometimes injure people. Rather than worry about being
sued, we should be able to talk to our patients when these departures from
good standards of care exist. We should discuss them with our hospitals and
make sure that the patients or their survivors are adequately compensated.
But in order to make this movement happen, it is going to take you, the
informed patient, to fully participate in your own health care.
In this high-tech world, any human endeavor can and will be associated
with mistakes. Millions of accidents outside of medicine occur yearly. Just a
few years ago, our government sent a billion dollar satellite into orbit that
went entirely in the opposite direction intended. The technician mistakenly
put in coordinates in metric instead of American standard values. We, as
physicians, strive for perfection, but we have to understand that perfection
cannot always happen. Perfection is impossible when we deal with so many
facts and nuances. We make unintentional mistakes that, until now, we were
taught to deny. We conjure up all sorts of excuses, blaming the laboratory,
the x-ray department, the nurses. It reminds me of some of my patients who
get fired from their jobs. I often hear someone say “the supervisor had it in
for me” or something similar. It is rare to overcome one’s denial, as I almost
never hear someone admit to messing up. It seems that to me that we
physicians never ask how did I contribute or how can I make sure that we,
the medical community, don’t do it again? If we do not admit that we
caused the problem and speak up about it, how will the problem get fixed?
Certainly not by capping medical malpractice insurance or lowering our
insurance rates.
The health care crisis is multifactorial. It begins long before a patient
ever engages a health care professional. It starts with the type of insurance
or Medicare coverage that one has, if one is lucky enough to have insurance