Doctors who are nice. I like that.

I was reading through the comments on Kevin, M.D. for the post in which he mentioned my unfortunate incident with an evil hair-removal laser that burned and scarred me and a dermatologist who must have been absent on the day they taught ethics, and I read this comment that I wanted to bring over here for posterity. I would LOVE to know which physician that knows me took the time to post this in my defense - it makes me feel all warm and fuzzy.

I know this woman. I am a doctor. I can't believe that after seeing the pictures, untouched, of an 18 year old woman with facial disfigurement, that anyone has the right to critique the patient! Yes, all procedures have risks - this case of substandard care was artificially absolved as follow-up care for a major burn with keloid scarring was remediated. However, the patient did trust that the ethically correct move was being made in this regard and the physician mocked her by dropping all guilt as soon as "time for a lawsuit is up!" This is an outrage and a sadness to a profession. Knowing the patient's character and decency, I assure you that the blog is meant as a warning, not as a critique among all physicians. It is also meant as a testament to the standard of care of which SHE chooses to practice after medical school.

An unfortunate guest lecturer, and Dave Matthews on House EEEEEE!

Hey, you know what I keep forgetting to tell y'all? While perusing my pharmacology lecture schedule (which is a completely interesting thing to do during class sometimes) I discovered that one of our required lectures (on dermatologic pharmacology) is to be given by none other than my ex-dermatologist who doesn't know how to use lasers or treat patients like real people. I will, of course, be completely professional and sit there and take notes like the good adequate medical student that I am, unless she tries to describe in detail how to use a hair-removal laser. Or how to deal with a patient that you have permanently scarred and left looking like Elvis, now and forever. If that happens, then I'll just quietly put down my Family Guy pen (thanks Joyce!) and think about kittens or something.

In other news, Dave Matthews was on House MD this week, in the episode Half Wit (there's an mpeg file in downloads) and it was so good ... I don't know, I can't come up with an analogy. It was just really good. When both House and Dave were sitting at the piano in Dave's hospital room, my head almost exploded. I couldn't handle having both of them in the same frame. It's a good thing I was doing my evil genetics homework and wasn't completely rapt.

I have two exams on Monday and two on Tuesday (and a nervous breakdown somewhere in there) so I may be scarce for a few days. Don't miss me too much.

Oh! Something else I meant to tell you. Harvey at IMAO is snarking on West Virginia, and it's terribly funny. Go read it. Here's a couple of my favorites:

The state motto of West Virginia is "Montani semper liberi", which is Latin for "Sister, daughter, wife... whatever".

The variety of apple known as Golden Delicious originated in Wellsburg, West Virginia, in 1775. It was greeted with overwhelming enthusiasm by a population who'd spent years being stuck with eating the Ochre Atrocious.

In May, 1860, the first oil well in West Virginia was drilled at Burning Springs. In June, 1860, the former governor of Texas invaded West Virginia and stole it.

In a recent survey, 95% of West Virginians report having checked out a book from their local public library within the last year. During the same time period, 95% of West Virginians also reported having found a way to fix that wobbly kitchen table with the short leg.

The state flag of West Virginia consists of a blue-edged white background, overlaid by an image of two men debating whether Fahrenheit 9/11 or An Inconvenient Truth was a bigger load of crap.

The one where I post lots of non-airbrushed pictures

Since I was accused by commenters at Kevin MD and now at the RateMDs forums of being deceitful by using my "excessively airbrushed senior picture as a "before" picture in my "victim of malpractice" story, I thought I'd post some pre-burn snapshots. You know, so you can see what a freakazoid I REALLY am, and that I look absolutely nothing like the senior picture I posted earlier. Except not. The debated senior picture is included at the end, so you can compare. Here's what you're supposed to notice in the "before" pictures - that both sides of my upper lip used to be EVEN.

Oh, and the fact that I have pancreatitis has absolutely nothing to do with the fact that I was horribly burned and scarred. Yes, that was really suggested. Idiots.

Finally, I have a brilliant cousin who is an attorney specializing in healthcare (his firm represents doctors in cases like these, not patients) and he told me that this is 100% malpractice and that I would have won a suit hands down. Anyway, behold the pictures:

Summer 1997 ; Fall 1995

Spring 1997 ; Summer 1997

Spring 1997 ; Winter 1996

Both Spring 1997

Spring 1997

August 1997

Told you that the senior picture really looked like me. And the reason I'm not wearing makeup in the pictures featuring the burn is that I was told not to - for risk of infection. I did have a big gaping wound, you know. The reason that you don't see any "before" pictures without makeup is that I typically am not photographed makeup-less (is any girl? Really?)

Kevin, MD is talking about meeeeeee!

Wow - my eeeeevil dermatologist story got picked up by Kevin, MD. Awesome.

The kind of doctor I'm NOT going to be

For the 2nd installment of our medical ethics course, we had to write a critique of a peer-reviewed article that addressed one of the topics on our schedule for the semester. The paper I critiqued was on medical errors, and it focused on whether or not doctors would even tell the patients about particular hypothetical errors, or how much detail they would provide, etc., and a bunch of other boring stuff that y'all don't care about. In this paper on medical errors, I had to include the following personal story (altered slightly from the way it appeared in my paper to make it more blog-friendly.) This is the story of a doctor who "oopsed" with me, and then proceeded to make a major goof four years later. She is now the kind of doctor I do not want to become. Enjoy. Or not.

Being on the wrong end of a medical error myself, I cannot discuss this topic without a personal bias from a patient’s point of view. When I was a freshman in college, I had laser hair removal done on my upper lip by my dermatologist, and the laser severely burnt my skin (see the next two images, taken the day of the procedure.)

November 4, 1997

My doctor was very apologetic and it was obvious that she felt terrible about what had happened. She called me at home multiple times to check on me, and scheduled an appointment with a local plastic surgeon (with the understanding that she would cover any costs incurred until I was nearly back to normal.) I am not a litigious person by any stretch of the imagination, but my dermatologist's apologetic attitude and the steps she took to correct the mistake at her own expense basically took any thought of a lawsuit off of the table. "Everyone makes mistakes," I thought (although I wished it hadn't been on MY face!) and my doctor seemed genuinely sorry. So my family and I decided that taking responsibility for my medical care related to the burn would be enough. We didn't even disclose her name to anyone that asked (and there were many inquiries about my face – one of my professors even asked if I was in an abusive relationship!)

The wound healed as a keloid scar, and my dermatologist paid for cortisone injections, which were administered by a local plastic surgeon, and then for removal of the keloid (the first image is the icky-looking keloid, the second is after it was removed. I know, I know - the removal left me looking like Elvis. Well, Elvis with an unfortunate flesh-wound.)

February 1998 (left) and April 1998 (right)

Incidentally, we thought that a collagen injection may improve the asymmetry of my lip. So we gave it a whirl - and I ended up looking like Elvis had run into a wall. Not good.

The final surgery that I had was performed by a doctor in Pittsburgh. And here's where my ex-dermatologist messed up. My main problem, four years after I was burned, was the asymmetry of my upper lip (the fibrous scar tissue had caused the left side of my upper lip to be pulled higher than the other side - i.e., Elvis.) My dermatologist recommended a plastic surgeon in Pittsburgh (Dr. Brodland, who was excellent) and set up the appointment for me. I traveled there for a consultation, and asked him for a copy of his treatment plan so that my dermatologist could be aware of the procedure that I would undergo and the costs involved (below are before and after pictures of Dr. Brodland's scar-rearrangement surgery - called a V-to-Y procedure, which would "push" the scar (and my lip) down.)

November 2001

Imagine my surprise when the response to my letter came from her attorney, refusing to cover the costs of the surgery ($1400.00, which my middle class family ended up paying out of pocket.) Conveniently for her, she had taken advantage of my kindness and my naiveté for just long enough – the four-year statute of limitations had just passed, and there was absolutely nothing I could do legally.

The letter from the attorney also said that she hoped that I would continue to visit her office for my dermatologic needs. Needless to say, I found another doctor.

I included my story because most articles and sources (at least those in scholarly publications) concern themselves with protecting the physician from litigation, and avoiding apologetic terms, and disclosure of the error. As I perused these articles, I found myself thinking, "What about the patient?" I can tell you that as long as my dermatologist was apologetic and was trying to fix her mistake, I did not consider a lawsuit and I continued to visit her office for dermatologic appointments unrelated to the scar. Patients are reasonably intelligent people, and I believe that they deserve to know about procedures that they have incurred or illnesses that resulted due to circumstances beyond their control. I believe that a certain amount of lawsuits are necessary – if a patient must pay for extra surgeries, more medicine, more office visits, etc. that are the result of a medical error, then they deserve reimbursement. Healthcare is expensive anyway, and patients should not be expected to pay in order to preserve their doctor’s pride or reputation.

There are many discussions involving legal action, shame, status, and other issues related to medical error disclosure, but there is one thing that is all but absent in these discussions – the right thing to do. I cannot make sense of the fact that doctors do not have to take responsibility when they make mistakes, while most other professions are expected to do so. Not taking responsibility, not telling the patient the truth – is equivalent to lying, as far as I am concerned. Right up until the day I received the letter from my dermatologist’s lawyer, I admired her. She was a female doctor, a profession that I aspired to myself, she had a family as well as a successful private practice, and although she had made a mistake with my care, she was taking responsibility and trying to restore my face to normal. The lawyer’s letter changed all of that. Now, she is the kind of doctor that I hope that I will not be – the kind that looks after their own interests before the interest of their patients. And worst of all, the kind that is an effective actress as well as a physician. She put on a completely convincing performance – I truly believed that she was sorry and that she would see the mistake through until my face looked the way it did before I walked into her office on the day she burnt me with the laser. In reality, she was sorry – but she was sorry for herself, not sorry for what had happened to me. Not sorry that my face will never look the same again and that it is her fault. Not sorry that I had to treat the scar night after night after night, had to endure painful injections and more than one surgery, and have to use special makeup every day to try to cover it. Not sorry that complete strangers notice and ask me what happened. I used to protect her, back when I thought she was protecting me. Now I tell them – and I tell them her name, too. (If you're in this area, just so you know, it's not Dr. Vaughan or Dr. Marshall.)

I am sure that I will make mistakes as a physician. Maybe I have stars in my eyes, but I hope that I will never react to a mistake in the way that she did – sugar and spice and promises to help, but only until the statute of limitations expires – and then my patient receives a letter from my malpractice attorney. I definitely believe that physicians should take steps to prevent lawsuit abuse, but I believe that these steps include placing certain individuals in the legislature, and taking the utmost care where a patient’s health is concerned – and that the steps do not include deceiving a patient or telling them a half-truth about the extra care that they ended up requiring as a result of a medical error. Patients should not all be treated as ignorant, litigious monsters.

I have totally avoided all references to Dr. Evil and the "laser". Until now. I just couldn't help myself. And also, here's one of my senior pictures (from high school) so that you can see my face before it was messed up:

August 1996

Dang, that's depressing. I used to be not-so-hideous to look at. *sigh* I really am going to work on this fat thing. I hate being fat.

Addendum (12/1/06, 6:15PM) - based on the comments left at Kevin MD, I feel that I should address a couple of things, since I wasn't expecting to be critiqued by a bunch of health professionals. First of all, I'm not a physician - I'm a medical student (2nd year). And I WASN'T a medical student at the time of the procedure, or I would have researched the risks myself. (Had I been a medical student in November of 1997 and STILL only in my 2nd year in of medical school in December of 2006 - wow. Talk about extending the torture!) I was 18 years old, barely an undergraduate in my first semester of college, and I stupidly trusted my doctor, who told me that my skin may be a little pink after the procedure, but it should fade by that evening. Of course the fine print said "scarring, death, etc." as it always does. So of course I was aware of the "risks". But every release form warns of the worst, doesn't it?

As for using my high school photo as a comparison - I just happened to have that on my computer, which is why I used it. I will replace it as soon as I get back home to my scanner. It was taken one year before my surgery, and you can't see the upper lip hair because it was taken at the end of August and I had a tan. The use of the photo was not meant to be "manipulative". It wasn't excessively airbrushed either - that's what I looked like.

And I didn't fail to disclose the use of photosensitizing agents, tanning, or medical conditions; nor did I fail to disclose a propensity to develop keloids. I had no idea I had such a propensity - things that I've read since say that keloid scarring is most often seen in people of African descent.

What upsets me is not that I was burnt (which probably was faulty laser settings, due to the fact that the procedure hurt BADLY. And I have hereditary pancreatitis, so I know pain. This laser HURT. I almost asked her not to do the other side!) I was upset that my doctor seems to have taken advantage of my naivete. When I got the letter from her lawyer, I cried. I felt so, so stupid for believing her, for feeling that she had my best interests at heart. That hurt worse than the burn, truthfully - leaving a different kind of scar, you know?

It's upsetting to see people blame ME for this incident - it really is.

Edit (12/9/06) - More before pictures (non-airbrushed) are posted here.