The Magic Word

When I was a kid, my mother and teachers reminded me to mind my manners by teaching me to say the magic word, which was “please.” I was able to acquire all sorts of things by using the magic word - ice cream, a new comic book, 10 extra minutes of playing stickball (kids that grew up in New York played stickball, or the less complicated “stoopball” and the more dangerous “kill the guy with the ball”). The chances of getting what you wanted increased tremendously with use of the magic word. 

Today I was reminded of the 21st century version of the magic word when one of my patients threatened to sue me. The magic word is no longer “please,” it’s “sue.” People think that a threat to sue will get them what they want or open doors that are arbitrarily and capriciously closed. People think that a lawsuit threat will somehow defuse an explosive or hostile situation when in reality it exacerbates most social interactions. Some people think that the word has 10 syllables: “Ah’mo ssssssssuuuuuuuuueeee you!”

In the ER, people threaten to sue me at least once a day. Any little perceived slight is grounds for a patient or a family member to drop the sue bomb. Fortunately most of the threats are just that - threats, but the damage to civil discourse is done.

“Sue” really is a magic word because it can make me disappear. Years ago, before I actually was sued, I’d engage the individual and try to talk them out of whatever rhetorical tree they had climbed and become trapped in to try to negotiate and find a compromise. No more.

One actual lawsuit was all it took for me to treat any lawsuit threat as radioactive. Once the sue card has been played, I’m outta there and a patient advocate rep or some other administrator can deal with it. Another physician is invited to interact with the patient. If there are no other physicians in the ER, then the patient will have a real problem getting care, because the threat to sue me destroys the physician-patient relationship. Once I’ve been threatened with a lawsuit, regardless of the ridiculous nature of the complaint, I don’t think that I can provide quality, unbiased care, and I certainly can’t act as a patient advocate.

I’ve been threatened with lawsuits because I wouldn’t order an unnecessary X-ray for a child and because I wouldn’t write narcotic painkillers for a patient with no identifiable painful condition. I’ve been threatened with lawsuits because a patient with a three-week-old headache was made to wait in the waiting room and I didn’t retrieve a cup of ice water for a family member of a patient. I had a patient once complain to me because she had asked me to get her a cup of water “not a cup of ice water.” I told her to wait for the ice to melt and she would have her plain water - she wasn’t pleased but at least she didn’t threaten to sue me.

I’ve entered into a roomful of family members to sit down and have the most difficult conversation an ER doctor can have with a family member - “Your (grandmother, mother, father, child…) is extremely sick and we need to consider whether or not to continue resuscitation efforts…” - and I’ll suddenly realize that someone in the family is filming me with a cell phone.

You know, just in case they want to sue.