Falling Through the Cracks

Hit and run medicine. The term is often used to describe a surgeon who performs several surgeries in a day. An example would be an eye doctor doing dozens of cataract operations a day. But our overcrowded and overburdened system also treats psychiatric patients like an assembly line.  

Psychiatric malpractice is tough to prove.  Failing to monitor medications properly is malpractice, but it’s not as obvious as a plastic surgeon horribly disfiguring a patient.  Many psychiatric patients don’t have the wherewithal or the resources to sue. Lawyers will take on the plastic surgery case on a contingency fee basis. But not for psychiatric malpractice.

Two kinds of psychiatric malpractice cases are abuse and negligence.  What was common treatment decades ago would be considered abuse today.

Negligence has four elements: there must be a doctor-patient relationship, the doctor failed to provide reasonable care, there were harms, and finally the harms were caused directly by the lack of care.  The question must be asked: what would a reasonable doctor have done?11

My psychiatric nurse provider regularly orders up blood tests to make sure my medicine is at therapeutic levels — enough to be working, but not so much to be damaging my liver.  To not do so would be malpractice.  

The problem in our system is when some doctor on call at a hospital catches some indigent patient.  The doctor doesn’t really consider that patient to be his/hers. I wasn’t told, but I found out by accident that withdrawal from the benzodiazepine I was on causes seizures.  That would be called “falling through the cracks” rather than malpractice.  There’s too much falling through the cracks