DVT Epiphany: The Battle Over Blood Clots

The practice of medicine vs. the business of medicine

So, a medical malpractice attorney and an orthopaedic surgeon are on a golf trip… This sounds like the worst joke of all time, but it’s actually the story of my brother and I 20 years ago.

Amidst the rough, he laid some serious philosophy on me…In most families, that might be about life and love and whatnot. Not in our family. We were engaged about deep venous thrombosis (DVT) and the medico-legal ramifications surrounding this “complication.

”In case you didn’t know, DVT refers to blood clots in the lower leg, which are potentially very serious and can be deadly. Causes and risk factors include age, obesity, and infection, to name a few. Post-operative DVT in particular – those incidences that all too often result in lawsuits – was the focus of our conversation.

My brother said physicians are clueless when it comes to how the medical community should handle this situation, at least from the medico-legal viewpoint. I agreed with him in 1988, and I agree with him now.

As he pointed out, we surgeons have produced and continue to produce volumes of literature on prevention of postoperative DVT. However, each of these studies touts their own concoction of drugs, pneumatic boots — you name it — as the latest and the greatest, yet at the end of the day, all are similar in their effectiveness as DVT prevention.

Even worse, each protocol is right, and at the same time wrong, depending which way the malpractice plaintiff’s attorney needs to spin it. The point is: there is simply a finite low incidence of post op-DVT that is going to occur no matter what we do.

Don’t get me wrong; I’m all for scientific advancement, but trying to beat the incidence down nanometer-by-nanometer, scientific study by scientific study, only accomplishes two things. First, it gives plaintiff attorneys the data needed to successfully sue our pants off. Second, it lines the pockets of the drug and medical equipment companies who cater to this business (more on this later).

Let’s face it, what we really needed to know about DVT prevention, we learned by the mid 90’s, which is why we’ve only seen negligible advances in the past decade. Physicians, quit quibbling over these negligible differences.

Keep moving, my friends,

AO

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